呼吸训练在产后压力性尿失禁中的应用

doi:10.3969/j.issn.1006-9771.2018.06.018

《中国康复理论与实践》 ›› 2018, Vol. 24 ›› Issue (6): 720-725.doi: 10.3969/j.issn.1006-9771.2018.06.018

呼吸训练在产后压力性尿失禁中的应用

赵祥虎¹,马明¹,徐亮¹,林萍²,孙武东¹,张荣²,李玲²,卢洁²

1.东南大学附属中大医院康复医学科,江苏南京市 210009;
2.江都人民医院产后康复中心,江苏扬州市 225200

收稿日期:2018-04-13 修回日期:2018-05-09 出版日期:2018-06-25 发布日期:2018-06-28
通讯作者: 卢洁。E-mail: 594138434@qq.com
作者简介:赵祥虎(1988-),男,汉族,山东临朐县人,硕士研究生,康复治疗师,主要研究方向：运动康复。通讯作者：卢洁(1980-),女,汉族,江苏盐城市人,博士研究生,副主任中医师,主要研究方向：中医妇科孕产康复。
基金资助:
南京市体育局课题(No. NJTY2015-501)

Application of Breathing Training in Postpartum Stress Urinary Incontinence

ZHAO Xiang-hu¹, MA Ming¹, XU Liang¹, LIN Ping², SUN Wu-dong¹, ZHANG Rong², LI Ling², LU Jie²

1. Rehabilitation Medicine Department, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu 210009, China;
2. Postpartum Rehabilitation Center of Jiangdu People's Hospital, Yangzhou, Jiangsu 225200, China

Received:2018-04-13 Revised:2018-05-09 Published:2018-06-25 Online:2018-06-28
Contact: LU Jie. E-mail: 594138434@qq.com

摘要/Abstract

摘要： 目的探讨呼吸训练结合盆底肌锻炼和生物反馈电刺激对产后压力性尿失禁的临床疗效。方法 2017年7月至10月,产后6周诊断为压力性尿失禁的患者64例随机分为对照组(n=32)和观察组(n=32)。对照组给予盆底肌锻炼和生物反馈电刺激治疗,观察组在对照组基础上辅以呼吸训练。治疗前和治疗12周后采用盆底肌肌电值、尿失禁次数、1 h尿垫试验和腹横肌厚度进行评价。结果治疗前,两组盆底肌肌电值、尿失禁次数、1 h尿垫试验和腹横肌厚度均无显著性差异(P>0.05)。治疗12周后,两组盆底肌肌电值较治疗前均显著提高(t>12.564, P<0.001),且观察组显著高于对照组(t=14.064, P<0.001);两组尿失禁次数和1 h尿垫试验阳性率均显著降低(Z>9.615, P<0.001),且观察组均低于对照组(Z=-2.767, χ²=6.564, P<0.05);对照组腹横肌厚度无变化(t=-1.510, P>0.05),而观察组显著提高(t=-10.681, P<0.001),且显著高于对照组(t=7.541, P<0.001)。结论在盆底肌锻炼和生物反馈电刺激的基础上再辅以呼吸训练,可进一步减轻产后压力性尿失禁的症状,改善功能,提高生活质量。

关键词: 产后压力性尿失禁, 盆底肌锻炼, 生物反馈电刺激, 呼吸训练

Abstract: Objective To observe the effect of breathing training on postpartum stress urinary incontinence (SUI) based on pelvic floor muscle exercise and biofeedback electrical stimulation.Methods From July to October, 2017, 64 SUI patients at the sixth week after childbirth were randomly divided into control group (n=32) and observation group (n=32). The control group was treated with pelvic floor muscle exercise and biofeedback electrical stimulation. The observation group was supplemented with breathing training additionally. The pelvic floor muscle myoelectric value, urinary incontinence frequency, one hour urine pad test and the average thickness of the transversus abdominis were evaluated before and twelve weeks after treatment.Results Before treatment, there was no significant difference in the pelvic floor muscle myoelectric value, urinary incontinence frequency, one hour urine pad test and the average thickness of the transversus abdominis between two groups (P>0.05). Twelve weeks after treatment, the pelvic floor muscle myoelectric value significantly increased in both groups (t>12.564, P<0.001), and was higher in the observation group than in the control group (t=14.064, P<0.001); the urinary incontinence frequency and the positive rate of one hour urine pad test significantly decreased in both groups (Z>9.615, P<0.001), and were lower in the observation group than in the control group (Z=-2.767, χ²=6.564, P<0.05); the average thickness of the transversus abdominis had no improvement in the control group (t=-1.510, P>0.05), and significantly increased in the observation group (t=-10.681, P<0.01), which was higher in the observation group than in the control group (t=7.541, P<0.001).Conclusion On the basis of pelvic floor muscle exercise and biofeedback electrical stimulation, supplementation with breathing training could reduce the symptoms of postpartum stress urinary incontinence, and improve the function and the quality of life.

