生物反馈结合盆底训练治疗男性压力性尿失禁的效果  

Biofeedback combined with pelvic floor training in the treatment of male stress urinary incontinence

作　　者：安迪 王建霞 张帆[3] 靖华芳 高轶[3] 从惠玲 廖利民[3] An Di;Wang Jianxia;Zhang Fan;Jing Huafang;Gao Yi;Cong Huiling;Liao Limin(Department of PT2,China Rehabilitation Research Center,the School of Rehabilitation,Capital Medical University,Beijing 100068,China;Department of ICU,Cancer Hospital Chinese Academy of Medical Science,Beijing 100021,China;Department of Urology,China Rehabilitation Research Center,the School of Rehabilitation,Capital Medical University,Beijing 100068,China)

机构地区：[1]中国康复研究中心物理疗法2科(PT2科)首都医科大学康复医学院,北京100068 [2]中国医学科学院肿瘤医院重症医学科,北京100021 [3]中国康复研究中心泌尿外科首都医科大学康复医学院,北京100068

出　　处：《中华泌尿外科杂志》2023年第8期616-621,共6页Chinese Journal of Urology

基　　金：中国康复研究中心课题基金(2020-Q1)。

摘　　要：目的探讨生物反馈结合盆底训练治疗男性压力性尿失禁的效果。方法卡本研究为前瞻性研究,纳人2019年9月至2020年6月中国康复研究中心收治的根治性前列腺切除术后尿失禁患者。除外不能完成或拒绝本次试验者、有其他泌尿系统病史者、中枢神经系统病变者。采用随机数字表法将患者分为单纯凯格尔训练组(A组),进行收缩肛门训练,每次收缩5s,每次收缩间隔休息2s;生物反馈结合凯格尔训练组(B组),进行生物反馈结合收缩肛门训练;生物反馈结合普拉提组(C组),进行生物反馈结合普拉提训练。B组和C组生物反馈治疗时,患者取右侧卧位,将直肠探头表面电极插人肛门,参考电极固定于右侧大腿的内收肌处。嘱患者尽可能用力收缩肛门挤压电极,使收缩肛门产生的肌电信号与电脑屏幕上的肌电信号同步。在生物反馈治疗的电刺激阶段,采用电流强度30~50Hz、脉宽300μus的菱形波,电刺激强度以可见到肌肉的细微收缩为准。3组的训练时间均为每日训练45min,共训练8周,每周末记录1h尿垫试验、每日尿失禁次数、国际尿失禁咨询问卷(简表)(ICIQ-SF)、牛津评分量表评分,比较3组治疗前后的上述指标的差异和组间差异,记录4种评价指标差异有统计学意义的时间点。结果3组患者治疗前的年龄、身高、体重、糖尿病或高血压病史、术后至开始训练的时间、手术方式、术中是否保留神经束、Gleason评分、1h尿垫试验、尿失禁次数、ICIQ-SF和牛津等级量表评分的差异均无统计学意义(P>0.05)。A、B、C组治疗后的1h尿垫试验结果分别为(37.4±7.2)、(22.2±4.7)、(18.3±2.4)g,3组间差异有统计学意义(P<0.01),3组与治疗前[(57.0±8.3)、(58.6±8.6)、(56.5±9.2)g]比较差异均有统计学意义(P<0.01)。A、B、C组治疗后的尿失禁次数分别为(4.6±0.7)、(3.4±0.6)、(3.0±0.8)次,3组间差异有统计学意义(P<0.01),3组与治疗前[(7.Objective To investigate the effect of biofeedback combined with pelvic floor training on stress urinary incontinence in elderly men.Methods This study was prospective and Patients with urinary incontinence after radical prostatectomy from China Rehabilitation Research Center were enrolled.The patients who could not complete or refused the study,had a history of other urinary diseases,and central nervous system diseases were excluded.Patients were divided by random number table method into 3 groups.They were Kegel training group(Group A)which underwent anus contraction training with each contraction for 5 seconds and a rest interval of 2 seconds.Biofeedback combined with Kegel training group(Group B),which was biofeedback combined with anus contraction training and the biofeedback combined Pilates group(Group C)which received the biofeedback combined Pilates training.In group B and group C,patients were placed in the right lateral position and the surface electrode of the rectal probe was inserted into the anus.The reference electrode was fixed at the adductor muscle of the right thigh.The patient is asked to squeeze the electrode as hard as possible by constricting the anus so that the electromyographic signals produced by constricting the anus are synchronized with those on the computer screen.In the electrical stimulation stage of biofeedback therapy,rhomboid waves with current intensity of 30-50 Hz and pulse width of 300μs were used,and the electrical stimulation intensity was determined by the subtle muscle contraction visible.Each of the three training sessions lasted 45 minutes a day for 8 weeks.1 hour pad test,daily incontinence times,(International Incontinence Counseling Questionnaire,ICIQ),and Oxford Score Scale were recorded every weekend.The 1-hour pad test,the number of incontinent episodes,ICIQ,Oxford Score scale before and after treatment were compared among the three groups,as well as the differences between the groups.ResultsTThere were no significant differences in age,height,weight,history of

关 键 词：前列腺切除术 前列腺术后尿失禁 盆底训练 凯格尔训练 生物反馈训练 

分 类 号：R699.8[医药卫生—泌尿科学]