摘要
目的探讨经会阴表面肌电位生物反馈疗法(BF)对治疗老年女性压力性尿失禁的近期疗效。方法2018年1月至2019年12月共纳入分别在北京医院和云南省第一人民医院门诊治疗的60岁及以上女性压力性尿失禁患者87例,采用自愿选择入组方法分成经会阴表面肌电位的生物反馈治疗组53例、经阴道表面肌电位的生物反馈治疗组34例。经阴道表面肌电位治疗组有3例患者中途退出治疗,最终完成治疗者为31例。治疗频率为每周2次,治疗时间为8周,治疗前后分别对两组患者进行1 h尿垫试验、盆底肌纤维肌力和生活质量问卷评估,并比较两组患者的治疗有效率、不良反应和舒适度评价。结果经过8周治疗后,会阴BF组患者漏尿量(4.65±2.33)g、评估尿失禁患者生活质量的尿失禁影响问卷简表(ⅡQ-7)评分(4.34±2.66)分,较治疗前(11.02±4.85)g、(7.96±5.11)分显著改善(t=8.62、4.58,均P<0.001);阴道BF组患者漏尿量(3.85±1.89)g、ⅡQ-7评分(3.81±1.23)分,较治疗前(12.43±3.96)g、(8.29±5.01)分显著改善(t=10.89、4.84,均P<0.001)。两组患者的盆底肌纤维肌力分级通过治疗虽然有所提高,但与治疗前相比较差异均无统计学意义[会阴BF组:(3.93±2.77)级比(2.98±2.10)级,阴道BF组:(4.51±3.38)级比(3.07±2.02)级,t=1.99、2.04,P=0.056、0.051]。两组患者治疗后平均漏尿量、盆底肌力分级和ⅡQ-7评分差异均无统计学意义(均P>0.05)。会阴BF组患者的临床有效率81.13%(43/53),与阴道BF组有效率为83.87%(26/31)比较差异无统计学意义(χ^2=0.10,P=0.750);但阴道BF组患者的不良反应发生率(7/34、20.59%)显著高于会阴BF组(1/53、1.89%)(χ^2=8.68,P=0.003),治疗中的舒适度(VAS)评分(8.11±2.93)分也显著低于经会阴治疗组(9.88±2.48)分(t=2.95,P=0.004)。经阴道治疗组患者不良反应主要包括疼痛或不适、阴道出血和阴道分泌物增多。结论经会阴表面肌电位的生物反馈方法在治疗老年女性压力性尿失禁方面同阴道内BF方法有类似的临床疗效,且治疗不良反应显著减少。
Objective To explore the therapeutic effects of biofeedback therapy of perineal surface on stress urinary incontinence(SUI)in elderly women.Methods A total of 87 elderly women with SUI treated at the outpatient clinics of Beijing Hospital and Yunnan First People's Hospital between January 2018 and December 2019 were recruited in this prospective cohort study.All participants were therapeutically divided into the perineal BF group(n=53)and the intravaginal BF group(n=34),based on the voluntary selection.In the intravaginal BF group,3/34 cases dropped out of the study,and finally in 31 cases the treatment was completed.All patients were treated with biofeedback for 8 weeks with twice treatment per week.The quality of life was assessed by the incontinence impact questionnaire scores.Patients underwent the 1-hour pad-weighing test,pelvic floor muscle assessment and quality of life assessment by incontinence impact questionnaire(ⅡQ-7)scores before and after treatment.The effective rate of treatment,adverse reactions and treatment satisfaction scores were compared between the two groups.Results The urine leakage and scores ofⅡQ-7 questionnaire were significantly improved after versus before 8 weeks of treatment in the perineal BF group[(4.65±2.33)g vs.(11.02±4.85)g,(7.96±5.11)scores vs.(4.34±2.66)scores,t=8.62 and 4.58,P<0.001],and in the intravaginal BF group[(3.85±1.89)g vs.(12.43±3.96)g,(3.81±1.23)scores vs.(8.29±5.01)scores,t=10.89 and 4.84,P<0.001].Compared with before treatment,the grading of pelvic floor muscle strength was improved after treatment,but had no significant difference in the perineal BF group(3.93±2.77 vs.2.98±2.10,t=1.99,P=0.056)and in the intravaginal BF group(4.51±3.38 vs.3.07±2.02,t=2.04,P=0.051).There was no significant difference in the urine leakage,grading of pelvic floor muscle strength and scores ofⅡQ-7 questionnaire between two groups(P>0.05).The effective rate of treatment had no significant difference between the perineal and intravaginal BF groups(81.13%or 43/53 vs.83.87%or 26/31,χ^2=0.10,P=0.750).The incidences of adverse effects were higher(20.59%or 7/34 vs.1.89%or 1/53,χ^2=8.68,P=0.003)and the comfort levels during treatment assessed by visual analog scale(VAS)scores were lower in the intravaginal BF group than in the perineal BF group[(8.11±2.93)scores vs.(9.88±3.84)scores,t=2.95,P=0.004].The main adverse effects included pain or discomfort,vaginal bleeding and increased vaginal discharge in the intrasvaginal BF treatment group.Conclusions The perineal BF method is as effective as intravaginal BF in female stress urinary incontinencetreatmentin elderly women,and has fewer adverse effects.
作者
李旻
吴晓梅
吕秋波
改天姿
冯庆
吕爱明
邓文慧
Li Min;Wu Xiaomei;Lyu Qiubo;Gai Tianzi;Feng Qing;Lyu Aiming;Deng Wenhui(Department of Obstetrics and Gynecology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Gynecology,the First People's Hospital in Yunnan Province,Affiliated Hospital of Kunming University of Science and Technology,Kunming 650032,China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2020年第7期829-833,共5页
Chinese Journal of Geriatrics
基金
北京医院临床研究121项目(BJ-2018-204)。
关键词
尿失禁
压力性
物理疗法
生活质量
Urinary incontinence,stress
Physical therapy
Quality of life
