CAJ | 학술논문

目的观察不同分娩方式产后女性盆底肌力通过电刺激联合生物反馈治疗前后的变化、治疗效果，探索其变化机制。方法选取产后42 d复诊时经筛查发现存在重度盆底肌力减退的产妇130例，其中顺产70例、剖宫产60例。顺产组及剖宫产组受试者用数字法随机分为研究组及对照组。接受电刺激联合生物反馈治疗者为研究组，对照组在家中自行缩肛提肛运动康复训练。产后42 d用PHENIX检测仪量化评估盆底肌力后，采用电刺激联合生物反馈治疗16次，在产后3个月、6个月及12个月再次检测产妇盆底肌力情况。结果顺产组和剖宫产组重度盆底肌力减退患者Ⅰ类肌力和Ⅱ类肌力评分在治疗后均较治疗前（产后42 d）有显著增高，差异有统计学意义（P＜0.01）。经阴道分娩组和剖宫产组比较，治疗前盆底肌力评分差异无统计学意义(P＞0.05)；治疗后，产后3个月两组Ⅰ、Ⅱ类肌力评分差异无统计学意义（P＞0.05），产后6个月及12个月顺产组的Ⅰ、Ⅱ类肌力评分均高于剖宫产组，差异有统计学意义（P＜0.05）。研究组产后3个月、6个月和12个月的Ⅰ、Ⅱ类肌力评分均显著高于对照组，差异有统计学意义（P＜0.05）。结论电刺激联合生物反馈治疗重度盆底肌力减退疗效显著，不同分娩方式对产后早期盆底肌力均有影响，盆底肌电刺激康复治疗对产后女性健康具有重要的临床意义。
목적관찰불동분면방식산후녀성분저기력통과전자격연합생물반궤치료전후적변화、치료효과，탐색기변화궤제。방법선취산후42 d복진시경사사발현존재중도분저기력감퇴적산부130례，기중순산70례、부궁산60례。순산조급부궁산조수시자용수자법수궤분위연구조급대조조。접수전자격연합생물반궤치료자위연구조，대조조재가중자행축항제항운동강복훈련。산후42 d용PHENIX검측의양화평고분저기력후，채용전자격연합생물반궤치료16차，재산후3개월、6개월급12개월재차검측산부분저기력정황。결과순산조화부궁산조중도분저기력감퇴환자Ⅰ류기력화Ⅱ류기력평분재치료후균교치료전（산후42 d）유현저증고，차이유통계학의의（P＜0.01）。경음도분면조화부궁산조비교，치료전분저기력평분차이무통계학의의(P＞0.05)；치료후，산후3개월량조Ⅰ、Ⅱ류기력평분차이무통계학의의（P＞0.05），산후6개월급12개월순산조적Ⅰ、Ⅱ류기력평분균고우부궁산조，차이유통계학의의（P＜0.05）。연구조산후3개월、6개월화12개월적Ⅰ、Ⅱ류기력평분균현저고우대조조，차이유통계학의의（P＜0.05）。결론전자격연합생물반궤치료중도분저기력감퇴료효현저，불동분면방식대산후조기분저기력균유영향，분저기전자격강복치료대산후녀성건강구유중요적림상의의。
Objectives To evaluate the therapeutic effectiveness of biofeedback combined with electrical stimulation on severe postpartum pelvic floor dysfunction after vaginal delivery or cesarean section. Methods 130 cases of severe pelvic floor dysfunction diagnosed at 42 days postpartum visit were selected to accept ten times therapy of biofeedback combined with electrical stimulation,including 70 cases of vaginal birth and 60 cases of cesarean section. Quantitative reassessment of the maternal pelvic lfoor muscle strength of type Ⅰ and type Ⅱ were done using the PHENIX tester at 3 months and 6 months postpartum. Results Regardless of vaginal delivery or cesarean section,typeⅠand typeⅡsevere pelvic lfoor muscle strength decline in patients increased signiifcantly after one therapy procedure of biofeedback combined with electrical stimulation(P<0.01),type Ⅰand type Ⅱ of pelvic lfoor muscle strength continued to increase in vaginal birth group at 3 months and 6 monthes, otherwise, compared to the 3 months and 6 months,type Ⅰ muscle strength remained, while the class Ⅱ strength decreased slightly in cesarean section group. Conclusions Biofeedback electrical stimulation in treatment of severe pelvic lfoor dysfunction may have obvious curative effect. More therapy procedures should be needed in severe postpartum pelvic lfoor dysfunction patients after cesarean section.