研究呼吸电刺激对功能性便秘的作用临床观察

发布时间：2019-05-14 01:56

【摘要】：目的利用表面肌电测量腹肌、膈肌和盆底肌肌电改变,超声测量膈肌、腹肌增厚率和膈肌活动度改变,采用慢性便秘严重程度评分量表、焦虑自评量表、抑郁自评量表、便秘患者生活质量问卷评分变化,评价呼吸电刺激治疗功能性便秘的疗效。方法共46例功能性便秘患者纳入研究,按随机数字表法分为对照组和治疗A组、治疗B组共3组,治疗A组在乳果糖治疗基础上进行盆底生物反馈治疗联合呼吸电刺激训练(15例),治疗B组在乳果糖治疗基础上进行盆底生物反馈治疗(16例),对照组采用乳果糖治疗(15例)。分别于治疗前以及治疗后对两组选用慢性便秘严重程度评分量表、焦虑自评量表、抑郁自评量表、便秘患者生活质量问卷进行评分,采用表面肌电图技术检测膈肌和腹肌表面肌电均方根,Glazer法评估盆底肌肌电参数,采用超声检测膈肌、各腹肌增厚率和膈肌活动度。结果治疗2周后,3组患者慢性便秘严重程度评分较治疗前下降(P0.05),且治疗A组评分低于治疗B组和对照组(P0.05);2个治疗组患者的膈肌和腹直肌均方根值较治疗前改善(P0.05),且治疗A组患者膈肌改善程度与治疗B组比较有统计学差异(P0.05);治疗后,Glazer法评估3组患者5次快速收缩最大收缩波幅、5次持续收缩波幅、耐久收缩波幅较治疗前明显增高,差异有统计学意义(P0.05);2个治疗组前基线、后基线波幅值较治疗前降低(P0.05),且治疗A组5次快速收缩最大收缩波幅、5次持续收缩波幅、耐久收缩波幅显著高于治疗B组和对照组(P0.05),前基线波幅值较治疗B组和对照组降低,差异有统计学意义(P0.05);治疗后,治疗A组膈肌活动度和膈肌、腹外斜肌、腹内斜肌、腹横肌、腹直肌增厚率较治疗前增高(P0.05),且治疗A组膈肌活动度和膈肌、腹外斜肌、腹内斜肌、腹横肌、腹直肌增厚率显著高于治疗B组和对照组(P0.05);治疗后,3组患者便秘患者生活质量问卷、焦虑自评量表、抑郁自评量表评分较治疗前下降(P0.05),且治疗A组评分低于治疗B组和对照组(P0.05)。结论呼吸电刺激训练可有效辅助提高膈肌、腹肌收缩力和降低盆底肌的过度活动,增强盆底生物反馈治疗功能性便秘的效果及患者的精神心理状态,最终改善其生活质量。
[Abstract]:Objective to measure the myoelectric changes of abdominal muscle, diaphragm and pelvic floor by surface electromyography, and to measure the thickening rate of diaphragm, abdominal muscle thickening rate and diaphragm activity by ultrasound. Chronic constipation severity scale, self-rating anxiety scale, self-rating depression scale, self-rating anxiety scale, self-rating depression scale, self-rating anxiety scale, self-rating depression scale, self-rating anxiety scale, self-rating depression scale, The scores of quality of life questionnaire in patients with constipation were evaluated to evaluate the efficacy of respiratory electrical stimulation in the treatment of functional constipation. Methods A total of 46 patients with functional constipation were randomly divided into control group and treatment group A, and group B was treated with 3 groups. Group A received pelvic floor biofeedback therapy combined with respiratory electrical stimulation training on the basis of lactulose therapy (15 cases), and group B received pelvic floor biofeedback therapy on the basis of lactulose therapy (16 cases). The control group was treated with lactulose (15 cases). Before and after treatment, the severity scale of chronic constipation, self-rating anxiety scale, self-rating depression scale and quality of life questionnaire were used to evaluate the severity of chronic constipation, self-rating anxiety scale, self-rating depression scale and quality of life questionnaire. The surface EMG of diaphragm and abdominal muscle were measured by surface electromyography (EMG). The myoelectric parameters of pelvic floor were evaluated by Glazer method, and the thickening rate of diaphragm, the thickening rate of abdominal muscle and the activity of diaphragm were measured by ultrasound. Results after 2 weeks of treatment, the severity score of chronic constipation in the three groups was lower than that before treatment (P 0.05), and the score in treatment group A was lower than that in treatment group B and control group (P 0.05). The root mean square values of diaphragm and rectus abdominis in the two treatment groups were improved compared with those before treatment (P 0.05), and the degree of diaphragm improvement in group A was significantly different from that in group B (P 0.05). After treatment, Glazer method was used to evaluate the maximum amplitude of rapid contraction and the amplitude of continuous contraction of 5 times in the three groups, and the amplitude of durable contraction was significantly higher than that before treatment, the difference was statistically significant (P 0.05). The amplitudes of the pre-and post-baseline waves in the two treatment groups were lower than those before treatment (P 0.05), and in group A, the maximum amplitude of rapid contraction was 5 times, and the amplitude of continuous contraction was 5 times. The amplitude of durable contraction was significantly higher than that of treatment group B and control group (P 0.05), and the amplitude of pre-baseline wave was lower than that of treatment group B and control group, the difference was statistically significant (P 0.05). After treatment, the diaphragm activity and the thickening rate of diaphragm, extraabdominal oblique muscle, intraabdominal oblique muscle, transverse abdominal muscle and rectus abdominis muscle in group A were higher than those before treatment (P 0.05), and the diaphragm activity and diaphragm, extraabdominal oblique muscle, intraabdominal oblique muscle and transverse abdominal muscle in group A were higher than those before treatment. The thickening rate of rectus abdominis muscle was significantly higher than that of treatment group B and control group (P 0.05). After treatment, the scores of quality of life questionnaire, self-rating anxiety scale and self-rating depression scale in the three groups were lower than those before treatment (P 0.05), and the scores in treatment group A were lower than those in treatment group B and control group (P 0.05). Conclusion Respiratory electrical stimulation training can effectively improve the contractility of diaphragm and abdominal muscle and reduce the overactivity of pelvic floor muscle, enhance the effect of pelvic floor biofeedback in the treatment of functional constipation and the mental and psychological state of the patients, and finally improve their quality of life.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574.62

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