凯格尔训练 核心肌群运动联合盆底肌仿生物理疗法对产后压力性尿失禁患者漏尿量的影响

Effect of Kegel training,core muscle group exercise,and pelvic floor biomimetic therapy on urinary leakage in postpartum stress urinary incontinence patients

目的 分析凯格尔训练、核心肌群运动联合盆底肌仿生物理疗法对产后压力性尿失禁(SUI)患者漏尿量的影响。方法 选取2018年2月—2022年2月杭州市第三人民医院收治的产后SUI患者158例作为研究对象,按照训练方法分为盆底疗法组79例,训练联合组79例。盆底疗法组采用核心肌群运动联合盆底肌仿生物理疗法进行治疗,训练联合组采用凯格尔训练、核心肌群运动联合盆底肌仿生物理疗法进行治疗。采用会阴肌力检测法检测两组患者盆底肌力水平;采用尿失禁生活质量问卷(I-QOL)评估患者生活质量;采用国际尿失禁咨询委员会尿失禁问卷表(ICI-QLF评分)检测两组患者尿失禁情况;采用Ingelman-Sundberg分度法检测两组患者漏尿量;测量盆腔器官脱垂分期(POP-Q)各指示点;观察两组患者治疗效果,并进行比较。结果 治疗后,盆底疗法组患者ICI-QLF评分为(7.10±4.89)分,训练联合组患者ICI-QLF评分为(5.12±2.01)分,两组比较差异有统计学意义(t=3.329,P<0.05)。治疗后,盆底疗法组盆底肌力评分为(3.58±0.18)分,I-QOL评分为(19.24±9.24)分,训练联合组盆底肌力评分为(5.10±0.34)分,I-QOL评分为(26.58±16.57)分,训练联合组盆底肌力评分和I-QOL评分均高于盆底疗法组(t=58.220,3.439,均P<0.05)。治疗后,盆底疗法组漏尿量为(4.46±1.34)g,训练联合组漏尿量为(3.23±1.41)g,两组比较差异有统计学意义(t=5.620,P<0.05)。治疗后,盆底疗法组POP-Q分级0级、Ⅰ级、Ⅱ级比例分别为30.38%、46.84%及22.78%,训练联合组POP-Q分级0级、Ⅰ级、Ⅱ级比例分别为45.57%、48.10%及6.33%,与盆底疗法组相比,训练联合组POP-Q分级0级、Ⅰ级比例升高,Ⅱ级比例降低(χ^(2)=4.869,3.114,12.461,均P<0.05)。训练联合组的治疗总有效率为94.94%,显著高于盆底疗法组的84.81%,差异有统计学意义(χ^(2)=4.450,P<0.05)。结论 凯格尔训练、核心肌群运动联合盆底肌仿生物理疗法可以改善产后SUI患者漏尿情况,提高患者生活质量,值得在临床上广泛推广。

Objective To analyze the effect of Kegel training,core muscle group exercise,and pelvic floor biomimetic therapy on urinary leakage in postpartum stress urinary incontinence(SUI)patients.Methods A total of 158 postpartum SUI patients admitted to the Third People's Hospital of Hangzhou from February 2018 to February 2022 were selected as study subjects,then they were divided into pelvic floor therapy group(79 patients)and training combination group(79 patients).The patients in pelvic floor therapy group were treated with core muscle group exercise combined with pelvic floor biomimetic therapy;the patients in training combination group were treated with Kegel training,core muscle group exercise,and pelvic floor biomimetic therapy.Perineal muscle strength test was used to detect pelvic floor muscle strength,I-QOL questionnaire was used to evaluate life quality,ICI-QLF score was used to detect SUI degree,Ingelman-Sundberg method was used to detect urinary leakage,POP-Q indication points were measured,the curative effects in the two groups were observed and compared.Results After treatment,ICI-QLF score in pelvic floor therapy group was(7.10±4.89),ICI-QLF score in training combined group was(5.12±2.01),there was statistically significant difference(t=3.329,P<0.05).After treatment,pelvic floor muscle strength in pelvic floor therapy group was(3.58±0.18)points,I-QOL score was(19.24±9.24)points,pelvic floor muscle strength in training combination group was(5.10±0.34)points,I-QOL score was(26.58±16.57)points,pelvic floor muscle strength and I-QOL score in training combination group were statistically significantly higher than those in pelvic floor therapy group(t=58.220,3.439,P<0.05).After treatment,urinary leakage in pelvic floor therapy group was(4.46±1.34)g,urinary leakage in training combination group was(3.23±1.41)g,there was statistically significant difference(t=5.620,P<0.05).After treatment,the proportions of grade POP-Q 0,gradeⅠ,and gradeⅡin pelvic floor therapy group were 30.38%,46.84%,and 22.78%,respectively,and the proportions of grade POP-Q 0,gradeⅠ,and gradeⅡin training combination group were 45.57%,48.10%,and 6.33%,respectively.Compared with pelvic floor therapy group,the proportions of POP-Q grade 0 andⅠincreased,and the proportion of POP-Q gradeⅡdecreased(χ^(2)=4.869,3.114,12.461,all P<0.05).The total effective rate of training combination group was 94.94%,which was significantly higher than that of pelvic floor therapy group(84.81%),the difference was statistically significant(χ^(2)=4.450,P<0.05).Conclusion Kegel training,core muscle group exercise combined with pelvic floor muscle biomimetic therapy can improve urinary leakage and the quality of life in patients with postpartum SUI,which is worthy of clinical popularization.