基于电诊断评估的产后压力性尿失禁综合康复治疗临床疗效观察  

Clinical and EMG observation on comprehensive rehabilitation treatment for postpartum stress urinary incontinence

作　　者：周勋琦 邓乙首 李丹[1] 邝志强[1] 龚金生[1] 梁振文[1] 陈卓铭[1] 李建华[2] ZHOU Xunqi;DENG Yishou;LI Dan(Department of Rehabilitation Medicine,the First Affiliated Hospital,Jinan University,Guangzhou,Guangdong,510630)

机构地区：[1]暨南大学附属第一医院康复医学科,广东省广州市510630 [2]浙江大学医学院附属邵逸夫医院康复科

出　　处：《中国康复医学杂志》2021年第5期553-558,共6页Chinese Journal of Rehabilitation Medicine

摘　　要：目的:明确产后尿失禁患者肛提肌是否存在神经源性损伤或肌源性损伤,进一步观察盆底肌训练结合生物反馈治疗对两种损伤类型的尿失禁患者的临床疗效。方法:81例产后压力性尿失禁患者均采用同心圆针电极评估左右侧肛提肌后分为神经源性组(n=33)和肌源性组(n=48),两组患者均接受盆底肌训练联合生物反馈治疗,分析并对比两组患者治疗前后,肛提肌运动单位动作电位(motor unit action potential,MUAP)波幅,改良牛津评分法(modified oxford scale,MOS)评分,尿失禁生活质量量表(incontinence quality of life scale,I-QOL)评分及尿失禁发生的情况。结果:经过6周治疗后,两组I-QOL、MOS评分与治疗前相比均有显著提高(P<0.05),且肌源性组I-QOL评分(85.26±9.43)明显高于神经源性组I-QOL评分(74.40±8.01)(P<0.05);肌源性组尿失禁发生率(10%)明显低于神经源性组(18%);肌源性组MOS评分明显优于神经源性组(P<0.05);肌源性组左、右侧肛提肌运动单位动作电位波幅明显高于治疗前(P<0.05),神经源性组左、右侧肛提肌运动单位动作电位波幅明显低于治疗前(P<0.05)。结论:产后尿失禁患者肛提肌存在神经源性损伤或肌源性损伤,盆底肌训练结合生物反馈治疗能有效改善两种损伤类型的压力性尿失禁患者临床症状,但对于肛提肌出现神经源性损伤的患者应考虑做进一步的临床处理。Objective:To determine whether there exists neurogenic or myogenic injury in levator ani muscle in patients with postpartum urinary incontinence,and furthermore to observe the clinical efficacy of conventional pelvic floor muscle training combined with biofeedback therapy on urinary incontinence caused by two types of injury.Method:81 patients with postpartum stress urinary incontinence were divided into neurogenic group(n=33)and myogenic group(n=48)based on needle electromyography.Both two groups received the same biofeedback therapy and pelvic floor muscle training.Before and after treatment,the motor unit action potential(MUAP)amplitude of Levator ani muscle,modified oxford scale(MOS),incontinence quality of life scale(IQOL)and the occurrence of urinary incontinence were analyzed and compared between two groups.Result:After 6 weeks of treatment,the I-QOL and MOS scores of the two groups were significantly higher than those before treatment(P<0.05),and the I-QOL scores of the myogenic group(85.26±9.43)were significantly higher than those of the gneurogenic group(74.40±8.01)(P<0.05).The incidence of urinary incontinence in the myogenic group(10%)was significantly lower than that in the neurogenic group(18%).The motor unit action potential(MUAP)amplitude of left and right Levator ani muscle in the myogenic group were significantly higher than that before treatment(P<0.05);the motor unit action potential(MUAP)amplitude of left and right Levator ani muscle in the neurogenic group were significantly lower than that before treatment(P<0.05).Conclusion:There exist neurogenic or myogenic injury in patients with levator ani muscle of postpartum incontinence,and the regular pelvic floor muscle training combined with biofeedback therapy can effectively improve the clinical symptoms of stress urinary incontinence caused by the two types of injury.Yet,the patients with neurogenic injuries of the levator ani muscle should be considered for further clinical treatment.

关 键 词：电诊断 盆底肌训练 压力性尿失禁 生物反馈 肛提肌 

分 类 号：R695.1[医药卫生—泌尿科学] R49[医药卫生—外科学]