艾灸联合生物反馈与电刺激治疗女性压力性尿失禁的临床观察

发布时间：2018-05-29 00:20

本文选题：艾灸 + 女性压力性尿失禁　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的压力性尿失禁为临床常见病,特别是中老年女性。随着我国社会人口老龄化日益加剧,本病的发病率呈上升趋势,严重地影响了妇女的正常生活和身心健康。妇女们常认为尿失禁是一种随年龄增长而出现的正常现象,羞于向他人提及,更很少主动就诊,除非被直接问及,直接影响生活质量。因此探寻一种科学有效并且简便的方法预防和治疗本病具有十分积极的意义,本实验的目的就是探讨艾灸联合生物反馈与电刺激治疗女性压力性尿失禁的临床效果。方法收集我院妇产科门诊西医诊断为轻、中度女性压力性尿失禁,中医辨证属肾气虚型的患者120例,根据随机抽样的方法分为治疗组和对照组,各60例,对照组通过盆底康复仪进行盆底功能康复治疗(生物反馈+电刺激),3天一次,10次为一个疗程。治疗组在对照组的基础上联合应用艾条灸气海、关元、中极穴,每处灸5-7分钟,共20分钟,隔天一次,20次为一疗程。治疗前后观察患者国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)评分、会阴肌力及三维B超下监测膀胱颈移动度(UVJ-M)、膀胱尿道后角(PUVA)和盆膈裂孔前后径、左右径、面积的变化,进行临床疗效的评价,并在治疗结束后3个月、6个月进行随访。结果经治疗后,两组各项指标较治疗前均有改善,治疗组与对照组比较,ICI-Q-SF评分明显降低,并且在3个月、6个月随访中ICI-Q-SF评分也较对照组降低。一个疗程治疗后及3个月、6个月随访治疗组较对照组I类肌力改善明显,II类肌力改善不明显,两者差别无统计学差异。三维B超结果提示,经一个疗程治疗后,两组UVJ-M和PUVA较治疗前均降低(P0.05),治疗组较对照组两项指标明显降低;治疗后3个月,治疗组与对照组比较,PUVA减小,UVJ-M差异无统计学意义;治疗后6个月,治疗组UVJ-M和PUVA水平均降低。在静息期,治疗后、3个月、6个月治疗组与对照组比较,盆膈裂孔左右径、前后径及面积均降低。在缩肛期,一个疗程治疗后盆膈裂孔前后径、左右径均降低,盆膈裂孔面积虽减小,但无统计学意义;疗程结束后3个月随访,盆膈裂孔左右径及面积均降低,但盆膈裂孔左右径无统计学差异;疗程结束后6个月随访,盆膈裂孔左右径及面积均减小,盆膈裂孔前后径虽减小,但无统计学差异。临床疗效比较,1个疗程治疗结束后、3个月、6个月总有效率分别为96.67%、88.33%、81.67%,与对照组比较差异明显,临床疗效总有效率优于对照组,远期疗效好。结论艾灸联合生物反馈与电刺激和单用生物反馈与电刺激对女性压力性尿失禁均有治疗作用,但联合应用优于单用生物反馈与电刺激,且远期疗效更佳。
[Abstract]:Objective stress urinary incontinence is a common clinical disease, especially in middle-aged women. With the aging of social population, the incidence of this disease is on the rise, which seriously affects the normal life and physical and mental health of women. Women often think of urinary incontinence as a normal age-related phenomenon, shy of mentioning it to others, and less likely to seek medical attention unless asked directly about it, directly affecting the quality of life. Therefore, it is of great significance to explore a scientific, effective and simple method for the prevention and treatment of this disease. The purpose of this experiment is to explore the clinical effect of moxibustion combined with biofeedback and electrical stimulation in the treatment of female stress urinary incontinence. Methods 120 patients with mild and moderate female stress urinary incontinence diagnosed as mild and moderate female stress urinary incontinence in our outpatient department of gynecology and obstetrics were randomly divided into treatment group (n = 60) and control group (n = 60). The control group was treated with pelvic floor rehabilitation by pelvic floor rehabilitation instrument (biofeedback electrical stimulation was given 10 times a day as a course of treatment). On the basis of the control group, the treatment group was treated with moxibustion at Qihai, Guanyuan and Zhongji points for 5-7 minutes in each place for 20 minutes, 20 times every other day as a course of treatment. Before and after treatment, the ICI-Q-SFscore of urinary incontinence questionnaire of the International Advisory Committee on urinary incontinence (ICI-Q-SF), the changes of bladder neck mobility (UVJ-MN), posterior vesicourethral horn (PUVAA) and the anterior and posterior diameter, left and right diameter and area of pelvic and phrenic fissure were monitored under perineal muscle strength and three dimensional B ultrasound. The clinical efficacy was evaluated and followed up 3 months and 6 months after treatment. Results after treatment, the indexes of the two groups were improved. The ICI-Q-SF score of the treatment group was significantly lower than that of the control group, and the ICI-Q-SF score of the treatment group was lower than that of the control group during the follow-up of 3 months and 6 months. After a course of treatment and 3 months and 6 months follow-up treatment group compared with the control group the improvement of type I muscle strength was not obvious and there was no significant difference between the two groups. The results of three dimensional ultrasound showed that after one course of treatment, both UVJ-M and PUVA in the two groups were significantly lower than those in the control group, and that in the treatment group was significantly lower than that in the control group 3 months after treatment, there was no significant difference between the treatment group and the control group in the reduction of UVJ-M and PUVA. The levels of UVJ-M and PUVA in the treatment group decreased 6 months after treatment. In the rest period, 3 months and 6 months after treatment, the diameter, anterior and posterior diameter and area of the pelvic diaphragm hiatus decreased in the treatment group compared with the control group. In the period of anus contraction, the anterior and posterior diameter, left and right diameter of the pelvic diaphragm hiatus decreased after one course of treatment, but the area of the pelvic diaphragm hiatus decreased, but there was no statistical significance, and the left and right diameter and area of the pelvic diaphragm hole decreased after 3 months follow-up after the end of the course of treatment. But there was no statistical difference in the diameter of the left and right of the pelvic diaphragm hole, and there was no statistical difference in the diameter and area of the left and right of the hole of the pelvic diaphragm after 6 months follow-up, but there was no significant difference in the anterior and posterior diameter of the hole of the pelvic diaphragm. Compared with the control group, the total effective rates of one course of treatment, 3 months and 6 months, were 96.67 and 88.33, respectively. The difference was significant compared with the control group. The total effective rate was better than that of the control group, and the long-term effect was good. Conclusion moxibustion combined with biofeedback and electrical stimulation and single biofeedback and electrical stimulation have therapeutic effects on female stress urinary incontinence, but the combination of moxibustion with biofeedback and electrical stimulation is superior to biofeedback and electrical stimulation alone, and the long-term effect is better.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.59

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