妊娠中晚期压力性尿失禁的超声特点及压力性尿失禁盆底康复治疗的疗效评估

发布时间：2018-06-08 17:54

本文选题：盆底二维超声 + 中晚期妊娠　；参考：《广州医科大学》2017年硕士论文

【摘要】：第一部分:中晚期妊娠孕妇盆底二维超声特点与压力性尿失禁的相关性目的本研究旨在比较妊娠中、晚期孕妇经会阴盆底二维超声的表现特点,为研究妊娠与压力性尿失禁之间的关系提供影像学依据。方法对2013年5月至2016年6月在广州医科大学附属第一医院妇产科接受常规产前检查,孕龄为14-40周的74例中晚期单胎妊娠孕妇为研究对象,采用尿失禁(简表7),纳入标准为:孕期有无在打喷嚏、大笑或提重物时出现不自主尿液漏出,出现次数至少3次,将其分为尿失禁组(34例)和无尿失禁组(40例)。所有受检者均接受静息状态和最大Valsalva动作时的经会阴盆底二维超声检查,比较观察中晚期妊娠孕妇盆底二维超声的表现特点。观察指标有:膀胱颈角度(βr、βs)、膀胱颈旋转角度(△β)、膀胱颈活动度(BND)、膀胱尿道后角(θr、θs)、尿道旋转角度(△ɑ)。对中晚期妊娠尿失禁组和无尿失禁组的各项观察指标进行比较分析,进行独立样本t检验、偏相关分析。PO.05认为有统计学意义。两组受检者的年龄、BMI、孕周、产次等基本资料比较,差异均无统计学意义(P0.05)。所有受检者均签署知情同意书。结果1、34例中晚期妊娠尿失禁组孕妇中,在早期妊娠就开始发生SUI的有5例(14.7%),在中期妊娠就开始发生SUI的有20例(58.8%),在晚期妊娠开始发生SUI的有9例(26.5%)。2、中晚期妊娠尿失禁组的膀胱颈旋转角度、膀胱颈活动度以及最大Valsalva动作时的膀胱颈角度、膀胱尿道后角均大于无尿失禁组,(t值分别=3.18、3.138、2.765、3.401),其差异均有统计学意义,P值均0.05。中晚期妊娠尿失禁组的尿道旋转角度以及静息状态时的膀胱颈角度、膀胱尿道后角亦大于无尿失禁组,(t值分别=1.602、0.859、1.711),差异无统计学意义,P值均0.05。3、中晚期妊娠尿失禁组的尿道旋转角度与孕周呈中度相关,偏相关系数=0.378(P0.05),有统计学意义。结论患有SUI的中晚期妊娠孕妇膀胱尿道周围支持结构有明显改变。会阴盆底二维超声的膀胱颈旋转角度、膀胱颈活动度以及最大Valsalva动作时的膀胱颈角度、膀胱尿道后角对中晚期妊娠孕妇SUI的诊断具有一定的参考价值。妊娠期行会阴盆底超声安全可行。第二部分:轻、中度压力性尿失禁盆底康复治疗的疗效评估目的本研究旨在探讨电刺激+生物反馈治疗联合kegel训练对女性轻、中度压力性尿失禁患者盆底功能的康复疗效。方法对2013年5月至2016年6月在广州医科大学附属第一医院妇产科门诊就诊的78例轻、中度压力性尿失禁患者为研究对象。将患者随机分成2组,治疗组(39例)进行电刺激+生物反馈+kegel训练,对照组(39例)进行单纯kegel训练。通过问卷调查、盆底肌力测定、尿流率检查、护垫试验、会阴盆底二维超声检查比较轻、中度SUI患者电刺激+生物反馈+kegel训练和单纯kegel训练在治疗前、治疗后3个月、6个月的疗效。应用SPSS 19.0统计软件,对定量资料,组间比较采用独立样本t检验;组内比较采用配对样本t检验,结果用(?)±s表示。定性资料采用Х2检验和秩和检验进行分析。P0.05为差异有统计学意义。所有受检者均签署知情同意书。结果1、治疗组和对照组患者治疗前与治疗后3个月、6个月的比较,问卷评分较治疗前均减少,生活质量较治疗前均有改善,差异均有统计学意义(P0.01)。2、治疗组和对照组治疗前与治疗后3个月、治疗后6个月比较,肌力较治疗前增加,差异均有统计学意义,(P0.05)。对照组治疗后6个月比治疗后3个月肌力较前改善,差异有统计学意义,(P0.05)。3、治疗组和对照组治疗前、治疗后3个月、治疗后6个月的峰值尿流率、平均尿流率和到达峰值尿流率时间比较,差异均无统计学意义,(P0.05)。4、治疗组中治疗前与治疗后6个月比较,护垫试验的漏尿量较治疗前明显减少,差异有统计学意义,(P0.05)。对照组护垫试验的漏尿量治疗前与治疗后3个月、治疗后6个月比较,差异均无统计学意义,(P0.05)。5、组内比较,治疗组的尿道旋转角度、膀胱颈移动度、静息状态下膀胱尿道后角在治疗后3个月、治疗后6个月较治疗前均减小;治疗组Valsalva动作下膀胱尿道后角在治疗6个月后较治疗前减小,差异均有统计学意义,(P0.05)。对照组的尿道旋转角度在治疗后3个月、治疗后6个月较治疗前均减小;对照组静息状态下膀胱尿道后角在治疗6个月后较治疗前减小,差异均有统计学意义,(P0.05)。治疗组中,膀胱颈移动度、Valsalva动作下的膀胱尿道后角的治疗前后的改变,效果持续6个月,优于对照组。组间比较,治疗组与对照组的膀胱颈角度、膀胱颈旋转角度、膀胱颈移动度、膀胱尿道后角、尿道旋转角度分别在治疗前、治疗后3个月、治疗后6个月比较,差异均无统计学意义,(P0.05)。结论电刺激+生物反馈治疗联合kegel训练及单纯kegel训练均能改善膀胱尿道周围支持结构。电刺激+生物反馈治疗联合kegel训练,效果持续6个月,优于单纯kegel训练。
[Abstract]:The first part: the correlation between the two dimensional ultrasound characteristics of pelvic floor and stress urinary incontinence in pregnant women with middle and late pregnancy. The purpose of this study was to compare the characteristics of the pelvic floor two-dimensional ultrasound in the pregnant and late pregnant women, and to provide the imaging basis for the study of the relationship between pregnancy and stress urinary incontinence. Methods from May 2013 to June 2016 were in Guangzhou. The First Hospital Affiliated First Hospital of the medical university received routine prenatal examination, and 74 cases of middle and late single pregnancy pregnant women with 14-40 weeks of gestational age were studied. Urinary incontinence (Table 7) was adopted as the standard: unregulated urine leakage occurred during pregnancy during sneezing, laughter or weight lifting, at least 3 times, which was divided into urinary incontinence group (34 Cases (40 cases) and anuria group (40 cases). The two dimensional ultrasound examination of the pelvic floor in the rest of the patients received the resting state and the maximum movement of the perineal pelvic floor. The characteristics of