不同治疗方式对产后压力性尿失禁的疗效评估

目的:探究不同方法治疗产后压力性尿失禁(stress urinary incontinence,SUI)的临床疗效,并分析其相关的产科影响因素,为该病的预防和治疗提供相关的依据。方法:选取2015年1月至2016年1月在汉川市人民医院于产后42天返院行盆底功能筛查时诊断为产后SUI同时符合纳入标准的初产妇103例,并将其按患者的意愿分为3个治疗组,随访观察组(I组)有30例患者,盆底肌锻炼组(II组)有35例患者,生物反馈联合电刺激治疗组(III组)有38例患者。分别治疗8周后,通过国际尿失禁咨询委员会尿失禁问卷表(ICI-Q-SF)问卷调查、尿垫试验及盆底肌力测定进行疗效评价,并分析生物反馈联合电刺激疗效的影响因素。结果:治疗前,三组间盆底肌力无显著性差异(P0.05);治疗后,三组间两两比较均有显著性差异(P0.05)。治愈率而言,III组与II组和I组比较,差异有统计学意义(P0.05)。单因素分析显示:孕期体重增加量与产后SUI严重程度和抑郁评分对生物反馈联合电刺激治疗疗效显著相关(P0.05),而年龄、产前BMI、新生儿出生体重等对治疗疗效无显著相关性(P0.05)。多因素非条件Logistic回归分析显示:孕期体重增加量与产后SUI严重程度是影响生物反馈联合电刺激治疗疗效的独立因素。结论:电刺激联合生物反馈治疗对产后SUI的疗效与单纯盆底肌锻炼治疗和单纯随访观察相比具有明显的优势,可作为临床治疗产后SUI的首选方案。影响其疗效的主要因素为孕期体重增加量与产后SUI严重程度,故控制孕期体重可能会促进电刺激对产后SUI的疗效。

Curative Effect of Different Treatment Methods on PostpartumStress Urinary Incontinence

Objective:To explore the therapeutic effect of different treatment methods on postpartum stress urinary incontinence (SUI), and investigate the influencing factors of the treatment above, so as to provide evidence for the prevention and treatment of postpartum SUI.Methods:103 primiparas diagnosed with postpartum SUI when they came back to Hanchuan City People''s Hospital for pelvic floor function examination on the day 42 postpartumfrom January 2015 to January 2016 were assigned for three treatment groups, with 30 patients in following-up group (Group I), 35 patients in PFMexercising group (Group II), 38 patients in biofeedback combined with electrical stimulation group (Group III), respectively. After 8 weeks of treatment, International Advisory Committee on Urinary Incontinence Questionnaire table (ICI-Q-SF), urine pad test and measurements of pelvic floor muscle strength were conducted to evaluate the efficacy of the three treatment methods, and the influencing factors of curative effect of biological feedback combined with electrical stimulation were analyzed.Results:There were significant differences of pelvic floor muscle strength and the cure rate after treatment among the three groups (P<0.05). Single factor analysis showed that the effect of biofeedback combined with electrical stimulation therapy related to weight increase during pregnancy, the severity of postpartum SUI and depression scores. Further multivariate non-conditional Logistic regression analysis showed that weight gain during pregnancy and the severity of postpartum SUI were independent factors combined with the efficacy of the treatment above.Conclusion:Electrical stimulation combined with biofeedback therapy has obvious advantages compared with simple PFMexercising and following-up observation. It is possible that control the weight during pregnancy may have a certain role in increasing the efficacy of electrical stimulation.