生物反馈电刺激治疗子宫切除术后盆底功能障碍的疗效及危险因素分析  

Analysis of the efficacy and risk factors of biofeedback electrical stimulation for pelvic floor dysfunction after hysterectomy

作　　者：赵志宏 刘艳娟[1] 冯芳[2] Zhao Zhihong;Liu Yanjuan;Feng Fang(Department of Obstetrics and Gynecology,Baoding Third Central Hospital,Hebei Rongjun Hospitaly Baoding Hebei 071000,P.R.China;Department of Obstetrics and Gynecology,Hebei Rongjun Hospitaly Baoding Hebei 071000,P.R.China)

机构地区：[1]保定市第三中心医院妇产科,河北保定071000 [2]河北省荣军医院妇产科,河北保定071000

出　　处：《中国计划生育和妇产科》2021年第8期47-51,共5页Chinese Journal of Family Planning & Gynecotokology

基　　金：河北省卫生和计划生育委员会科研基金项目(项目编号:20191228);保定市科学技术局科技计划项目(项目编号:18ZF144)。

摘　　要：目的探究生物反馈电刺激治疗子宫切除术后盆底功能障碍(pelvic floor dysfunction,PFD)的疗效及危险因素分析。方法选取2018年1月至2019年12月保定市第三中心医院妇产科收治的240例子宫切除术后PFD患者,均接受生物反馈电刺激治疗,观察治疗后盆底肌力、盆腔器官脱垂和尿失禁的改善情况。治疗后6个月根据预后情况分为预后良好组和预后不良组,对预后影响因素进行Logistic回归分析,并采用受试者工作特征曲线(receiver operating characteristic curve,ROC)判定各指标的预测价值。结果治疗后,183例(76.25%)患者盆底肌力恢复正常(≥3级),盆腔器官脱垂(≥Ⅰ度)由治疗前的192例(80.00%)减少至65例(27.08%),尿失禁患者由145例(60.42%)减少至46例(19.17%),差异有统计学意义(P<0.05)。单因素分析结果显示,年龄、产次、分娩方式和留置导尿管时间为影响预后的主要因素(P<0.05)。Logistic回归分析结果显示,年龄(OR=1.123,95%CI 1.065-1.184)、产次(OR=1.852,95%CI 1.669-2.054)、分娩方式(OR=1.255,95%CI 1.118-1.409)和留置导尿管时间(OR=1.166,95%CI 1.056-1.289)均为影响PFD预后的独立危险因素。ROC分析结果表明,年龄、产次、分娩方式和留置导尿管时间的曲线下面积分别为0.739、0.711、0.887、0.698,敏感度分别为69.39%、61.22%、87.76%、59.18%,特异度分别为74.66%、77.38%、78.28%、73.76%。结论生物反馈电刺激治疗子宫切除术后PFD疗效显著,其预后受年龄、产次、分娩方式和留置导尿管时间的影响,提示患者和医生在临床上要针对性地干预和规避。Objective To investigate the risk factors and efficacy of biofeedback electrical stimulation in the treatment of pelvic floor dysfunction(PFD)after hysterectomy.Methods 240 patients with PFD after hysterectomy admitted to Department of Obstetrics and Gynecology,Baoding Third Central Hospital from January 2018 to December 2019 were treated with biofeedback electrical stimulation therapy,the improvement of pelvic floor muscle strength,pelvic organ prolapse and urinary incontinence after treatment were evaluated.After 6 months,all patients were divided into good prognosis group and poor prognosis group according to the diagnosis of PFD,the prognostic factors were analyzed by Logistic regression analysis and predictive value was evaluated by receiver operating characteristic(ROC)curve.Results After treatment,pelvic floor muscle strength measurements showed that 183 cases(76.25%)were returned to normal muscle strength(≥3 degree),patients with pelvic organ prolapse decreased from 192 cases(80.00%)to 65 cases(27.08%),patients with urinary incontinence decreased from 145 cases(60.42%)to 46 cases(19.17%),the differences were statistically significant(P<0.05).Univariate analysis result showed that age,parity,delivery mode and indwelling catheter time were the prognostic factors of PFD(P<0.05).Logistic regression analysis showed that age(OR=1.123,95%CI 1.065-1.184),parity(OR=1.852,95%CI 1.669-2.054),delivery mode(OR=1.255,95%CI 1.118-1.409)and indwelling catheter time(OR=1.166,95%CI 1.056-1.289)were the independent risk factors of prognosis of PFD.ROC analysis showed that AUC of age,parity,delivery mode and indwelling catheter time was 0.739,0.711,0.887,0.698,sensitivity was 69.39%,61.22%,87.76%,59.18%,specificity was 74.66%,77.38%,78.28%,73.76%.Conclusion Biofeedback electrical stimulation had a notable curative effect in the treatment of PFD after hysterectomy,age,parity,delivery mode and indwelling catheter time were the independent risk factors,the patients and doctors should interfere and aviod targeted.

关 键 词：生物反馈电刺激 盆底功能障碍 子宫切除 影响因素 

分 类 号：R711.2[医药卫生—妇产科学]