生物反馈电刺激疗法对经阴道分娩后盆底功能康复效果的临床随机对照研究  

Biofeedback Electrical Stimulation Therapy in the Rehabilitation of Pelvic Floor Function after Vaginal Delivery:a Clinical Randomized Controlled Study

作　　者：李亚 白文佩[1] 张瑾[1] 张蕊[1] LI Ya;BAI Wenpei;ZHANG Jin;ZHANG Rui(Department of Obstetrics and Gynecology,Beijing Shijitan Hospital Affiliated to Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属世纪坛医院妇产科,北京市100038

出　　处：《中国全科医学》2024年第5期547-551,共5页Chinese General Practice

基　　金：北京市自然科学基金资助项目(7202075);北京市医院管理中心临床医学发展专项经费资助(ZYLX202112);北京市医院管理中心“登峰”计划专项经费资助(DFL20190701)。

摘　　要：背景妊娠和经阴道分娩是导致女性盆底功能障碍(PFD)的重要因素,表现为盆腔器官脱垂(POP)、压力性尿失禁(SUI)以及性功能障碍;产后盆底功能康复近年来成为研究热点,通过主动锻炼和被动收缩以刺激盆底肌群,提高逼尿肌稳定性、改善肛提肌功能,以预防和治疗PFD。目的探讨生物反馈电刺激+盆底肌训练(PFMT)联合疗法在经阴道分娩产妇盆底功能康复中的应用价值。方法选取2020年1月—2022年1月在首都医科大学附属世纪坛医院妇产科分娩后存在PFD的产妇作为研究对象,采用随机数字表法将研究对象分为观察组和对照组。观察组采用生物反馈电刺激+PFMT方法进行盆底功能康复,对照组仅采用PFMT方法进行盆底功能康复。记录两组治疗前后盆底Ⅰ类与Ⅱ类肌纤维肌力情况以及SUI比例、POP分度情况;产后PFMT训练情况;治疗前及治疗后3个月、6个月的盆底功能障碍问卷(PFDI-20)、盆底障碍影响简易问卷7(PFIQ-7)、尿失禁问卷表简表(ICI-Q-SF)评分情况。结果观察组共纳入327例、对照组共纳入343例。治疗后:观察组Ⅰ类与Ⅱ类肌纤维肌力恢复情况均优于对照组(P<0.001);观察组SUI比例低于对照组(P=0.005);两组POP分度情况比较,差异无统计学意义(P>0.05)。观察组治疗后3个月和治疗后6个月PFMT频次≥5次/周的比例均高于对照组(P<0.001);观察组治疗后3个月和治疗后6个月PFDI-20、PFIQ-7、ICI-Q-SF评分均低于对照组(P<0.05)。结论与单纯PFMT比较,产妇经阴道分娩后采用生物反馈电刺激联合PFMT进行盆底功能康复Ⅰ类与Ⅱ类肌纤维肌力恢复情况更好、SUI比例更低,实施PFMT的依从性更高,生活质量评分也更佳。Background Pregnancy and vaginal delivery are important factors leading to pelvic floor dysfunction(PFD)in women,manifested as pelvic organ prolapse(POP),stress urinary incontinence(SUI),and sexual dysfunction.Postpartum pelvic floor function rehabilitation has become a research hotspot in recent years.Stimulating the pelvic floor muscle groups through active exercise and passive contraction can improve detrusor stability and levator muscle function to prevent and treat PFD.Objective To investigate the clinical value of biofeedback electrical stimulation combined with pelvic floor muscle training(PFMT)therapy in the rehabilitation of pelvic floor function after vaginal delivery through a clinical controlled study.Methods Postpartum women with PFD after delivery implemented in Department of Obstetrics and Gynecology,Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2020 to January 2022 were selected as the research subjects,and divided into the observation group and the control group using a random number table method.The observation group was treated with biofeedback electrical stimulation combined with PFMT,while the control group was treated with PFMT alone.The muscle strength of the pelvic floor classⅠand classⅡmuscle fibers,the ratio of SUI and POP level of the two groups before and after treatment;postpartum PFMT situation;scores of Pelvic Floor Dysfunction Questionnaire(PFDI-20),Pelvic Floor Impact Questionnaire-7(PFIQ-7),and International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form(ICI-Q-SF)before and at 3 and 6 months after the treatment.Results A total of 327 cases were included in the observation group and 343 cases in the control group.After the treatment,the strength recovery of typeⅠandⅡmuscle fibers in the observation group was better than the control group(P<0.001).The ratio of SUI in the observation group was lower than that in the control group(P=0.005).There was no significant difference in POP level between the two groups(P>0.

关 键 词：盆底疾病 盆底功能障碍 生物反馈电刺激 阴道分娩 盆底肌训练 生活质量 随机对照试验 

分 类 号：R714.25[医药卫生—妇产科学]