【摘要】 目的 探讨产后压力性尿失禁(SUI)患者接受生物反馈电刺激结合放松训练治疗对盆底肌表面电信号及漏尿情况的影响,以期为临床治疗提供参考。方法 本研究选取2023年5月—2024年5月在北京市通州区妇幼保健院接受治疗的319例产后SUI患者作为研究对象,根据治疗方式不同将患者分为对照组(n=152)和研究组(n=167)。对照组患者接受生物反馈电刺激治疗。研究组患者在对照组基础上进行生物反馈放松训练治疗。治疗12周时,比较2组患者临床疗效、漏尿情况。治疗前及治疗12周时,比较2组患者盆底肌肉做功值、最大峰值、活力值、最大尿道闭合压(PMUC)、功能性尿道长度(FUL)、最大尿道压(PMU)及盆底功能阻碍影响评价表(PFIQ-7)、国际尿失禁咨询委员会尿失禁问卷简表(ICI-Q-SF)、盆腔脏器脱垂/尿失禁性功能问卷-12(PISQ-12)、7项-广泛性焦虑量表(GAD-7)评分。结果 研究组患者临床总有效率高于对照组,差异有统计学意义(P<0.05)。治疗前,2组患者做功值、最大峰值以及活力值比较,差异无统计学意义(P>0.05)。治疗后,2组患者做功值、最大峰值以及活力值均高于治疗前,且研究组高于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者漏尿量比较,差异无统计学意义(P>0.05)。治疗后,2组患者漏尿量均少于治疗前,且研究组少于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者PMUC、FUL及PMU比较,差异无统计学意义(P>0.05)。治疗后,2组患者PMUC和PMU均大于治疗前,且研究组大于对照组,差异均具有统计学意义(P<0.05);治疗后,2组患者FUL长于治疗前,且研究组长于对照组,差异具有统计学意义(P<0.05)。治疗前,2组患者PFIQ-7、ICI-Q-SF、PISQ-12及GAD-7评分比较,差异无统计学意义(P>0.05)。治疗后,2组患者PFIQ-7、ICI-Q-SF、PISQ-12及GAD-7评分均低于治疗前,且研究组患者PFIQ-7与GAD-7评分低于对照组,差异均有统计学意义(P<0.05)。结论 生物反馈电刺激联合生物反馈放松训练治疗产后SUI患者的疗效显著,能有效改善患者盆底肌表面电信号水平及漏尿情况,调节尿动力状态,提高生活质量,并改善患者心理状态,值得临床推广应用。更多还原

【Abstract】 Objective To investigate the effects of biofeedback electrical stimulation combined with biofeedback relaxation training on pelvic floor muscle surface electromyographic(sEMG) signals and urinary leakage in patients with postpartum stress urinary incontinence(SUI),providing a reference for clinical practice.Methods From May 2023 to May 2024,319postpartum SUI patients treated at Tongzhou District Maternal and Child Health Hospital were enrolled and assigned to a control group(n=152) and a study group(n=167) according to treatment method.The control group received biofeedback electrical stimulation;the study group received biofeedback relaxation training in addition to the control-group treatment.After 12 weeks of treatment,the two groups were compared for clinical efficacy and urinary leakage.Before treatment and after 12 weeks the following were compared:pelvic floor muscle work value,maximum peak value,activity value,maximum urethral closure pressure(PMUC),functional urethrcal length(FUL),maximum urethral pressure(PMU),and scores on the Pelvic Floor Impact Questionnaire-7(PFIQ-7),International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form(ICI-Q-SF),Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12(PISQ-12),and Generalized Anxiety Disorder scale-7(GAD-7).Results The overall clinical response rate in the study group was higher than that in the control group,and the difference was statistically significant(P<0.05).Before treatment,there were no significant differences between groups in work value,maximum peak value,or activity value(P>0.05),After treatment,work value,maximum peak value,and activity value in both groups were significantly higher than before treatment,and values in the study group were higher than those in the control group(P<0.05).Before treatment,urinary leakage volume did not differ significantly between groups(P>0.05).After treatment,urinary leakage volume in both groups was significantly less than before treatment,and the study group had less leakage than the control group(P<0.05).Before treatment,PMUC,FUL,and PMU did not differ significantly between groups(P>0.05),After treatment,PMUC and PMU in both groups were significantly greater than before treatment,and values in the study group were greater than those in the control group(P<0.05);after treatment,FUL was significantly longer in both groups than before treatment and longer in the study group than in the control group(P<0.05).Before treatment,PFIQ-7,ICI-Q-SF,PISQ-12,and GAD-7 scores did not differ significantly between groups(P>0.05).After treatment,all these scores were lower than before treatment in both groups;the study group showed greater reductions in PFIQ-7 and GAD-7 than the control group,with statistically significant differences(P <0.05).Conclusion Biofeedback electrical stimulation combined with biofeedback relaxation training is effective for postpartum SUI:it notably improves pelvic floor muvscle sEMG parameters and urinary leakage,optimizes urodynamic indexes,raises quality of life,and ameliorates psychological status.The combined approach is safe and merits clinical promotion.更多还原