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目的探讨盆底肌肉训练(muscle exercise,ME)和电刺激(electrical stimulation,ES)单用或联合应用在改善产后压力性尿失禁中的效果。方法选择2012年1月—2015年6月76例轻中度产后压力性尿失禁患者,依据保守治疗措施分为4组:对照组盆底肌肉训练组(ME组)、盆底电刺激组(ES组)、盆底肌肉训练联合电刺激组(ME+ES组)各19例。比较各组治疗前后国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)评分、1 h尿垫试验尿垫增重量和尿动力学指标。计量资料比较采用方差分析和配对t检验,计数资料比较采用χ2检验,P<0.05为差异有统计学意义。结果治疗后ME组、ES组、ME+ES组和对照组ICI-Q-SF评分分别为(11.5±1.4)、(10.8±1.7)、(7.6±1.5)和(16.7±1.8)分,比较差异有统计学意义(P<0.05)。各观察组治疗后1 h尿垫试验尿垫增重量均较治疗前明显降低,差异均有统计学意义(均P<0.05);ME+ES组治疗后1 h尿垫试验尿垫增重量低于ME组、ES组和对照组,差异均有统计学意义(均P<0.05)。各观察组治疗后valsalva漏尿点压(valsalva leak point pressture,VLPP)、最大尿道压(maximal urethral pressure,MUP)、最大尿道闭合压(maximum urethral closure pressure,MUCP)均较治疗前明显提高,差异均有统计学意义(均P<0.05);其中ME+ES组治疗后VLPP、MUP和MUCP指标均高于ME组、ES组和对照组治疗后,组间比较差异均有统计学意义(均P<0.05)。结论综合利用保守治疗措施更有利于产后压力性尿失禁患者ICI-Q-SF评分、1 h尿垫试验尿垫增重量和尿动力学等指标的改善。
Objective To explore the effect of pelvic floor muscle exercise (ME) and electrical stimulation (ES) on the improvement of postpartum stress urinary incontinence. Methods From January 2012 to June 2015, 76 patients with mild-to-moderate postpartum stress urinary incontinence were divided into 4 groups according to conservative treatment: control group pelvic floor muscle training group (ME group), pelvic floor electrical stimulation group ES group), pelvic floor muscle training combined with electrical stimulation group (ME + ES group) 19 cases. The scores of ICI-Q-SF before and after treatment were compared between the two groups. The weight of urinary pad and urodynamic parameters of urine pad in 1 h urine pad test were compared. Measurement data were compared using analysis of variance and paired t test, count data were compared using χ2 test, P <0.05 for the difference was statistically significant. Results The ICI-Q-SF scores of ME group, ES group, ME + ES group and control group after treatment were 11.5 ± 1.4, 10.8 ± 1.7, 7.6 ± 1.5 and 16.7 ± 1.8, respectively The difference was statistically significant (P <0.05). The weights of the pad in each observation group were significantly lower than those before treatment (all P <0.05), and the weight gain of the pad in the ME + ES group was lower In ME group, ES group and control group, the differences were statistically significant (all P <0.05). The valsalva VLP, MUP, and maximum urethral closure pressure (MUCP) in each observation group were significantly higher than those before treatment, the differences (All P <0.05). The indexes of VLPP, MUP and MUCP in ME + ES group were higher than those in ME group, and there was significant difference between ES group and control group after treatment P <0.05). Conclusion Comprehensive utilization of conservative treatment measures is more conducive to postpartum stress urinary incontinence in patients with ICI-Q-SF score, 1h urine pad test urine pad weight and urodynamic improved indicators.