摘要
目的探讨产后盆底功能障碍性疾病患者神经肌肉电刺激的同时行主动功能训练对盆底肌力、盆腔脏器脱垂及腹直肌分离的改善作用。方法2023年5月—2024年5月新乡市中心医院行康复治疗的初产产后盆底功能障碍性疾病患者140例,70例行神经肌肉电刺激治疗者为对照组,70例神经肌肉电刺激治疗的同时行主动功能训练者为观察组,均1周治疗2次,10次为1个疗程。记录2组治疗1个疗程后盆底Ⅰ类肌和Ⅱ类肌肌力正常率;比较2组治疗前与治疗1个疗程后阴道总长度,阴道前壁Aa、Ba,后壁Ap、Bp,C点至处女膜缘距离,腹直肌分离程度。结果观察组治疗后盆底Ⅰ类肌、Ⅱ类肌肌力正常率(90.0%、90.0%)均高于对照组(62.9%、74.3%)(χ^(2)=7.755,P=0.005;χ^(2)=5.892,P=0.015)。观察组、对照组治疗前阴道总长度[(7.30±0.54)、(7.43±0.44)cm]及Aa[(0.80±0.69)、(0.96±0.62)cm]、Ba[(0.80±0.69)、(0.96±0.62)cm]、Ap[(1.58±0.58)、(1.65±0.66)cm]、Bp[(1.58±0.58)、(1.65±0.66)cm]、C点至处女膜缘距离[(4.37±0.68)、(4.08±1.73)cm]、腹直肌分离距离[(4.45±0.99)、(4.46±1.13)cm]比较差异均无统计学意义(t=0.518~1.554,P均>0.05)。观察组、对照组治疗后Aa[(1.77±0.48)、(1.60±0.49)cm]、Ba[(1.77±0.48)、(1.60±0.49)cm]、Ap[(2.25±0.39)、(2.14±0.46)cm]、Bp[(2.25±0.39)、(2.14±0.46)cm]、C点[(1.56±0.63)、(4.19±1.71)cm]至处女膜缘距离均大于治疗前(t=2.984~19.837,P均<0.05),腹直肌分离距离[(2.21±0.58)、(2.65±0.61)cm]均小于治疗前(t=21.986、11.743,P均<0.05),阴道总长度[(7.32±0.51)、(7.45±0.43)cm]与治疗前比较差异均无统计学意义(t=1.653、1.758,P均>0.05)。观察组治疗后Aa、Ba、Ap、Bp、C点至处女膜缘距离均大于对照组(t=1.610~2.080,P均<0.05),腹直肌分离距离小于对照组(t=4.361,P<0.001),阴道总长度与对照组比较差异无统计学意义(t=1.546,P=0.124)。结论产后盆底功能障碍性疾病患者在神经肌肉电刺激的同时辅助主动功能训练可增加盆底肌肌力,改善盆腔脏器脱垂及腹直肌分离,促进产后康复。
Objective To investigate the efficacy of neuromuscular electrical stimulation combined with active functional training on improving pelvic floor muscle strength,pelvic organ prolapse and diastasis recti abdominis in postpartum patients with pelvic floor dysfunction.Methods From May 2023 to May 2024,140 primiparous patients with pelvic floor dysfunction received postpartum rehabilitation therapy in Xinxiang Central Hospital,among whom 70patients received neuromuscular electrical stimulation(the control group)and 70patients received neuromuscular electrical stimulation combined with active functional training(the observation group),twice a week,with 10times as a course.The normal rates of muscle strength of typeⅠandⅡpelvic floor muscles after one course of treatment were recorded in two groups.The total vagina length,distances from point Aa and Ba of the anterior vaginal wall,point Ap and Bp of the posterior vaginal wall,and point C to the hymen margin,and the degree of diastasis recti abdominis were compared before treatment and after one course of treatment between two groups.Results The normal muscle strength rates of typeⅠandⅡpelvic floor muscles after treatment were higher in the observation group(90.0%,90.0%)than those in the control group(62.9%,74.3%)(χ^(2)=7.755,P=0.005;χ^(2)=5.892,P=0.015).There were no significant differences in the total vagina length[(7.30±0.54)cmvs(7.43±0.44)cm],distances from point Aa[(0.80±0.69)cmvs(0.96±0.62)cm],Ba[(0.80±0.69)cmvs(0.96±0.62)cm],Ap[(1.58±0.58)cmvs(1.65±0.66)cm],Bp[(1.58±0.58)cmvs(1.65±0.66)cm]and C[(4.37±0.68)cmvs(4.08±1.73)cm]to the hymen margin,and distance of diastasis recti abdominis[(4.45±0.99)cmvs(4.46±1.13)cm]between the observation and control groups before treatment(t=0.518-1.554,all P values>0.05).The distances from point Aa[(1.77±0.48),(1.60±0.49)cm],Ba[(1.77±0.48),(1.60±0.49)cm],Ap[(2.25±0.39),(2.14±0.46)cm],Bp[(2.25±0.39),(2.14±0.46)cm]and C[(1.56±0.63),(4.19±1.71)cm]to the hymen margin in the observation and control groups were longer after treatment than those before treatment(t=2.984-19.837,all P values<0.05),the distances of diastasis recti abdominis[(2.21±0.58),(2.65±0.61)cm]were shorter after treatment than those before treatment(t=21.986,11.743;all Pvalues<0.05),and there were no significant differences in the total vagina lengths in both groups after treatment[(7.32±0.51),(7.45±0.43)cm]than those before treatment(t=1.653,1.758;all Pvalues>0.05).After treatment,the distances from point Aa,Ba,Ap,Bp and C to the hymen margin were longer in the observation group than those in the control group(t=1.610-2.080,all Pvalues<0.05),the distance of diastasis recti abdominis was shorter in the observation group than that in the control group(t=4.361,P<0.001),and the total vagina length showed no significant difference between two groups(t=1.546,P=0.124).Conclusion Neuromuscular electrical stimulation combined with active functional training can improve pelvic floor muscle strength,relieve pelvic organ prolapse and diastasis recti abdominis,and promote postpartum rehabilitation in patients with postpartum pelvic floor dysfunction.
作者
郭祥翠
李若冰
王漪琳
李力
许鑫铭
王倩青
孙秀丽
GUO Xiangcui;LI Ruobing;WANG Yilin;LI Li;XU Xinming;WANG Qianqing;SUN Xiuli(Department of Gynecology,Xinriang Central Hospital,the Fourth Clinical College of Xinziang Medical University,Xinziang Key Laboratory for Minimally Invasive Treatment of Pelvic Floor Diseases,Xinriang,Henan 453000,China;Department of Gynecology and Obstetrics,Peking University People's Hospital,Beijing 100044,China)
出处
《中华实用诊断与治疗杂志》
2025年第1期56-60,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划项目(LHGJ20230880)。
关键词
产后盆底功能障碍性疾病
神经肌肉电刺激
主动功能训练
产后康复
postpartum pelvic floor dysfunction
neuromuscular electrical stimulation
active functional training
postpartum rehabilitation
