针刺足三里联合体外磁波盆底治疗产后盆底功能障碍的疗效观察

Observations on the efficacy of acupuncture at Zusanli(ST36)plus extracorporeal magnetic wave pelvic floor therapy for postpartum pelvic floor dysfunction

目的观察针刺足三里穴联合体外磁波盆底治疗产后盆底功能障碍的临床疗效。方法用随机数字表法将98例行阴道分娩后6~8周的产后盆底功能障碍患者分为观察组(49例)和对照组(49例)。对照组采用体外磁波盆底治疗,观察组在对照组基础上联合针刺足三里穴治疗。比较两组临床疗效以及子宫及阴道前壁脱垂情况,观察两组治疗前后国际尿失禁咨询委员会问卷简表(International Consultation on Incontinence questionnaire-short form,ICIQ-SF)评分、盆底表面肌电指标和尿动力学指标的变化。结果观察组和对照组总有效率分别为93.9%和71.4%,组间差异具有统计学意义(P<0.05)。观察组和对照组子宫及阴道前壁脱垂总有效率分别为98.0%和81.6%,差异均具有统计学意义(P<0.05)。两组治疗后盆底表面肌电指标5次快肌收缩最大值、10 s慢肌收缩平均值和60 s慢肌收缩平均值均较治疗前提高(P<0.05),且观察组上述盆底表面肌电指标均高于对照组(P<0.05)。观察组治疗后最大尿流率和最大膀胱容量均优于对照组(P<0.05),观察组治疗后ICIQ-SF评分低于观察组(P<0.05)。结论针刺足三里穴联合体外磁波盆底治疗产后盆底功能障碍的临床疗效优于单一体外磁波盆底治疗,可有效提高盆底肌肌力,改善尿失禁,降低子宫和阴道前壁脱垂的发生。

Objective To observe the clinical efficacy of acupuncture at Zusanli(ST36)plus extracorporeal magnetic wave pelvic floor therapy for postpartum pelvic floor dysfunction.Method Ninety-eight patients with pelvic floor dysfunction 6-8 weeks after vaginal delivery were allocated,using a random number table,to an observation group(49 cases)and a control group(49 cases).The control group received extracorporeal magnetic wave pelvic floor therapy and the observation group received acupuncture at Zusanli in addition.The clinical therapeutic effects and uterine and anterior vaginal wall prolapses were compared between the two groups.The International Consultation on Incontinence questionnaire-short form(ICIQ-SF)score,pelvic floor surface myoelectricity indicators and urodynamic indicators were observed in the two groups before and after treatment.Result The total efficacy rate was 93.9%in the observation group and 71.4%in the control group with a statistically significant between-group difference(P<0.05).The total efficacy rate for uterine and anterior vaginal wall prolapses was 98.0%in the observation group and 81.6%in the control group with a statistically significant difference(P<0.05).After treatment,pelvic floor surface myoelectricity indicators: the maximum value of 5 fast-twitch muscle contractions and the mean values of 10 s and 60 s slow-twitch muscle contractions increased in the two groups compared with before (P<0.05) and were higher in the observation group than those in the control group (P<0.05). After treatment, the maximum flow rate and the maximum cystometric capacity were better in the observation group than those in the control group (P<0.05). After treatment, the ICIQ-SF score was lower in the observation group than that in the control group (P<0.05). Conclusion Acupuncture at Zusanli plus extracorporeal magnetic wave pelvic floor therapy is clinically more effective than extracorporeal magnetic wave pelvic floor therapy alone in treating postpartum pelvic floor dysfunction. It can effectively improve pelvic floor myodynamia, relieve urinary incontinence and reduce the occurrence of uterine and anterior vaginal wall prolapses.