盆底康复训练联合电刺激治疗产后压力性尿失禁产妇的效果及对炎症应激反应的影响

Therapeutic effect of pelvic floor rehabilitation training combined with electrical stimulation in treatment of postpartum stress urinary incontinence and the impact on inflammatory stress response

目的 探讨盆底康复训练联合电刺激治疗产后压力性尿失禁产妇的效果及对炎症应激反应的影响。方法 选取2020年7月—2022年3月金华市中心医院收治的产后压力性尿失禁产妇92例,随机分为盆底康复组、盆底康复联合电刺激组(联合组),每组46例。盆底康复组患者接受常规盆底康复训练,联合组在上述基础上加用低频电刺激,两组患者均治疗8周。于治疗前、治疗8周后测定患者的Ⅰ类纤维肌力、Ⅱ类纤维肌力。使用盆底障碍影响简易问卷7(PFIQ-7)、盆底功能障碍调研表(PFDI-20)评估产后压力性尿失禁患者的盆底情况。统计患者72 h排尿次数、72 h漏尿次数以及最大排尿量。使用国际尿失禁问卷调查表评估对患者的影响,记录1 h漏尿量。检测血清C-反应蛋白、肿瘤坏死因子-α、白细胞介素-6、皮质醇、前列腺素E2、去甲肾上腺素水平。结果 与治疗前相比,治疗后两组患者Ⅰ类纤维、Ⅱ类纤维肌力均明显升高,其中联合组[(4.77±0.62)μV、(3.59±0.55)μV]明显高于盆底康复组[(2.91±0.46)μV、(2.74±0.40)μV],差异均有统计学意义(P<0.05)。与治疗前相比,治疗后两组患者PFIQ-7、PFDI-20评分均明显降低,其中联合组[(20.72±3.94)分、(17.95±2.71)分]明显低于盆底康复组[(32.16±4.32)分、(35.62±3.94)分],差异均有统计学意义(均P<0.05)。与治疗前相比,治疗后两组患者排尿次数、漏尿次数明显降低,最大排尿量明显增加,其中联合组患者排尿次数、漏尿次数明显低于盆底康复组,最大排尿量明显高于盆底康复组(均P<0.05)。与治疗前相比,治疗后两组患者国际尿失禁问卷调查表评分、1 h漏尿量均明显降低,其中联合组明显低于盆底康复组(均P<0.05)。与治疗前相比,治疗后两组患者血清C-反应蛋白、肿瘤坏死因子-α、白细胞介素-6、皮质醇、前列腺素E2、去甲肾上腺素水平均明显升高,其中联合组明显低于盆底康复组(均P<0.05)。结论 盆底康复训练联合电刺激疗法对产后压力性尿失禁患者的疗效确切,能够改善患者盆底肌功能,同时降低炎症应激反应。

Objective To explore the therapeutic effect of pelvic floor rehabilitation training combined with electrical stimulation in treatment of postpartum stress urinary incontinence and the impact on inflammatory stress response.Methods Ninety-two postpartum women with stress urinary incontinence admited to Jinhua Central Hospital from July 2020 to March 2022 were selected and randomly divided into pelvic floor rehabilitation group and pelvic floor rehabilitation combined with electrical stimulation group(combined group),with 46 cases in each group.The patients in pelvic floor rehabilitation group received routine pelvic floor rehabilitation training,while the patients in combined group received low-frequency electrical stimulation on the basis of routine pelvic floor rehabilitation training.The patients in the two groups were treated for 8 weeks.Type I and type II fibromuscular strength of patients with postpartum stress urinary incontinence were measured before and after 8 weeks of treatment.Pelvic floor condition of postpartum stress urinary incontinence patients was evaluated using Simplified Pelvic Floor Disorder Impact Questionnaire 7(PFIQ-7)and Pelvic Floor Dysfunction Survey Form(PFDI-20).The numbers of urination and leakage within 72 hours,and maximum urination volume were recorded.The effect on patients was evaluated using International Urinary Incontinence Questionnaire,1-hour urine leakage was recorded.The levels of serum C-reactive protein,tumor necrosis factor-α,interleukin-6,cortisol,prostaglandin E2,and norepinephrine were detected.Results Compared with before treatment,type I and type II fibromuscular strength in the two groups after treatment significantly increased,the levels in combined group[(4.77±0.62)μV and(3.59±0.55)μV]were significantly higher than those in pelvic floor rehabilitation group[(2.91±0.46)μV and(2.74±0.40)μV](P<0.05).Compared with before treatment,PFIQ-7 and PFDI-20 scores in the two groups afer treatment significantly decreased,the scores in combined group[(20.72±3.94)and(17.95±2.71)J were significantly lower than those in pelvic floor rehabilitation group(32.16±4.32)and(35.62±3.94)J(P<0.05).Compared with before treatment,the numbers of urination and leakage in the two groups after treatment significantly decreased,while the maximum urination volume significantly increased,the numbers of urination and leakage in combined group were lower than those in pelvic floor rehabilitation group,the maximum urination volume was higher than that in pelvic floor rehabilitation group(P<o.05).Compared with before treatment,the scores of International Urinary Incontinence Questionnaire and 1-hour urine leakage significantly decreased in the two groups after treatment,the scores of International Urinary Incontinence Questionnaire and 1-hour urine leakage in combined group were significantly lower than those in pelvic floor rehabilitation group(P<0.05).Compared with before treatment,the levels of serum C-reactive protein,tumor necrosis factor-α,interleukin-6,cortisol,prostaglandin E2,and norepinephrine in the two groups after treatment significantly increased,the levels of above-mentioned indexes in combined group were significantly lower than those in pelvic floor rehabilitation group(P<0.05).Conclusion Pelvic floor rehabilitation training combined with electrical stimulation therapy has a definite therapeutic effect on postpartum stress urinary incontinence patients,which can improve pelvic floor muscle function and reduce inflammatory stress response.