盆底肌训练联合神经肌电刺激治疗盆腔脏器脱垂的临床疗效

目的探讨盆底肌训练(PFMT)联合神经肌电刺激(NMES)治疗，对盆腔脏器脱垂(POP)患者的临床疗效。 方法选择2015年6月至2018年4月，于徐州市中心医院接受治疗的150例POP患者为研究对象。采用随机数字表法，将其分为观察组(n＝80)及对照组(n＝70)。对观察组患者采用PFMT联合NMES治疗，对照组患者仅采用PFMT治疗。采用《盆腔脏器脱垂/尿失禁性生活质量问卷(PISQ)-12》，评价患者性生活质量；采用《SF-36健康调查量表》，评价患者生活质量(QoL)；采用神经肌电刺激治疗仪，评估患者盆底肌力；采用《汉密顿焦虑量表》(HAMA)及《汉密顿抑郁量表》(HAMD)，评估患者焦虑及抑郁情况；采用腹部超声检查，评估患者POP程度。采用t检验或χ²检验，对2组POP患者治疗前及治疗1年时的上述相关指标，进行组内或组间比较。本研究遵循的程序经徐州市中心医院伦理委员会批准(审批文号：20150056)，与所有受试者签署知情同意书。 结果①性生活质量比较：观察组中经治疗后有性生活的POP患者治疗1年时PISQ-12评分为(24.5±8.0)分，显著高于其治疗前的(19.7±8.2)分，亦显著高于对照组中经治疗后有性生活的POP患者治疗1年时的(20.6±7.1)分，并且差异均有统计学意义(t＝8.326、P＝0.037，t＝7.422、P＝0.042)。②生活质量比较：治疗1年时，观察组POP患者生理功能(PF)、生理职能(RP)、躯体疼痛(BP)、总体健康(GH)、生理健康总评(PCS)、活力(VT)、社会功能(SF)、情感职能(RE)、精神健康(MH)、心理健康总评(MCS)分值分别为(88.0±13.4)分、(91.9±22.6)分、(98.4±22.6)分、(88.1±9.5)分、(90.8±21.7)分、(92.1±19.6)分、(91.6±18.5)分、(92.1±21.6)分、(91.2±27.4)分、(91.9±14.5)分，均显著高于对照组POP患者的(71.6±8.5)分、(76.9±9.5)分、(73.8±12.1)分、(69.4±8.6)分、(79.1±10.3)分、(76.8±10.4)分、(75.5±11.7)分、(78.6±9.5)分、(75.2±11.6)分、(80.1±7.3)分，并且差异均有统计学差异(t＝8.805、9.537、8.643、10.335、8.036、8.605、9.060、8.254、8.814、8.541，均为P<0.001)。③盆底肌力比较：治疗1年时，观察组POP患者盆底肌力为Ⅲ级＋Ⅳ级＋Ⅴ级所占比例为90.0%，显著高于对照组的44.3%，并且差异有统计学意义(χ²＝12.652，P＝0.011)。④焦虑及抑郁情况比较：治疗1年时，观察组POP患者HAMA、HAMD评分分别为(7.4±2.1)分、(8.1±3.1)分，均显著低于对照组的(10.3±2.3)分、(10.1±3.1)分，并且差异均有统计学意义(t＝5.170、P＝0.041，t＝5.352、P＝0.039)。⑤POP程度比较：治疗1年时，观察组POP患者膀胱颈及宫颈外口距基线的距离分别为(0.71±0.62) cm、(1.5±0.8) cm，均显著长于对照组患者的(0.14±0.74) cm、(1.1±0.6) cm；肛提肌裂孔面积为(18.2±2.8) cm²，显著小于对照组的(22.5±4.9) cm²，并且差异均有统计学意义(t＝3.275、P＝0.039，t＝3.073、P＝0.046，t＝3.770、P＝0.043)。 结论采用PFMT联合NMES治疗，可使POP患者性生活质量改善、生活质量及盆底肌力提高，POP严重程度下降，而且焦虑、抑郁情绪缓解。

Effects of pelvic floor muscle training combined with neuromuscular electrical stimulation in treatment of pelvic organ prolapse

