盆底功能锻炼联合盆底肌电刺激治疗产后压力性尿失禁的临床效果

Clinical effect of pelvic floor functional exercise combined with pelvic floor electromyography stimulation in the treatment of postpartum stress urinary incontinence

目的 探讨盆底功能锻炼联合盆底肌电刺激治疗产后压力性尿失禁的临床效果,并分析其对患者相关指标的影响。方法 选取2021年1月—2022年12月金华市中心医院收治的产后压力性尿失禁患者220例为研究对象,分为盆底功能锻炼组和盆底功能锻炼联合电刺激组,每组各110例。分别于治疗前、治疗1个疗程后使用尿动力仪检测平均尿流率、腹压漏尿点压及最大尿道闭合压;收集治疗前后的盆底肌收缩力度数据;采用Ingelman-Sundberg分度法评估患者尿失禁程度;采用酶联免疫吸附法检测血清结缔组织生长因子(CTGF)、弹性蛋白酶抑制剂(Elafin)及基质金属蛋白酶1(MMP-1)水平。结果 治疗后,两组患者平均尿流率、腹压漏尿点压及最大尿道闭合压均高于治疗前,且盆底功能锻炼联合电刺激组患者平均尿流率[(14.72±2.28)ml/s]、腹压漏尿点压[(12.48±1.95)kPa]及最大尿道闭合压[(8.23±0.96)kPa]均明显高于盆底功能锻炼组[(12.05±2.11)ml/s、(10.13±1.69)kPa及(7.35±0.91)kPa],差异均有统计学意义(t=7.185、7.307及5.091,均P<0.05)。治疗后,两组患者Ⅰ类盆底肌力和Ⅱ类盆底肌力均高于治疗前,且盆底功能锻炼联合电刺激组患者Ⅰ类盆底肌力[(31.72±1.95)μV]和Ⅱ类盆底肌力[(40.06±4.26)μV]均明显高于盆底功能锻炼组[(28.06±1.69)μV、(33.71±3.85)μV],差异均有统计学意义(t=7.861、12.837,均P<0.05)。治疗后,两组患者尿失禁程度均明显低于治疗前,且盆底功能锻炼联合电刺激组患者明显低于盆底功能锻炼组,差异有统计学意义(P<0.05)。治疗后,两组患者血清CTGF、MMP-1水平均明显低于治疗前,血清Elafin水平均明显高于治疗前,且盆底功能锻炼联合电刺激组患者血清CTGF[(69.80±3.16)μg/L]、MMP-1[(6.94±0.58)μg/L]水平均明显低于盆底功能锻炼组[CTGF(77.14±3.42)μg/L、MMP-1(9.31±0.62)μg/L],血清Elafin[(9.92±1.25)pg/ml]水平明显高于盆底功能锻炼组[(7.16±0.84)pg/ml],差异均有统计学意义(t=14.627、8.347及7.805,均P<0.05)。盆底功能锻炼联合电刺激组治疗总有效率明显高于盆底功能锻炼组,差异有统计学意义(P<0.01)。盆底功能锻炼联合电刺激组110例患者中,治疗无效患者的治疗前血清CTGF、MMP-1水平均明显高于治疗有效患者,治疗前血清Elafin水平明显低于治疗有效患者,差异均有统计学意义(均P<0.05)。治疗前CTGF、Elafin及MMP-1截断值为97.39μg/L、4.26 pg/ml及15.81μg/L时对产后压力性尿失禁患者盆底功能锻炼联合电刺激疗效具有较高的预测价值(P<0.05),各指标联用的预测价值最高。结论 盆底功能锻炼联合盆底肌电刺激治疗能够有效改善产后压力性尿失禁患者的病情,CTGF、Elafin及MMP-1可能参与其作用机制,治疗前联合检测对疗效具有较高的预测价值。

