生物反馈电刺激联合地特胰岛素注射液及凯格尔训练治疗妊娠糖尿病产后盆底功能障碍性疾病患者的疗效观察  

Observation on the efficacy of biofeedback electrical stimulation combined with insulin detemir injection and Kegel training in the treatment of postpartum pelvic floor dysfunction in patients with gestational diabetes mellitus

作　　者：李荣华 刘威[1] 郭淑惠[1] 卢艳 马雪莲 李爽 LI Rong-hua;LIU Wei;GUO Shu-hui(Tangshan Maternal and Child Health Hospital,Tangshan Hebei 063000,China)

机构地区：[1]唐山市妇幼保健院产科,河北唐山063000

出　　处：《临床和实验医学杂志》2024年第24期2631-2636,共6页Journal of Clinical and Experimental Medicine

基　　金：河北省2018年度医学科学研究重点课题计划(编号:20181329)。

摘　　要：目的探讨生物反馈电刺激联合地特胰岛素注射液、凯格尔训练治疗妊娠糖尿病盆底功能障碍性疾病患者的临床疗效。方法前瞻性纳入2021年6月至2023年1月唐山市妇幼保健院产科收治的124例妊娠糖尿病产后盆底功能障碍性疾病患者作为研究对象。按照随机数字表法将患者分为对照组、试验组,每组各62例。对照组予地特胰岛素注射液联合凯格尔训练干预,试验组在对照组基础上予生物反馈电刺激干预,持续干预3个月。干预后,比较两组患者的临床疗效、会阴肌力测定法分级(≥Ⅲ级、≤Ⅱ级)、Ⅰ型及Ⅱ型肌纤维肌力。比较两组患者干预前及干预1、3个月后盆底肌纤维的疲劳度,以及盆腔脏器脱垂症状评分表(POP-SS)评分。评估两组患者的盆底结构超声检查结果[盆膈裂孔面积(LHS)、肛提肌尿道间隙(LUG)和肛提肌厚度]。监测干预后两组稳态模型-胰岛素抵抗指数(HOMA-IR)、β细胞功能评估(HOMA-β)指标水平。结果干预后,试验组总有效率为98.39%,高于对照组(82.26%),差异有统计学意义(P<0.05)。试验组会阴肌力测定法分级≥Ⅲ级患者占比为96.77%,高于对照组(72.58%),试验组Ⅰ型和Ⅱ型肌纤维肌力分别为(8.14±1.36)、(9.56±1.69)μV,均高于对照组[(5.45±1.58)、(7.05±1.15)μV],差异均有统计学意义(P<0.05)。干预1、3个月后,两组Ⅰ、Ⅱ型肌纤维疲劳度均较干预前降低,且试验组Ⅰ、Ⅱ型肌纤维疲劳度均低于对照组,差异均有统计学意义(P<0.05)。干预1、3个月后,两组POP-SS评分均较干预前降低,且试验组POP-SS评分明显低于对照组,差异均有统计学意义(P<0.05)。干预3个月后,对照组患者的LUG较干预前降低,试验组患者的LHS、LUG均较干预前降低,两组患者的肛提肌厚度均较干预前升高,且试验组患者的LHS、LUG均显著低于对照组,肛提肌厚度显著高于对照组,差异均有统计学意义(P<0.05)。干预3个月后,两组�Objective To investigate the clinical efficacy of biofeedback electrical stimulation combined with insulin detemir injection and Kegel training in the treatment of patients with gestational diabetes mellitus and pelvic floor dysfunction.Methods A total of 124 patients with postpartum pelvic floor dysfunction caused by gestational diabetes mellitus admitted to the Department of Obstetrics,Tangshan Maternal and Child Health Hospital from June 2021 to January 2023 were prospectively included in the study.According to the random number table method,the patients were divided into the control group and the experimental group,with 62 cases in each group.The control group was given insulin injection combined with Kegel training intervention,and the experimental group was given biofeedback electrical stimulation intervention based on the control group.The intervention lasted for 3 months.After intervention,the clinical efficacy,perineal muscle strength assessment grading(≥grade Ⅲ,≤grade Ⅱ),type Ⅰ and type Ⅱ muscle fiber strength were compared between the two groups.The fatigue of pelvic floor muscle fibers and the pelvic organ prolapse symptom scale(POP-SS)score were compared before intervention and 1 and 3 months after intervention.At the same time,ultrasound findings of pelvic floor structure[levator hiatus(LHS),levator-urethra gap(LUG),and the thickness of the levator ani muscle]were evaluated.In addition,homeostasis model assessment insulin resistance index(HOMA-IR)and β cell function assessment(HOMA-β)were monitored after the intervention.Results After intervention,the total effective rate of the experimental group was 98.39%,which was higher than that of the control group(82.26%),and the difference was statistically significant(P<0.05).The proportion of patients with perineal muscle strength assessment grade≥Ⅲ in the experimental group was 96.77%,which was higher than that in the control group(72.58%),the muscle strength of type Ⅰ and type Ⅱ muscle fibers in the experimental group were(8.14±1.

关 键 词：妊娠糖尿病 骨盆底 盆底功能障碍性疾病 生物反馈电刺激 盆底康复训练 盆底肌力 

分 类 号：R47[医药卫生—护理学]