运动处方对HIFU术后子宫腺肌病患者痛经的影响

Effect of exercise prescription on dysmenorrhea in patients with adenomyosis after high-intensity focused ultrasound

目的:评估运动处方联合高强度聚焦超声(high intensity focused ultrasound,HIFU)对子宫腺肌病患者痛经的影响。方法:纳入2017年1月到2018年3月HIFU治疗的子宫腺肌病患者,据患者术后对运动处方医嘱(150 min/周有氧运动)的执行情况分组,随访术后3、6、12个月痛经视觉模拟评分法(visual analogue score,VAS)评分及子宫体积变化。结果:本研究纳入217例子宫腺肌病女性患者,115例患者执行运动处方列为'运动组',运动处方依从率53.0%,102例患者无运动列为'无运动组',2组患者基线资料及HIFU治疗方案差异无统计学意义,组间具有可比性(P>0.05)。运动组和无运动组术前VAS评分差异无统计学意义(P=0.092),术后3、6、12个月运动组VAS评分分别为3.0(2.0,4.0)、2.0(0.0,3.0)和2.5(1.0,4.0)分,均低于无运动组的3.5(3.0,5.0)、4.0(2.0,5.8)和4.5(2.0,6.0)分,差异有统计学意义(P<0.01);术后3、6个月运动组子宫体积缩小中位数为9.780、14.046 cm3,而无运动组为2.935、-2.432 cm3,运动组术后3、6个月子宫体积缩小程度均高于无运动组(P<0.01)。结论:HIFU术后结合运动处方能够更有效降低VAS评分,缓解痛经症状,缩小子宫体积;运动处方可以作为子宫腺肌病HIFU术后康复治疗的方案,改善患者自我评价。

Objective:To investigate the effect of exercise prescription combined with high-intensity focused ultrasound(HIFU)on dysmenorrhea in patients with adenomyosis.Methods:The patients with adenomyosis who underwent HIFU from January 2017 to March 2018 were enrolled.According to the implementation of exercise prescription(aerobic exercise 150 minutes per week)after surgery,the patients were divided into exercise group and non-exercise group.The patients were followed up at 3,6,and 12 months after surgery to observe visual analogue scale(VAS)score of dysmenorrhea and the change in uterine volume.Results:A total of 217 patients were enrolled,with 115 in the exercise group(the rate of compliance with exercise prescription was 53.0%)and 102 in the non-exercise group.There were no significant differences in baseline data and HIFU regimen between the two groups(P>0.05).Before surgery,there was no significant difference in VAS score between the two groups(P=0.092),and at 3,6,and 12 months after surgery,the exercise group had a significantly lower VAS score than the non-exercise group(3.0(2.0,4.0)/2.0(0.0,3.0)/2.5(1.0,4.0)vs.3.5(3.0,5.0)/4.0(2.0,5.8)/4.5(2.0,6.0),all P<0.01)At 3 and 6 months after surgery,the medians of the reduction in uterine volume were 9.780 cm3 and 14.046 cm3 in the exercise group and 2.935 cm3 and-2.432 cm3 in the non-exercise group,and the exercise group had a significantly greater reduction in uterine volume than the non-exercise group(P<0.01).Conclusion:Exercise prescription after HIFU can effectively reduce VAS score,alleviate the symptom of dysmenorrhea,and reduce uterine volume.Therefore,exercise prescription can be used as a rehabilitation treatment regimen for adenomyosis after HIFU and can improve patients’self-evaluation.