Objective To explore the clinical effect of pelvic floor functional exercise combined with pelvic floor electromyography stimulation in the treatment of postpartum stress urinary incontinence,and analyze its impact on relevant indicators of patients.Methods 220 postpartum stress urinary incontinence patients admitted to Jinhua Central Hospital from January 2021 to December 2022 were selected as the research subjects and divided into a pelvic floor function exercise group and a pelvic floor function exercise combined with e-lectrical stimulation group,with 110 cases in each group.Measure the average urinary flow rate,abdominal pressure leak point pressure,and maximum urethral closure pressure using a urodynamic instrument before treatment and after one course of treatment;Collect data on pel-vic floor muscle contraction strength before and after treatment;Use Ingelman Sundberg grading method to evaluate the degree of urinary in-continence in patients;Enzyme linked immunosorbent assay(ELISA)was used to detect the levels of serum connective tissue growth factor(CTGF),elastase inhibitor(Elafin),and matrix metalloproteinase-l(MMP-1).Results After treatment,the average urinary flow rate,abdominal leak point pressure,and maximum urethral closure pressure of both groups of patients were higher than before treatment,and the average urinary flow rate of patients in the pelvic floor functional exercise combined with electrical stimulation group was[(14.72±2.28)ml/s],abdominal pressure leak point pressure[(12.48±1.95)kPa]and maximum urethral closure pressure[(8.23±0.96)kPa]were significantly higher than those in the pelvic floor function exercise group[(12.05±2.11)ml/s,(10.13±1.69)kPa and(7.35±0.91)kPa],and the differences were statistically significant(t=7.185,7.307 and 5.091,all P<0.05).After treatment,both groups of pa-tients had higher levels of typeⅠand typeⅡpelvic floor muscle strength than before treatment,and the pelvic floor functional exercise com-bined with electrical stimulation group had higher levels of typeⅠpelvic floor muscle strength[(31.72±1.95)μV]and typeⅡpelvic floor muscle strength[(40.06±4.26)μV]were significantly higher than those in the pelvic floor function exercise group[(28.06±1.69)μV,(33.71±3.85)μV],and the differences were statistically significant(t=7.861,12.837,all P<0.05).After treatment,the degree of urinary incontinence in both groups of patients was significantly lower than before treatment,and the patients in the pelvic floor function exercise combined with electrical stimulation group were significantly lower than those in the pelvic floor function exercise group,with statistical significance(P<005).After treatment,the serum levels of CTGF and MMP-1 in both groups of patients were significantly lower than before treatment,and the serum level of Elafin was significantly higher than before treatment.In addition,the serum CTGF of pa-tients in the pelvic floor functional exercise combined with electrical stimulation group[(69.80±3.16)μg/L],MMP-1[(6.94±0.58)μg/L]were significantly lower than those of the pelvic floor function exercise group[CTGF(77.14±3.42)μg/L,MMP-1(9.31±0.62)μg/L],serum Elafin[(9.92±1.25)pg/ml]was significantly higher than that of the pelvic floor function exercise group[(7.16±0.84)pg/ml],with statistically significant differences(t=14.627,8.347 and 7.805,all P<0.05).The total effective rate of pelvic floor function exercise combined with electrical stimulation group was significantly higher than that of pelvic floor function exercise group,and the difference was statistically significant(P<0.01).Among the 110 patients in the pelvic floor function exercise combined with electrical stimulation group,the pre-treatment serum levels of CTGF and MMP-1 were significantly higher in patients who did not respond to treatment than in patients who responded to treatment.The pre-treatment serum Elafin level was significantly lower in patients who respon-ded to treatment,and the differences were statistically significant(P<005).The cutoff values of CTGF,Elafin,and MMP-1 before treat-ment were 97.39μg/L,4.26 pg/ml and 15.81μg/L,it has a high predictive value for the efficacy of pelvic floor functional exercise com-bined with electrical stimulation in postpartum stress urinary incontinence patients(P<0.05),the combination of various indicators has the highest predictive value.Conclusion Pelvic floor functional exercise combined with pelvic floor electromyography stimulation therapy can ef-fectively improve the condition of postpartum stress urinary incontinence patients.CTGF,Elafin,and MMP-1 may be involved in its mecha-nism of action,and pre-treatment combined testing has high predictive value for efficacy.