核心肌群训练联合CO_(2)点阵激光在产后轻中度压力性尿失禁患者中的应用分析

Application of core muscle training combined with CO_(2) fractional laser in postpartum patients with mild to moderate SUI

目的 分析核心肌群训练联合CO_(2)点阵激光在产后轻中度压力性尿失禁(SUI)患者中的应用。方法 选取2020年10月~2022年10月于苏州大学附属第二医院接受治疗的SUI患者98例,依据随机数表法分为两组。对照组49例予以核心肌群训练,联合组49例予以核心肌群训练联合CO_(2)点阵激光治疗。比较两组的临床疗效、治疗前后的盆底肌肌力、盆底表面肌电位、阴道前壁膨出程度及72 h漏尿次数,并比较两组治疗前后的国际尿失禁委员会尿失禁问卷简表(ICI-Q-SF)及尿失禁生活质量问卷(I-QOL)评分。结果 联合组的临床疗效优于对照组(93.88%vs. 75.51%),差异有统计学意义(χ^(2)=6.376,P<0.05)。治疗后,两组盆底肌肌力均明显改善,且联合组改善效果优于对照组,差异有统计学意义(P<0.05);治疗后,两组快速收缩期、持续收缩期及耐受测试期的盆底表面肌电位均高于治疗前,其中联合组各时期的盆底表面肌电位均高于对照组[(34.78±2.53)μV vs.(30.25±2.49)μV、(30.32±2.63)μV vs.(24.15±2.59)μV、(25.44±2.61)μV vs.(20.66±1.89)μV],差异有统计学意义(t=8.933、11.701、10.383,P<0.05);治疗后,两组的阴道前壁膨出程度及72 h内漏尿次数均减少,其中联合组阴道前壁膨出程度及72 h内漏尿次数均少于对照组[(0.87±0.19)分vs.(1.25±0.21)分、(0.98±0.23)次vs.(1.65±0.31)次],差异有统计学意义(t=9.393、12.150,P<0.05);治疗后,两组ICI-Q-SF评分均降低,I-QOL评分均升高,且联合组ICI-Q-SF评分低于对照组,I-QOL评分高于对照组[(5.12±0.68)分vs.(6.25±1.43)分、(86.98±5.53)分vs.(82.65±6.49)分],差异有统计学意义(t=4.995、3.555,P<0.05)。结论 核心肌群训练联合CO_(2)点阵激光治疗用于产后轻、中度SUI患者效果显著,可有效改善患者的盆底肌肌力及盆底表面肌电位,减少阴道前壁膨出程度及漏尿次数,提高患者的生活质量。

Objective To analyze the application of core muscle training combined with CO_(2) fractional laser in the treatment of mild to moderate postpartum stress urinary incontinence(SUI).Methods 98 patients with SUI treated in our hospital from October 2020 to October 2022 were selected as the research object,and were divided into two groups according to the random number table.The control group(n=49)was treated with core muscle training,and the combined group(n=49)was treated with core muscle training combined with CO_(2) fractional laser.The clinical efficacy,pelvic floor muscle strength,pelvic floor surface myoelectric potential,anterior vaginal wall bulging degree and 72 hour urinary leakage frequency were compared between the two groups before and after treatment.The scores of international commission on urinary incontinence questionnaire(ICI-Q-SF)and incontinence quality of life questionnaire(I-QOL)were also compared between the two groups before and after treatment.Results The clinical effect of the combined group was better than that of the control group(P<0.05).After treatment,the pelvic floor muscle strength of the two groups were improved significantly,and the improvement effect of the combined group was better than that of the control group(P<0.05).After treatment,the surface EMG of pelvic floor in rapid systole,sustained systole and tolerance test were higher than those before treatment in both groups,and the surface EMG of pelvic floor in combined group was higher than that in control group(P<0.05).After treatment,the degree of anterior vaginal wall prolapse and the number of urinary leakage within 72 hours in both groups were reduced,and the degree of anterior vaginal wall prolapse and the number of urinary leakage within 72 hours in the combined group were less than those in the control group(P<0.05).After treatment,ICI-Q-SF scores decreased and I-QOL scores increased in both groups,and ICI-Q-SF scores were lower and I-QOL scores were higher in combination group than in control group(P<0.05).The clinical effect of the combined group was better than that of the control group(93.88%vs.75.51%)(χ^(2)=6.376,P<0.05).After treatment,the pelvic floor muscle strength of the two groups were improved significantly,and the improvement effect of the combined group was better than that of the control group(P<0.05).After treatment,the surface EMG of pelvic floor in rapid systole,sustained systole and tolerance test were higher than those before treatment in both groups,and the surface EMG of pelvic floor in combined group was higher than that in control group[(34.78±2.53)vs.(30.25±2.49),(30.32±2.63)vs.(24.15±2.59),(25.44±2.61)vs.(20.66±1.89)](t=8.933,11.701,10.383,P<0.05).After treatment,the degree of anterior vaginal wall prolapse and the number of urinary leakage within 72 hours in both groups were reduced,and the degree of anterior vaginal wall prolapse and the number of urinary leakage within 72 hours in the combined group were less than those in the control group[(0.87±0.19)vs.(1.25±0.21),(0.98±0.23)vs.(1.65±0.31)](t=9.393,12.150,P<0.05).After treatment,ICI-Q-SF scores decreased and I-QOL scores increased in both groups,and ICI-Q-SF scores were lower and I-QOL scores were higher in combination group than in control group[(5.12±0.68)vs.(6.25±1.43),(86.98±5.53)vs.(82.65±6.49)](t=4.995,3.555,P<0.05).Conclusion Core muscle group training combined with CO_(2) fractional laser treatment for postpartum patients with mild to moderate SUI has significant effect,can effectively improve the pelvic floor muscle strength and pelvic floor surface myopotential,reduce the degree of anterior vaginal wall bulging and leakage of urine,improve the quality of life of patients.