Key words: postpartum stress urinary incontinence, pelvic floor muscle exercise, biofeedback electrical stimulation, breathing training

中图分类号:

R694

赵祥虎,马明,徐亮,林萍,孙武东,张荣,李玲,卢洁. 呼吸训练在产后压力性尿失禁中的应用[J]. 《中国康复理论与实践》, 2018, 24(6): 720-725.

ZHAO Xiang-hu, MA Ming, XU Liang, LIN Ping, SUN Wu-dong, ZHANG Rong, LI Ling, LU Jie. Application of Breathing Training in Postpartum Stress Urinary Incontinence[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2018, 24(6): 720-725.

参考文献

[1] 朱兰,郎景和. 女性盆底学[M]. 北京:人民卫生出版社, 2008: 54.
[2] 鲍颖洁,胡孟彩,高桂香,等. 盆底功能障碍性疾病的多因素分析[J]. 中南大学学报(医学版), 2015, 40(11): 1229-1233.
[3] 中华医学会妇产科学分会妇科盆底学组. 女性压力性尿失禁诊断和治疗指南(试行)[J]. 中华妇产科杂志, 2011, 46(10): 796-798.
[4] Lalor AF, Brown T, Robins L, et al.Anxiety and depression during transition from hospital to community in older adults:concepts of a study to explain late age onset depression[J]. Healthcare (Basel), 2015, 3(3): 478-502.
[5] 丛志承,求旦旦. 闭孔尿道中段无张力悬吊术治疗压力性尿失禁的疗效及术后短暂性尿潴留的危险因素分析[J]. 中国妇幼保健, 2018, 33(7): 1651-1654.
[6] 孙智晶,朱兰,郎景和,等. 产后盆底康复锻炼对女性盆底功能障碍性疾病的预防作用[J]. 中华妇产科杂志, 2015, 50(6): 420-428.
[7] 刘娟,曾洁,王海兰,等. 生物反馈盆底肌训练治疗压力性尿失禁的疗效分析[J]. 中华妇产科杂志, 2014, 49(10): 754-757.
[8] Tajiri K, Huo M, Maruyama H.Effects of co-contraction of both transverse abdominal muscle and pelvic floor muscle exercises for stress urinary incontinence: a randomized controlled trial[J]. J Phys Ther Sci, 2014, 26(8): 1161-1163.
[9] Goldberg RP, Kwon C, Gandhi S, et al.Urinary incontinence among mothers of multiples: the protective effect of cesarean delivery[J]. Am J Obstet Gynecol, 2003, 188(6): 1447-1453.
[10] 黄丽霞,谷玉红,房桂英,等. 生物反馈电刺激联合盆底肌训练对产后压力性尿失禁的影响[J]. 河北医科大学学报, 2017, 38(5): 557-560.
[11] 杨素勉,丁秀平,张彦赏,等. 神经肌肉电刺激结合盆底肌肉锻炼预防产后压力性尿失禁[J]. 中华物理医学与康复杂志, 2011, 33(5): 382-383.
[12] Kiesel KB, Uhl TL, Underwood FB, et al.Measurement of lumbar multifidus muscle contraction with rehabilitative ultrasound imaging[J]. Man Ther, 2007, 12(2): 161-166.
[13] 陈玉芬,李环,丁小容,等. 盆底肌电刺激联合生物反馈改善产妇尿失禁的效果观察[J]. 护理学报, 2013, 20(11): 52-53.
[14] 蔡舒,任旭,宋均仿,等. 生物反馈电刺激联合盆底肌训练对产后压力性尿失禁的临床疗效[J]. 广东药学院学报, 2014, 30(4): 517-520.
[15] 寇金玲,党丽君,冯秀清. 产后康复治疗对改善盆底功能的临床研究[J]. 中国医学创新, 2013, 10(25): 55-57.
[16] 谢海鲲,段英伟. 中老年女性压力性尿失禁盆底肌肉(体操)锻炼的干预效果评价[J]. 中国全科医学, 2012, 15(20): 2340-2341.
[17] 赵娅倩,胡浩,许克新,等. 新的盆底肌锻炼方式治疗女性压力性尿失禁的临床疗效分析[J]. 中华泌尿外科杂志, 2013, 34(3): 201-203.
[18] Hirakawa T, Suzuki S, Kato K, et al.Randomized controlled trial of pelvic floor muscle training with or without biofeedback for urinary incontinence[J]. Int Urogynecol J, 2013, 24(8): 1347-1354.
[19] Borello-France DF, Zyczynski HM, Downey PA, et al.Effect of pelvic-floor muscle exercise position on continence and quality-of-life outcomes in women with stress urinary incontinence[J]. Phys Ther, 2006, 86(7): 974-986.
[20] 范星月,闫博馨,丁家喻,等. 呼吸训练对非特异性腰痛的疗效[J]. 中国康复理论与实践, 2018, 24(1): 93-96.
[21] Hodges PW, Butler JE, McKenzie DK, et al. Contraction of the human diaphragm during rapid postural adjustments[J]. J Physiol, 1997, 505(2): 539-548.
[22] Hodges PW, Sapsford R, Pengel LH.Postural and respiratory functions of the pelvic floor muscles[J]. Neurourol Urodyn, 2007, 26(3): 362-371.
[23] 卢霞,姚立丽,李小文. 产后盆底康复锻炼对女性盆底功能障碍性疾病的预防作用[J]. 中国妇幼保健, 2018, 33(1): 38-41.
[24] Kibler WB, Press J, Sciascia A.The role of core stability in athletic function [J]. Sports Med, 2006, 36(3): 189-198.
[25] Chang WD, Lin HY, Lai PT.Core strength training for patients with chronic low back pain[J]. J Phys Ther Sci, 2015, 27(3): 619-622.
[26] Frank C, Kobesova A, Kolar P.Dynamic neuromuscular stabilization & sports rehabilitation[J]. Int J Sports Phys Ther, 2013, 8(1): 62-73.
[27] 贾俊华,夏志军. 不同生物反馈电刺激方案治疗女性压力性尿失禁的疗效[J]. 中国医科大学学报, 2015, 44(8): 717-720.
[28] Kang JI, Jeong DK, Choi H.Effect of exhalation exercise on trunk muscle activity and oswestry disability index of patients with chronic low back pain[J]. J Phys Ther Sci, 2016, 28(6): 1738-1742.
[29] Hirayama F, Binns CW, Lee AH, et al.Urinary incontinence in Japanese women with chronic obstructive pulmonary disease[J]. J Phys Ther Sci, 2005, 17(2): 119-124.
[30] 王怀远. 行为疗法对女性慢阻肺患者压力性尿失禁的干预效果研究[D]. 济南:山东大学, 2014.
[31] Smith MD, Coppieters MW, Hodges PW.Postural response of the pelvic floor and abdominal muscles in women with and without incontinence[J]. Neurourol Urodyn, 2007, 26(3): 377-385.
[32] Zivkovic V, Lazovic M, Vlajkovic M, et al.Diaphragmatic breathing exercises and pelvic floor retraining in children with dysfunctional voiding[J]. Eur J Phys Rehabil Med, 2012, 48(3): 413-421.
[33] Kamel DM, Thabet AA, Tantawy SA, et al.Effect of abdominal versus pelvic floor muscles gxercises on vaginal and leak point pressures in mild stress urinary incontinence in obese women[J]. Life Sci J, 2011, 8(4): 542-549.