the pelvic floor two-dimensional ultrasound in the middle and late pregnant women were compared. The observation indexes were the angle of the bladder neck (beta R, beta s), the rotation angle of the bladder neck (delta beta), the bladder neck activity (BND), cysturia. Posterior horn (theta R, theta s), urethral rotation angle (delta). Compare and analyze the observation indexes of urinary incontinence group and incontinence group in middle and late pregnancy group, independent sample t test, partial correlation analysis.PO.05 think there is statistical significance. There is no significant difference between the two groups of age, BMI, gestational week, and secondary production, P0 .05) all subjects signed informed consent. Results in the 1,34 cases of middle and late pregnancy urinary incontinence, there were 5 cases of SUI in early pregnancy (14.7%), 20 cases (58.8%) in the mid-term pregnancy, 9 cases (26.5%).2, and the angle of bladder neck rotation in middle and late pregnancy urinary incontinence group. The bladder neck movement and the bladder neck angle at the maximum Valsalva movement were greater than those in the anuria group (t value =3.18,3.138,2.765,3.401), and the difference was statistically significant. The P values were both the urethral rotation angle of the middle and late pregnancy urinary incontinence group and the bladder neck angle at resting state, and the posterior urethra posterior angle of the vesical urethra. More than no incontinence group, (t value =1.602,0.859,1.711), the difference was not statistically significant, the P value was 0.05.3. The urethral rotation angle of the middle and late pregnancy urinary incontinence group was moderately correlated with the gestational age, and the partial correlation coefficient =0.378 (P0.05) was statistically significant. Conclusion the support structure of the urinary bladder and urethra around the middle and late pregnant women with SUI has a significant change. The bladder neck rotation angle of the pelvic floor of the perineum, the activity of the bladder neck and the angle of the bladder neck at the maximum Valsalva movement, the posterior angle of the bladder and urethra has a certain reference value for the diagnosis of SUI in pregnant women with middle and late pregnancy. The pelvic floor ultrasound of pregnancy is safe and feasible. Second parts: light and moderate stress urinary incontinence pelvic floor rehabilitation therapy The purpose of this study was to explore the curative effect of electrical stimulation plus biofeedback therapy combined with Kegel training on pelvic floor function in women with mild and moderate stress urinary incontinence. Methods 78 cases of mild, moderate stress urinary incontinence from May 2013 to June 2016 in the Department of Obstetrics and Gynecology, Affiliated First Hospital of Guangzhou Medical University, were investigated. The patients were randomly divided into 2 groups, the treatment group (39 cases) was trained with electrical stimulation + biofeedback +kegel, and the control group (39 cases) was trained with simple Kegel. Through questionnaire survey, pelvic floor muscle strength measurement, urine flow rate examination, padding test, pelvic floor two-dimensional ultrasound examination of perineum, moderate SUI patients and biofeedback +kegel training and single The effect of pure Kegel training before treatment was 3 months and 6 months