生物反馈盆底肌训练对儿童肛肠疾病术后大便失禁的治疗效果及对患儿心理的影响

Therapeutic effect and psychological influence of biofeedback pelvic floor muscle training on fecal incontinence after anorectal surgery in children

目的:探讨生物反馈盆底肌训练对儿童肛肠疾病术后大便失禁的治疗效果及对患儿心理的影响。方法:回顾性病例对照研究。选择2021年7月至2023年4月于新乡医学院第一附属医院因肛肠疾病术后大便失禁就诊的37例患儿,采用加拿大Laborie生物反馈治疗仪进行生物反馈盆底肌训练治疗,并每天进行不少于200次的盆底肌收缩功能锻炼。分别测量其治疗前、1个疗程结束时、治疗1个月及1年时的肛管电流强度、肛管基础运动肌电值、肛管收缩肌电差值及肛门持续收缩时间。选取10例健康同龄儿作为健康对照组。采用长处和困难问卷对大便失禁的患儿在治疗前、治疗1年时分别进行心理评估。采用配对样本t检验与独立样本t检验对研究结果进行比较分析。结果:大便失禁患儿治疗前、1个疗程结束时、治疗1个月时、治疗1年时肛管电流强度值分别为(11.32±1.92)mA、(10.22±1.28)mA、(8.45±1.09)mA、(7.80±1.23)mA,肛管基础运动肌电值分别为(235.58±55.03)μV、(185.65±34.30)μV、(124.81±36.56)μV、(93.99±28.29)μV,肛管收缩肌电差值分别为(45.64±20.38)μV、(64.20±16.59)μV、(93.63±25.53)μV、(109.83±26.95)μV,肛门持续收缩时间分别为(1.27±0.43)s、(1.58±0.40)s、(2.04±0.39)s、(2.47±0.38)s。将治疗前、1个疗程结束时、治疗1个月时数据与健康对照组[(7.20±1.09)mA、(88.65±21.76)μV、(120.73±27.57)μV、(2.68±0.29)s]进行比较,差异均有统计学意义(均P<0.05)。治疗1年与治疗前、治疗1个月时比较,差异均有统计学意义(均P<0.05)。但治疗1年与健康对照组比较,差异均无统计学意义(均P>0.05)。情绪症状、多动症状、同伴交往、亲社会行为及困难总分评分治疗前后比较[(3.46±1.88)分比(2.59±1.32)分、(5.78±2.12)分比(3.70±1.78)分、(3.05±1.72)分比(2.49±1.30)分、(7.30±1.54)分比(8.27±1.39)分、(21.57±4.57)分比(18.54±3.14)分],差异均有统计学意义(均P<0.05)。结论:生物反馈盆底肌训练是治疗儿童肛肠疾病术后大便失禁的一种可靠且无创伤的有效方法,且能有效改善患儿因大便失禁造成的心理及行为问题。

ObjectiveTo explore the therapeutic effect and psychological influence of biofeedback pelvic floor muscle training on fecal incontinence after anorectal surgery in children.MethodsA retrospective case-control study.A total of 37 children who were admitted to the First Affiliated Hospital of Xinxiang Medical University from July 2021 to April 2023 for fecal incontinence after anorectal surgery were collected.Biofeedback pelvic floor muscle training was performed with a Laborie biofeedback therapy device,and pelvic floor muscle contraction function exercise was performed no less than 200 times a day.The anal canal current intensity,basic motion myoelectric value,contractile myoelectric difference and continuous anal contraction time were measured at before treatment,at the end of 1 course,1 month and 1 year after treatment.Ten healthy children of the same age were selected as the healthy control group.The Strengths and Difficulties Questionnaire was used for psychological evaluation at before treatment and 1 year after treatment.Paired sample t test and independent sample t test were used to compare and analyze the results of this study.ResultsBefore treatment,at the end of 1 course,1 month and 1 year after treatment,the anal canal current intensity of children with fecal incontinence were(11.32±1.92)mA,(10.22±1.28)mA,(8.45±1.09)mA,and(7.80±1.23)mA,respectively;the anal canal basic motion myoelectric value were(235.58±55.03)μV,(185.65±34.30)μV,(124.81±36.56)μV,and(93.99±28.29)μV,respectively;the anal canal contractile myoelectric difference were(45.64±20.38)μV,(64.20±16.59)μV,(93.63±25.53)μV,and(109.83±26.95)μV,respectively;the continuous anal contraction time were(1.27±0.43)s,(1.58±0.40)s,(2.04±0.39)s,and(2.47±0.38)s,respectively.These parameters before treatment,at the end of 1 course and 1 month after treatment were significantly different from those in the healthy control group[(7.20±1.09)mA,(88.65±21.76)μV,(120.73±27.57)μV,(2.68±0.29)s](all P<0.05).These parameters at 1 year after treatment were significantly different from those before treatment and 1 month after treatment(all P<0.05).However,there were no significant differences in these parameters between the healthy control group and the treatment group at 1 year after treatment(all P>0.05).There were statistically significant differences in emotional symptoms,hyperactivity symptoms,peer interaction,prosocial behavior and difficulty scores before and after treatment[(3.46±1.88)points vs.(2.59±1.32)points,(5.78±2.12)points vs.(3.70±1.78)points,(3.05±1.72)points vs.(2.49±1.30)points,(7.30±1.54)points vs.(8.27±1.39)points,(21.57±4.57)points vs.(18.54±3.14)points](all P<0.05).ConclusionsBiofeedback pelvic floor muscle training is a reliable and non-invasive method for the treatment of postoperative fecal incontinence after anorectal surgery in children and can effectively relieve the psychological and behavioral problems caused by fecal incontinence in children.