压力性尿失禁患者物理治疗效果及其早期相关因素  

Physical therapy efficacy and early related factors in patients with stress urinary incontinence

作　　者：刘坤[1] 张红真[2] 邓艳东[3] 谢颖[4] 吕立召[5] 李学慧[6] LIU Kun;ZHANG Hong-zhen;DENG Yan-dong;XIE Ying;LYU Li-zhao;LI Xue-hui(Pelvic Floor Surgery Center,First Hospital of Hebei Medical University,Shijiazhuang 050030,Hebei,China;不详)

机构地区：[1]河北医科大学第一医院盆底整复中心,河北石家庄050030 [2]河北医科大学第一医院妇产学科,河北石家庄050030 [3]河北医科大学第一医院超声科,河北石家庄050030 [4]河北医科大学第一医院营养科,河北石家庄050030 [5]河北医科大学第一医院精神卫生科,河北石家庄050030 [6]河北医科大学第一医院妇科,河北石家庄050030

出　　处：《广东医学》2024年第6期738-743,共6页Guangdong Medical Journal

基　　金：河北省医学科学重点科技研究计划(20190493)。

摘　　要：目的对尿失禁患者物理治疗的疗效及其早期影响因素进行分析。方法将2019年6月至2021年12月于河北医科大学第一医院诊治的200例压力性尿失禁患者纳入研究,采用随机数字表法分为干预组及对照组,比较两组患者年龄、性别等一般临床资料,对照组予常规治疗,干预组在常规治疗基础上联合物理治疗,比较两组患者症状及生活质量等指标,并根据治疗结果将干预组患者分为有效组及无效组,比较两组患者一般临床资料,采用多因素logistics回归模型对影响患者疗效指标进行分析,采用R软件绘制疗效预测风险列线图,建立疗效预测评分模型,并对其预测价值进行验证。结果两组患者年龄、体质指数(BMI)、治疗前两组患者1 h漏尿量、I-QOL评分、快速收缩盆底肌电位等基线指标差异无统计学意义(均P>0.05)。治疗后及随访截止时两组患者1 h漏尿量、I-QOL评分等指标均较治疗前好转,且干预组改善情况显著优于对照组(均P<0.05)。有效组患者年龄、BMI、阴道分娩次数、既往盆腔手术史患者比例及站立休息肛提肌裂孔面积显著低于无效组,仰卧位休息膀胱颈高度、站立休息膀胱颈高度显著高于无效组(均P<0.05)。多因素logistics回归示高龄(OR=1.243,P=0.000)、高BMI(OR=1.792,P=0.000)、多阴道分娩次数(OR=6.537,P=0.003)是物理治疗无效的独立危险因素,而高站立休息膀胱颈高度(OR=0.855,P=0.024)是物理治疗疗效独立保护因素;SUI患者疗效预测列线图示疗效预测评分模型预测SUI临床疗效的一致性指数为0.986(0.912~0.997),疗效预测发生率与实际发生率的平均绝对误差为0.013,二者一致性良好。结论基于年龄、BMI及膀胱颈高度等指标构建的疗效预测模型可有效预测患者临床疗效,有助于早期制定干预措施。Objective To analyze the effect of physical therapy on patients with urinary incontinence and its early influencing factors.Methods From June 2019 to December 2021,200 patients with stress urinary incontinence(SUI)treated at the First Hospital of Hebei Medical University were included in the study and divided into an intervention group and a control group using a random number table.General clinical data,symptom severity,and quality of life were compared between the two groups.Based on treatment outcomes,patients in the intervention group were further divided into effective and ineffective groups.Multifactorial logistic regression models were used to analyze the factors affecting treatment outcomes.Risk line charts were drawn using R software to establish an efficacy prediction scoring model,which was then validated for its predictive value.Results There were no significant differences in age,body mass index(BMI),1-hour urine leakage volume,I-QOL score,and rapid contraction of pelvic floor muscle electromyography between the two groups at baseline(all P>0.05).After treatment and at follow-up,both groups showed improvements in 1-hour urine leakage volume and I-QOL scores compared to baseline,with the intervention group showing significantly better improvements(all P<0.05).Patients in the effective group had significantly lower age,BMI,number of vaginal deliveries,and history of pelvic surgery compared to the ineffective group,while lying rest bladder neck height and standing rest bladder neck height were significantly higher(all P<0.05).Multifactorial logistic regression indicated that advanced age(OR=1.243,P=0.000),higher BMI(OR=1.792,P=0.000),and multiple vaginal deliveries(OR=6.537,P=0.003)were independent risk factors for ineffective physical therapy,while higher standing rest bladder neck height(OR=0.855,P=0.024)was an independent protective factor.The consistency index of the efficacy prediction scoring model for predicting SUI clinical outcomes was 0.986(0.912-0.997),and the average absolute error between t

关 键 词：压力性尿失禁 物理治疗 疗效分析 预测模型 

分 类 号：R711.59[医药卫生—妇产科学] R694.54[医药卫生—临床医学]