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目的探讨仿生物电刺激技术、生物反馈及Kegel锻炼等康复技术对盆底肌肉功能恢复及改善盆腔营养的作用及其对复杂性外阴阴道假丝酵母菌病(RVVC)和复发性细菌性阴道病(RBV)的治疗效果。方法选择2014年1月至2015年7月淮安市妇幼保健院121例RVVC和RBV病例,随机分为对照组和观察组。对照组,RVVC:咪康唑栓剂阴道给药,1粒/晚,共7~14 d,首次口服氟康唑150 mg,72 h加服1次;维持治疗药物:克霉唑栓剂或氟康唑1次/周,连用6个月或者伊曲康唑400 mg,1次/月或100 mg,1次/周,共6个月;根据检查结果选择其中1种。RBV:甲硝唑、替硝唑或克林霉素口服,甲硝唑栓阴道用药,每晚1次,或2%克林霉素软膏涂擦,共7 d。观察组在阴道炎症非急性期给予盆底仿生物电刺激、生物反馈和Kegel锻炼。观察经盆底康复治疗1年内阴道炎复发的情况。结果盆底肌功能治疗前Ⅰ类肌肌力4、5级者4例,Ⅱ类肌肌力4、5级者8例;治疗后Ⅰ类肌肌力达4、5级者59例,Ⅱ类肌肌力达4、5级者60例(P<0.001);治疗前阴道前壁脱垂53例,治疗后阴道前壁脱垂49例(P=0.328),治疗前阴道后壁脱垂25例,治疗后阴道前壁脱垂11例(P=0.005),治疗前子宫脱垂14例,治疗后子宫脱垂2例(P=0.002);与单纯药物治疗相比较盆底康复治疗后随访1年阴道炎复发率显著降低,61例阴道炎患者,治疗后只有2例复发(P<0.05)。结论盆底康复治疗明显提高盆底功能,显著恢复妊娠和分娩对阴道结构造成的松弛和脱垂。与单纯药物治疗相比,盆底康复治疗明显降低RVVC和RBV复发率。
Objective To investigate the effects of biomimetic electrical stimulation, biofeedback and Kegel exercises on pelvic floor muscle function recovery and pelvic nutrition improvement and its effect on complex vulvovaginal candidiasis (RVVC) and recurrent bacterial vaginosis (RBV) treatment. Methods From January 2014 to July 2015, 121 RVVC and RBV cases from Huaian MCH hospital were randomly divided into control group and observation group. Control group, RVVC: miconazole suppository vaginal administration, a / night, a total of 7 to 14 days, the first oral fluconazole 150 mg, 72 h plus 1 time; maintenance treatment drugs: clotrimazole suppository or fluconazole Azoles 1 / week, once every 6 months or itraconazole 400 mg, 1 times / month or 100 mg, 1 time / week, a total of 6 months; according to the test results to choose one of them. RBV: metronidazole, tinidazole or clindamycin oral, metronidazole suppository vaginal medication, 1 night, or 2% clindamycin ointment rubbed a total of 7 d. The observation group was given pelvic floor bioelectrical stimulation, biofeedback and Kegel exercise in non-acute period of vaginal inflammation. To observe the recurrence of vaginitis within one year after pelvic floor rehabilitation. Results pelvic floor muscle function before treatment Ⅰ 4,5 muscular strength in class 4 in 4 cases, class Ⅱ muscular strength in 4,5 cases in 8 cases; class Ⅰ muscular strength up to class 4,5 in 59 cases, Ⅱ There were 60 cases with muscular strength up to grade 4 and grade 5 (P <0.001), 53 cases with anterior vaginal prolapse before treatment, 49 cases with anterior vaginal wall prolapse (P = 0.328), and posterior vaginal wall prolapse (P = 0.005), 14 cases of uterine prolapse before treatment and 2 cases of uterine prolapse after treatment (P = 0.002). Compared with the simple drug treatment, pelvic floor repair One year follow-up of vaginitis recurrence rate was significantly lower, 61 cases of vaginitis patients, after treatment, only 2 cases of recurrence (P <0.05). Conclusion pelvic floor rehabilitation significantly improve pelvic floor function, significantly restored pregnancy and childbirth on vaginal structure caused by relaxation and prolapse. Pelvic floor rehabilitation significantly reduced the recurrence rate of RVVC and RBV compared with pure drug treatment.