基于功能性近红外光谱技术观察不同康复治疗方法对产后盆底功能障碍的影响  

Effect of Different Rehabilitation Treatment Methods on Patients with Postpartum Pelvic Floor Dysfunction Based on fNIRS Observation

作　　者：徐明月 苏敏[1,3,4] 李春光[5] 祖晓彤[1] 祝宇飞 蔡丝妍 张娟 XU Mingyue;SU Min;LI Chunguang;ZU Xiaotong;ZHU Yufei;CAI Siyan;ZHANG Juan(Dushu Lake Hospital Affiliated to Soochow University,Suzhou,Jiangsu 215125,China;Lianyungang Fulin Rehabilitation Hospital,Lianyungang,Jiangsu 222006,China;Soochow University Rehabilitation Research Institute,Suzhou,Jiangsu 215006,China;The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215006,China;Mechanical and Electrical Engineering College of Soochow University,Suzhou,Jiangsu 215100,China)

机构地区：[1]苏州大学附属独墅湖医院,江苏苏州215125 [2]连云港市福临康复医院,江苏连云港222006 [3]苏州大学康复研究所,江苏苏州215006 [4]苏州大学附属第一医院,江苏苏州215006 [5]苏州大学机电工程学院,江苏苏州215100

出　　处：《康复学报》2024年第5期490-499,共10页Rehabilitation Medicine

基　　金：国家重点研发计划指导项目(2022YFC2009706)。

摘　　要：目的 采用功能性近红外光谱技术(fNIRS)观察不同治疗方法下氧合血红蛋白(HbO_(2))的浓度变化与脑区激活的相关性,为产后盆底康复的临床研究提供客观评估指标和分析依据。方法 选取2023年1-6月在苏州大学附属独墅湖医院收治的产后盆底功能障碍疾病(PFD)的患者40例,用随机数字表法将其分为4组:纯凯格尔组、电刺激组、磁刺激组和电磁联合组,每组10例。纯凯格尔组,进行凯格尔训练,每次30 min,每周3次;电刺激组给予生物反馈电刺激治疗,每次20 min,频率5~50 Hz,每次治疗前后进行5 min凯格尔训练;磁刺激组给予盆底磁刺激治疗,每次20 min,每次治疗前后进行5 min凯格尔训练;电磁联合组给予电刺激和盆底磁刺激交替联合治疗,每次20 min,每次治疗前后进行5 min凯格尔训练。4组均治疗1个疗程10次。4组治疗前后均采用盆底解剖学指标评估盆底脱垂情况,肌电图评估盆底肌表面肌电值,同时利用fNIRS观察不同脑区HbO_(2)的浓度变化和脑区的激活情况。结果 治疗后,纯凯格尔组膀胱颈移动度较治疗前有所改善(P<0.05),尿道旋转角、肛提肌裂口面积有一定程度改善(P<0.05);电刺激组、磁刺激组、电磁联合组盆底解剖学指标较治疗前均有所改善(P<0.05);进一步组间比较,电磁联合组治疗后改善幅度优于其他3组(P<0.05)。治疗后,纯凯格尔组前静息状态下盆底肌表面肌电值较治疗前改善(P<0.05),耐力收缩状态下较治疗前有改善(P<0.05);电刺激组、磁刺激组、电磁联合组较治疗前前静息、快速收缩、紧张收缩、耐力收缩和后静息状态下盆底肌表面肌电值均有所改善(P<0.05);进一步组间比较,磁刺激组对前静息、后静息状态下盆底肌表面肌电值改善幅度优于纯凯格尔组和电刺激组(P<0.05);电磁联合组快速收缩、紧张收缩、耐力收缩状态下盆底肌表面肌电值改善幅度均优于其他3组(P<0.05)。与组内�Objective To observe the correlation between oxyhemoglobin(HbO_(2))concentration changes and brain region activation under different treatment methods using functional near-infrared(fNIRS),providing objective evaluation indicators and analysis basis for the clinical research of postpartum pelvic floor rehabilitation.Methods A total of 40 patients with postpartum pelvic floor dysfunction(PFD)treated at Dushu Lake Hospital Affiliated to Soochow University from January to June 2023 were selected and randomly divided into 4 groups:pure Kegel group,electrical stimulation group,magnetic stimulation group,and electromagnetic combination group,with 10 cases in each group.The pure Kegel group performed Kegel training for 30 minutes each time,3 times a week;the electrical stimulation group received biofeedback electrical stimulation for 20 minutes each time,with a frequency of 5-50 Hz,and 5 minutes of Kegel training before and after each treatment;the magnetic stimulation group received pelvic floor magnetic stimulation for 20 minutes each time,and 5 minutes of Kegel training before and after each treatment;the electromagnetic combination group received alternating electrical stimulation and pelvic floor magnetic stimulation treatment for 20 minutes each time,and 5 minutes of Kegel training before and after each treatment.All four groups were treated for one course of 10 sessions.Before and after treatment,pelvic floor prolapse was assessed by pelvic floor anatomy indicators,surface electromyographic values of the pelvic floor muscles were assessed by EMG,and HbO_(2) concentration changes and activation in different brain regions were observed using fNIRS.Results After treatment,the mobility of bladder neck in the pure Kegel group improved compared with that before treatment(P<0.05),and the urethral rotation angle and levator ani fissure area improved to some extent(P<0.05).The electrical stimulation,magnetic stimulation and electromagnetic combination groups all showed improvements in pelvic floor anatomical indicators co

关 键 词：盆底功能障碍 凯格尔训练 盆底磁刺激 生物反馈电刺激 功能性近红外光谱技术 

分 类 号：R711.5[医药卫生—妇产科学] R49[医药卫生—临床医学]