盆底康复训练联合生物反馈电刺激对产后压力性尿失禁的疗效及相关机制  

The therapeutic effect and related mechanisms of pelvic floor rehabilitation training combined with biofeedback electrical stimulation on postpartum stress urinary incontinence

作　　者：陈嫣 杨晨 王春华 冯洪波 郑书真 叶利群 CHEN Yan;YANG Chen;WANG Chun-hua;FENG Hong-bo;ZHENG Shu-zhen;YE Li-qun(Ningbo Municipal Hospital of Traditional Chinese Medicine(TCM),Affiliated Hospital of Zhejiang Chinese Medical University,Ningbo,Zhejiang 315010,China)

机构地区：[1]宁波市中医院,浙江宁波315000

出　　处：《中国妇幼保健》2024年第12期2135-2139,共5页Maternal and Child Health Care of China

基　　金：浙江省宁波市科技计划项目(2021S159);国家中医药管理局科技司-浙江省中医药管理局共建科技计划项目(GZY-ZJ-KJ-Z3090)。

摘　　要：目的 探讨盆底康复训练联合生物反馈电刺激对产后压力性尿失禁的疗效及相关机制。方法 选取2020年5月—2022年7月间宁波市中医院收治的产后压力性尿失禁患者170例,分为对照组(单纯盆底康复训练)、观察组(联合生物反馈电刺激治疗),每组各85例。通过1 h尿垫试验结果和主观评价对疗效进行评定,记录显效、有效及无效的患者数,计算治疗有效率,分为有效组、无效组。治疗前后采用会阴肌力测试法评价盆底肌力,分为0~5级。记录两组患者治疗前后的24 h尿垫试验、24 h尿失禁次数及盆底肌肉肌电值。结果 观察组治疗有效率明显高于对照组,差异有统计学意义(P<0.01)。治疗后盆底肌力水平均明显高于治疗前,其中观察组患者治疗后盆底肌力5级比例明显高于对照组,差异有统计学意义(P<0.01)。治疗后观察组24 h尿垫试验(3.17±0.41)g、24 h尿失禁次数(0.79±0.27)次明显低于对照组(8.95±0.83)g、(1.41±0.33)次,盆底肌肉肌电值(56.51±8.46)μV明显高于对照组,差异有统计学意义(P<0.01);治疗后观察组产后压力性尿失禁患者血清CTGF(11.39±2.16)μg/L、骨桥蛋白(1.94±0.52)mg/L、基质金属蛋白酶水平明显低于对照组,差异有统计学意义(P<0.01)。观察组产后压力性尿失禁患者中有效组治疗前血清CTGF(94.91±16.78)μg/L、骨桥蛋白(12.30±1.74)mg/L及基质金属蛋白酶水平明显低于无效组,差异有统计学意义(P<0.05)。ROC曲线分析显示,血清CTGF、骨桥蛋白、基质金属蛋白酶-1及基质金属蛋白酶-2对产后压力性尿失禁患者预后均具有较高的预测价值(P<0.05);其中联合检测的预测价值最高(AUC=0.955)。结论 盆底康复训练联合生物反馈电刺激治疗可通过降低CTGF、骨桥蛋白、基质金属蛋白酶-1及基质金属蛋白酶-2表达来改善产后压力性尿失禁患者的病情,具有较好的治疗效果。Objective To explore the therapeutic effect and related mechanisms of pelvic floor rehabilitation training combined with biofeedback electrical stimulation on postpartum stress urinary incontinence.Methods 170 patients with postpartum stress urinary incontinence admitted to Ningbo Traditional Chinese Medicine Hospital from May 2020 to July 2022 were selected and divided into a control group(simple pelvic floor rehabilitation training)and an observation group(combined with biofeedback electrical stimulation treatment),with 85 cases in each group.Evaluate the therapeutic effect through the results of the 1-hour urine cushion test and subjective evaluation,record the number of patients who showed significant,effective,and ineffective effects,calculate the treatment response rate,and divide them into an effective group and an ineffective group.Before and after treatment,the perineal muscle strength test was used to evaluate pelvic floor muscle strength,which was divided into O to 5 levels.Record the 24-hour urinary pad test,24-hour urinary incontinence frequency,and pelvic floor muscle electromyography values of two groups of patients before and after treatment.Results The effective rate of treatment in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P<0.01).After treatment,the pelvic floor muscle strength level was significantly higher than before treatment,with the observation group significantly higher than the control group,and the difference was statistically significant(P<0.01):After the treatment,the number of 24-hour urinary pad test was(3.17±0.41)g,and 24-hour urinary incontinence tests was(0.79±0.27)times,they were significantly lower than before treatment(8.95±0.83)g and(1.41±0.33)times,and the pelvic floor muscle electromyography value(56.51±8.46)μV was also significantly higher than the control group,and the difference was statistically significant(P<0.01).Serum CTCF(11.39±2.16)μg/L in postpartum stress urinary inconti

关 键 词：压力性尿失禁 产后 盆底康复训练 生物反馈电刺激 疗效 机制 

分 类 号：R711[医药卫生—妇产科学]