ESPCS干预模式联合早期盆底功能训练对子宫内膜异位症手术患者全子宫切除术后恢复情况的影响

Effect of ESPCS intervention mode combined with early pelvic floor function training on recovery after total hysterectomy in patients with endometriosis

目的探讨ESPCS(Explain-Simulate-Practice-Communication-Support,即讲解、模拟、练习、沟通、支持五方面)干预模式联合早期盆底功能训练对子宫内膜异位症手术患者全子宫切除术后恢复的影响。方法将2020年5月至2022年5月在复旦大学附属妇产科医院妇科住院的子宫内膜异位症全子宫切除术后患者120例纳入研究,采用随机数字表法将入选患者分为对照组和试验组各60例。对照组术后行常规健康护理干预,试验组在对照组常规护理的基础上实施ESPCS干预模式联合早期盆底功能训练干预。比较两组患者训练依从性、盆底肌力恢复情况、排尿功能恢复情况及生活质量。结果试验组患者训练依从性差患者显著低于于对照组,差异有统计学意义(P<0.05);术后4 w,两组阴道静息压(Vaginal Resting Pressure,VRP)、阴道收缩压(Vaginal Squeezing Pressure,VSP)及阴道收缩持续时间(Persistent Time,PT)均较术后1 w有所上升,且试验组术后4 w VRP、VSP、PT高于对照组,差异均有统计学意义(均P<0.05);两组术后4 w最大逼尿肌压力、最大尿道压较术后1 w有所升高,且试验组上述指标均高于对照组,差异均有统计学意义(均P<0.05);术后4 w两组患者尿失禁生活质量问卷(Incontinence Quality of Life Questionnaire,IQOL)较术后1 w有所升高,盆底障碍影响简易问卷7(PFIQ-7)评分较术后1 w有所降低,差异均有统计学意义(均P<0.05);术后4 w试验组IQOL评分高于对照组且PFIQ-7评分低于对照组,差异均有统计学意义(均P<0.05)。结论 ESPCS干预模式联合早期盆底功能训练可增加患者依从性,帮助加速盆底肌力、排尿功能的恢复,有效促进患者盆底功能恢复进而对改善术后生活质量有所帮助。

Objective To explore the effect of Explain-Simulate-Practice-Communication-Support(ESPCS)intervention mode combined with early pelvic floor function training on the recovery of patients with endometriosis after total hysterectomy.Methods A total of 120 patients with endometriosis after total hysterectomy were admitted to the hospital from May 2020 to May 2022.The enrolled patients were divided into control group and experimental group with 60 cases in each group by random number table method.The control group received routine health care intervention after surgery,and the experimental group received ESPCS intervention mode combined with early pelvic floor function training intervention on the basis of routine care of the control group.The training compliance,pelvic floor muscle strength recovery,urination function recovery and quality of life were compared between the two groups.Results Patients with poor training compliance in experimental group were significantly lower than those in control group,and the difference was statistically significant(P<0.05).Four weeks after surgery,two groups of Vaginal Resting Pressure(VRP),Vaginal Squeezing Pressure(VSP)and Persistent Time(PT)increased after 1 week.VRP,VSP and PT in the experimental group were higher than those in the control group at 4 weeks after surgery,and the differences were statistically significant(P<0.05).The maximum detrusor pressure and maximum urethral pressure 4 weeks after surgery were increased in both groups compared with 1 week after surgery,and the above indexes in experimental group were higher than those in control group,and the differences were statistically significant(P<0.05).At 4 weeks after surgery,the score of Incontinence Quality of Life Questionnaire(IQOL)was increased in two groups compared with 1 week after surgery,and Pelvic Floor Impact Questionnaire-7(PFIQ-7)score was decreased compared with 1 week after surgery,and the differences were statistically significant(P<0.05).The IQOL score of the experimental group was higher than that of control group,and the PFIQ-7 score was lower than that of control group at 4 weeks after surgery,and the differences were statistically significant(P<0.05).Conclusions ESPCS intervention mode combined with early pelvic floor function training can increase patients'compliance,accelerate the recovery of pelvic floor muscle strength and urination function,promote the recovery of pelvic floor function,and improve the quality of life after surgery.