Objective To investigate the clinical effect of pelvic floor muscle training(PFMT)combined with neuromuscular electrical stimulation(NMES)on patients with pelvic organ prolapse(POP).Methods A total of 150 patients with POP who were treated in Xuzhou Central Hospital from June 2015 to April 2018,were chosen as research subjects.They were divided into observation group(n=80)and control group(n=70)according to random digits table method.Patients in observation group were treated with PFMT combined with NMES,while patients in control group were only treated with PFMT.Quality of sexual life was evaluated by Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form(PISQ)-12.Quality of life(QoL)of patients was evaluated by Mos 36-Item Short form Health Survey.The pelvic floor muscle strength of patients was evaluated by neuromuscular stimulation therapy apparatus.The anxiety and depression of patients were evaluated by Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD).The degree of POP of patients was evaluated by abdominal ultrasonography.The related indexes above mentioned before treatment and until one year of treatment of POP patients were compared intra-group or inter-group by t test or chi-square test.The study was carried out with the approval of Ethics Committee of Xuzhou Central Hospital(Approval No.20150056).All patients had informed consent to the study.Results①Comparison of quality of sexual life:PISQ-12 score of POP patients who had sexual life after treatment in observation group until one year of treatment was(24.5±8.0)scores,which was higher than that of(19.7±8.2)sores before treatment in observation group who had sexual life after treatment,also higher than that of(20.6±7.1)sores of POP patients in control group until one year of treatment,and the difference was statistically significant(t=8.326,P=0.037;t=7.422,P=0.042).②Comparison of QoL:the score of physiological function(PF),role physiological(RP),bodily pain(BP),general health(GH),physical component summary(PCS),vitality(VT),social functioning(SF),role emotional(RE),mental health(MH)and mental component summary(MCS)of POP patients in observation group until one year of treatment were(88.0±13.4)scores,(91.9±22.6)scores,(98.4±22.6)scores,(88.1±9.5)scores,(90.8±21.7)scores,(92.1±19.6)scores,(91.6±18.5)scores,(92.1±21.6)scores,(91.2±27.4)scores and(91.9±14.5)scores,which were higher than those of(71.6±8.5)scores,(76.9±9.5)scores,(73.8±12.1)scores,(69.4±8.6)scores,(79.1±10.3)scores,(76.8±10.4)scores,(75.5±11.7)scores,(78.6±9.5)scores,(75.2±11.6)scores and(80.1±7.3)scores in control group until one year of treatment,and the differences were statistically significant(t=8.805,9.537,8.643,10.335,8.036,8.605,9.060,8.254,8.814,8.541,all P<0.001).③Comparison of pelvic floor muscle strength:the proportion of grades of pelvic floor muscle strength ofⅢ+Ⅳ+Ⅴof POP patients in observation group until one year of treatment was 90.0%,which was higher than that of 44.3%in control group until one year of treatment,and the difference was statistically significant(χ2=12.652,P=0.011).④Comparison of anxiety and depression conditions:the score of HAMA and HAMD of POP patients in observation group until one year of treatment were(7.4±2.1)scores,(8.1±3.1)scores,which were lower than those of(10.3±2.3)scores,(10.1±3.1)scores in control group until one year of treatment,and the differences were statistically significant(t=5.170,P=0.041;t=5.352,P=0.039).⑤Comparison of degree of POP:the distance from bladder neck to baseline and from cervix to baseline of POP patients in observation group until one year of treatment were(0.71±0.62)cm,(1.5±0.8)cm,which were longer than those of(0.14±0.74)cm,(1.1±0.6)cm in control group until one year of treatment;the hiatus area of levator ani muscle of POP patients in observation group was(18.2±2.8)cm^2,which was less than that of(22.5±4.9)cm^2 in control group,and all the differences above were statistically significant(t=3.275,P=0.039;t=3.073,P=0.046;t=3.770,P=0.043).Conclusions PFMT combined with NMES for treatment of POP can improve the quality of sexual life,QoL and pelvic floor muscle strength of patients,also reduce the severity degree of POP,and relieve anxiety and depression.