【摘要】 目的 探讨产后压力性尿失禁(PSUI)伴腹直肌分离(DRA)患者在神经肌肉电刺激+Kegel训练基础上联合核心肌肉稳定训练治疗的效果。方法 2018年11月—2024年3月郑州大学第一附属医院诊治产后PSUI伴DRA患者210例，随机分为对照组和观察组各105例。对照组给予神经肌肉电刺激+Kegel训练，观察组在对照组治疗基础上给予核心肌肉稳定运动训练。治疗12周评定2组尿失禁治疗有效率；比较2组治疗前及治疗12周时阴道肌力、DRA距离、盆底Ⅰ类肌肌电均值、盆底Ⅱ类肌肌电最大值、1 h尿垫试验漏尿量、国际尿失禁咨询委员会尿失禁问卷表简表(ICIQ-SF)评分和生存质量测定量表简表(WHOQOL-BREF)评分。结果 治疗12周，观察组尿失禁治疗总有效率(94.3%)高于对照组(82.9%)(χ~2=6.774,P=0.009)。(2)观察组、对照组治疗12周时阴道肌力Ⅳ～Ⅴ级占比(16.2%、6.7%)均高于治疗前(0、0)(P<0.05),且观察组高于对照组(χ~2=4.704,P=0.030)。(3)治疗12周，观察组、对照组DRA距离[(1.1±0.2)、(1.9±0.4)cm]均小于治疗前[(4.3±0.8)、(4.4±0.8)cm](t=37.297、27.290,P均<0.001),Ⅰ类肌肌电均值[(40.59±4.04)、(32.01±4.82)V]、Ⅱ类肌肌电最大值[(55.40±8.97)、(45.45±8.47)V]、WHOQOL-BREF评分[(86.7±6.4)、(75.6±7.7)分]均高于治疗前[(20.27±4.88)、(20.27±5.78)V;(32.32±9.43)、(31.37±10.71)V;(58.7±9.5)、(57.4±8.7)分](t=-32.910～-10.573,P均<0.001),1 h漏尿量[(0.3±0.2)、(1.9±0.8)g]均少于治疗前[(11.1±7.6)、(10.3±6.5)g](t=14.353、13.034,P均<0.001),ICIQ-SF评分[(2.1±1.5)、6.1±2.9)分]均低于治疗前[(10.0±2.9)、(10.8±3.0)分](t=24.800、11.438,P均<0.001)。治疗12周，观察组DRA距离小于对照组(t=16.005,P<0.001),Ⅰ类肌肌电均值、Ⅱ类肌肌电最大值、WHOQOL-BREF评分均高于对照组(t=-13.979～-8.262,P均<0.001),1 h漏尿量少于对照组(t=18.252,P<0.001),ICIQ-SF评分低于对照组(t=12.384,P<0.001)。结论 PSUI伴DRA患者在神经肌肉电刺激+Kegel训练基础上联合核心肌肉稳定训练可增强盆底肌肌力，减少漏尿，提高生活质量。更多还原

【Abstract】 Objective To investigate the effect of core muscle stability training plus neuromuscular electrical stimulation+pelvic floor Kegel training on postpartum stress urinary incontinence(PSUI)and diastasis recti abdominis(DRA).Methods From November 2018to March 2024,210patients with PSUI+DRA in the First Affiliated Hospital of Zhengzhou University were randomly and equally divided into an observation group and a control group.The control group was given neuromuscular electrical stimulation+Kegel training,and the observation group was given core muscle stability training besides the treatment in control group.The total effective rate for PSUI was compared between two groups after 12-week treatment.The vaginal muscle strength,DRA distance,mean electromyography(EMG)value of pelvic floor typeⅠmuscle fibers,maximum EMG value of pelvic floor typeⅡmuscle fibers,urine leakage volume in 1-h pad test,International Consultation Committee on Incontinence Questionnaire-Short Form (ICIQ-SF)score and World Health Organization Quality of Life-BREF(WHOQOL-BREF)score were compared before treatment and after 12-week treatment between two groups.Results (1)After 12-week treatment,the total effective rate for treating PSUI was higher in the observation group(94.3%)than that in the control group(82.9%）（χ~2=6.774,P=0.009).(2)There was no significant difference in the vaginal muscle strength before treatment between two groups（χ~2=0.097,P=0.755).The percentages of vaginal muscle strengthⅣ-Ⅴgrade in the observation and control groups were higher after 12-week treatment(16.2%,6.7%)than those before treatment(0,0)(P<0.05),and higher in the observation group than that in the control group（χ~2=4.704,P=0.030).(3)After 12-week treatment in the observation group and the control group,the DRA distances[(1.1±0.2),(1.9±0.4)cm]were shorter than those before treatment[(4.3±0.8),(4.4±0.8)cm](t=37.297,27.290;all Pvalues<0.001);the mean EMG values of pelvic floor typeⅠmuscle fibers[(40.59±4.04),(32.01±4.82)V],maximum EMG values of pelvic floor typeⅡmuscle fibers[(55.40±8.97),(45.45±8.47)V],and WHOQOL-BREF scores (86.7±6.4,75.6±7.7)were higher than those before treatment[(20.27±4.88),(20.27±5.78)V;(32.32±9.43),(31.37±10.71)V;58.7±9.5,57.4±8.7](t=-32.910to-10.573,all Pvalues<0.001);the 1-h urine leakage volumes[(0.3±0.2),(1.9±0.8)g]were less than those before treatment[(11.1±7.6),(10.3±6.5)g](t=14.353,13.034;all Pvalues<0.001);the ICIQ-SF scores(2.1±1.5,6.1±2.9)were lower than those before treatment(10.0±2.9,10.8±3.0)(t=24.800,11.438;all Pvalues<0.001).After 12-week treatment,compared with control group,the observation group had shorter DRA distance(t=16.005,P<0.001),higher mean EMG value of pelvic floor typeⅠmuscle fibers,maximum EMG value of pelvic floor typeⅡmuscle fibers and WHOQOL-BREF score(t=-13.979to-8.262,all Pvalues<0.001),less1-h urine leakage volume(t=18.252,P<0.001),and lower ICIQ-SF score(t=12.384,P<0.001).Conclusion For patients with PSUI and DRA,core muscle stability training on the basis of neuromuscular electrical stimulation and Kegel training can enhance pelvic floor muscle strength,reduce urinary leakage,and improve quality of life.更多还原