临床研究
ENGLISH ABSTRACT
居家盆底神经肌肉电刺激治疗对尿失禁患者盆底功能持续改善的作用
孙智晶
朱兰
郎景和
王巍
史宏晖
庞红霞
史欣文
作者及单位信息
·
DOI: 10.3760/cma.j.issn.0529-567X.2015.12.011
Continuous improvement of portable domestic pelvic floor neuromuscular electrical stimulation on the pelvic floor function of patients with urinary incontinence
Sun Zhijing
Zhu Lan
Lang Jinghe
Wang Wei
Shi Honghui
Pang Hongxia
Shi Xinwen
Authors Info & Affiliations
Sun Zhijing
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
Zhu Lan
Lang Jinghe
Wang Wei
Shi Honghui
Pang Hongxia
Shi Xinwen
·
DOI: 10.3760/cma.j.issn.0529-567X.2015.12.011
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摘要

目的评估经过在院短期盆底电生理治疗后,居家继续盆底神经肌肉电刺激治疗对尿失禁患者盆底功能持续改善的作用。

方法2014年2月至2015年2月在中国医学科学院北京协和医院60例临床诊断为压力性尿失禁的妇女入选本随机对照临床研究,随机分为两组:对照组30例,只接受为期4周的在院盆底电生理治疗;观察组30例,在完成与对照组相同的在院短期治疗后,在医师指导下,应用便携式神经和肌肉刺激仪,居家继续进行12周的盆底神经肌肉电刺激治疗。治疗后6、9个月分别对两组患者进行1 h尿垫试验检测漏尿量,并检测盆底电生理参数,应用国际尿失禁咨询委员会尿失禁问卷简表(ICI-Q-SF)评估患者尿失禁症状的主观改善情况。

结果治疗后9个月随访,对照组和观察组压力性尿失禁患者漏尿量的平均降幅分别为(75±24)%、(99±3)%,两组比较,差异有统计学意义( P<0.01);观察组患者盆底Ⅰ类肌纤维肌力(4.4±0.7)、Ⅱ类肌纤维肌力(4.8±0.4)和阴道动态压力[(96±12)cmH 2O,1 cmH 2O=0.098 kPa]均优于对照组[分别为3.2±1.0、4.3±0.9、(86±10)cmH 2O],分别比较,差异均有统计学意义( P<0.01)。治疗后9个月,观察组和对照组患者的尿失禁主观症状ICI-Q-SF评分[分别为(1.8±1.7)和(6.5±2.9)分]均有明显改善,观察组改善更加显著,两组比较,差异有统计学意义( P<0.01)。

结论经过在院短期盆底电生理治疗后,居家盆底神经肌肉电刺激治疗对压力性尿失禁患者的盆底功能有持续改善作用。

尿失禁,压力性;电刺激疗法;骨盆底
ABSTRACT

ObjectiveTo evaluate continuous improvement of portable domestic pelvic floor neuromuscular electrical stimulation on the pelvic floor function of patients with stress urinary incontinence after short-term pelvic floor electrophysiological treatment in hospital.

MethodsTotally 60 women with stress urinary incontinence were recruited for this randomized controlled trial. The control group including a total of 30 patients, only received 4 weeks pelvic floor electrophysiological treatment in the hospital. Family consolidation treatment group (experimental group) including 30 patients, after 4-week treatment in hospital, received 12-week of pelvic floor neuromuscular electrical stimulation using portable electrical stimulator at home under the guidance of doctors. In post-treatment 6 months and 9 months, 1-hour pad test was measured for urine leakage, pelvic floor electrical physiological parameters were assessed, and subjective improvement of symptoms of urinary incontinence were evaluated. All these data were analysed to compare the effect of the two groups.

ResultsIn 9 months after treatment, average change of urine leakage, the control group and experiment group were (75±24)% versus (99±3)%, the difference was statistically significant ( P<0.01). In the experiment group, strength of type Ⅰ muscle (4.4±0.7), strength of type Ⅱ muscle (4.8±0.4) and pelvic floor dynamic pressure [(96±12) cmH 2O, 1 cmH 2O=0.098 kPa] were better than those of control group [3.2±1.0, 4.3±0.9, (86±10) cmH 2O, respectively], the differences were statistically significant ( P<0.01). Subjective outcome, the control group and experiment group were (6.5±2.9) versus (1.8±1.7), subjective outcome between the two groups had significant difference ( P<0.01).

ConclusionAfter short-term pelvic floor electrophysiological treatment in hospital, the portable domestic pelvic floor neuromuscular electrical stimulation in patients with stress urinary incontinence is helpful to continuous improvement of pelvic floor function.

Urinary incontinence, stress;Electric stimulation therapy;Pelvic floor
Zhu Lan, Email: mocdef.aabniseiluj_uhz
引用本文

孙智晶,朱兰,郎景和,等. 居家盆底神经肌肉电刺激治疗对尿失禁患者盆底功能持续改善的作用[J]. 中华妇产科杂志,2015,50(12):937-941.

DOI:10.3760/cma.j.issn.0529-567X.2015.12.011

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*以上评分为匿名评价
盆底功能障碍性疾病(pelvic floor dysfunction,PFD)主要包括压力性尿失禁(stress urinary incontinence,SUI)和盆腔器官脱垂(pelvic organ prolapse,POP)等疾病,严重影响妇女的生命质量。我国成年女性的尿失禁患病率达30.9% [ 1 ]。此外,随着人口老龄化的发展,估计在未来40年,因PFD而需要治疗的妇女会成倍增长 [ 2 ]。正常的盆底肌肉在腹腔压力增高的情况下,可以保持控制力 [ 3 ],因此,较弱的盆底肌肉会增加妇女患PFD的风险。有效保持盆底肌肉的强度,提高肌肉活动的意识感,对恢复盆底控制力和正常的盆底功能是有效的 [ 4 ]。盆底电生理治疗已广泛应用于PFD的治疗中,且疗效满意,但是,临床治疗结束后,如何保持和巩固治疗效果并未引起足够重视。本研究的目的是评估经过短期在院临床盆底电生理治疗后,患者在家继续使用便携式神经和肌肉刺激仪给予盆底神经肌肉电刺激,对巩固临床治疗效果以及保持正常的盆底功能的作用。
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备注信息
A
朱兰,Email: mocdef.aabniseiluj_uhz
B
中华预防医学会中国妇女盆底功能障碍防治专项资金 (20120102)
国家科技支撑计划 (2014BAI05B02)
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