after treatment. SPSS 19 statistical software was applied to quantitative data and independent sample t test was used for comparison between groups. The paired sample t test was used in the group. The result was (?) + s. Qualitative data using 2 test and rank sum test to analyze.P0.05 was statistically significant. Results 1, 1, the treatment group and the control group before treatment and 3 months after the treatment, 6 months after the comparison, the questionnaire scores were less than before treatment, the quality of life improved before treatment, the difference was statistically significant (P0.01).2, the treatment group and the group before and after treatment 3 months after the treatment, 6 months after the treatment, muscle. The difference was statistically significant before treatment, (P0.05). The difference was statistically significant in the control group 6 months after treatment compared with the 3 months after treatment. (P0.05).3, before treatment and 3 months after treatment, the peak urine flow rate, the average urine flow rate and the peak urine flow rate were compared between the treatment group and the control group before the treatment, and the difference between the average urine flow rate and the peak urine flow rate was compared. No statistical significance, (P0.05).4, the treatment group before treatment and 6 months after treatment compared with the treatment before treatment, the leakage urine volume decreased significantly than before the treatment, the difference was statistically significant, (P0.05). The control group before the treatment of leak urine test and 3 months after treatment, 6 months after treatment, the difference was not statistically significant, (P0.05).5, group comparison, In the treatment group, the urethral rotation angle, the bladder neck mobility, the resting state of the bladder and the posterior urethral angle were 3 months after treatment, and the 6 months after treatment decreased compared with those before the treatment. The treatment group was less than before the treatment for 6 months after the treatment of Valsalva, and the difference was statistically significant, (P0.05). The urethral rotation angle of the control group was treated. 3 months after treatment, the 6 months after treatment decreased compared with that before treatment, and the control group was less than before treatment after 6 months of treatment. The difference was statistically significant, (P0.05). In the treatment group, the change of bladder neck mobility and the posterior urethral angle of the bladder and urethra under the action of Valsalva lasted for 6 months, superior to the control group. Comparison between the treatment group and the control group of bladder neck angle, bladder neck rotation angle, bladder neck mobility, bladder urethral angle, urethral rotation angle before treatment, 3 months after treatment, 6 months after treatment, the difference was not statistically significant, (P0.05). Conclusion electrical stimulation plus biofeedback therapy combined with Kegel training and simple Kegel training are all It can improve the supporting structure of bladder and urethra. Electrical stimulation plus biofeedback therapy combined with Kegel training lasted for 6 months, better than Kegel training alone.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.2;R445.1

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