不同时机盆底康复结合围术期呼吸功能锻炼对腹腔镜子宫切除术患者康复的影响

Effects of pelvic floor rehabilitation at different time points combined with perioperative respiratory exercise on rehabilitation of patients undergoing laparoscopic hysterectomy

目的:观察不同时机盆底康复结合围术期呼吸功能锻炼对腹腔镜子宫切除患者康复的影响。方法:选取2022年6月至2023年6月因良性肿瘤行腹腔镜子宫切除术的120例患者为研究对象,依据随机对照原则,将患者分为两组。两组围术期均予以呼吸功能锻炼,观察组术后第7天开始进行盆底康复训练,对照组术后第14天开始进行盆底康复训练。统计两组疗效、术后下尿路与肠道不良事件发生率,比较两组盆底功能影响调查评分、尿动力学、盆底肌电值、生活质量综合评定量表评分等相关指标。结果:观察组术后12周尿失禁、尿急发生率及术后24周尿失禁、尿潴留、尿急、便失禁发生率低于对照组,差异有统计学意义(P<0.05)。术后12周、24周,两组最大尿流率、平均尿流率较训练前升高,排尿时间、残余尿量较训练前降低(P<0.05);观察组最大尿流率、平均尿流率高于对照组,排尿时间、残余尿量低于对照组(P<0.05);两组快肌收缩最大值、10 s与60 s慢肌收缩平均值较训练前升高(P<0.05),观察组盆底肌电值高于对照组(P<0.05);两组盆底功能影响调查评分较训练前下降,观察组低于对照组;生活质量综合评定量表评分较训练前升高(P<0.05),观察组高于对照组(P<0.05)。观察组总有效率高于对照组,差异有统计学意义(P<0.05)。结论:腹腔镜子宫切除术后早期进行盆底康复训练与围术期呼吸功能锻炼可促进盆底功能、膀胱功能的恢复,减少下尿路与肠道不良事件的发生,提高生活质量。

Objective:To observe the effect of pelvic floor rehabilitation at different time points combined with perioperative r espiratory function exercise on the recovery of patients undergoing laparoscopic hysterectomy.Methods:From Jun.2022 to Jun.2023,120 patients who underwent laparoscopic hysterectomy for benign tumors were selected as the study subjects,and randomly divided into two groups according to the principle of randomized control.Both groups were given respiratory function exercise during the perioperative period,and pelvic floor rehabilitation training started on the 7th postoperative day in the observation group,and on the 14th postoperative day in the control group.The efficacy,the incidence of postoperative lower urinary tract and intestinal adverse events,the impact of pelvic floor function survey score,urodynamics,pelvic floor electromyography values,and the comprehensive quality of life scale score and other related indicators were compared between the two groups.Results:The incidence of urinary incontinence and urinary urgency at 12 weeks postoperatively and the rates of urinary incontinence,urinary retention,urinary urgency,and fecal incontinence at 24 weeks postoperatively in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The maximum and average urinary flow rate at 12 and 24 weeks postoperatively in both groups were higher than those before training,and the time of urination and residual urine volume were lower than those before training(P<0.05).In the observation group,the maximum urine flow rate and average urine flow rate were higher than those in the control group,and the time of urination and residual urine volume were lower than those in the control group(P<0.05).The maximum value of fast muscle contraction and the average value of 10 s and 60 s slow muscle contraction were higher in both groups than those before training(P<0.05).The pelvic floor m yoelectricity values of the observation group were higher than those of the control group(P<0.05).The pelvic floor function impact survey scores in both groups were lower than those before training,and the observation group was lower than the control group;the comprehensive quality of life scale scores were higher than before training(P<0.05),and the observation group was higher than the control group(P<0.05).The total effective rate of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).Conclusions:Early pelvic floor rehabilitation training and perioperative respiratory exercise after l aparoscopic hysterectomy can promote the recovery of pelvic floor function and bladder function,reduce the occurrence of lower urinary tract and intestinal adverse events,and improve the quality of life.