呼吸训练在产后压力性尿失禁中的应用

Application of Breathing Training in Postpartum Stress Urinary Incontinence

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 13

Metrics

本文评价

推荐阅读 0

[1]	厉坤鹏,周宗磊,张梓楠,施伯翰,陈浩,罗云,朱燕. 呼吸训练对帕金森病患者肺功能和运动功能的效果[J]. 《中国康复理论与实践》, 2021, 27(3): 320-324.
[2]	郝文雪,郑婕,李瑞青,冯红霞,李洁莹,胡延超,冯晓东. 慢速呼吸训练调整血压功能的系统综述[J]. 《中国康复理论与实践》, 2021, 27(11): 1299-1306.
[3]	陈沛,任超学,李新通,代瑞兰,张恒银. 呼吸训练在非特异性腰痛防治中的研究进展[J]. 《中国康复理论与实践》, 2020, 26(8): 913-916.
[4]	田家伟, 蔡丽婷, 侯昕珩. 呼吸训练器在稳定期慢性阻塞性肺疾病患者肺康复中的应用现状[J]. 《中国康复理论与实践》, 2018, 24(4): 416-421.
[5]	吴登宠, 周瑜欢. 呼吸训练对基底节区脑梗死并发阻塞性睡眠呼吸暂停综合征的效果[J]. 《中国康复理论与实践》, 2018, 24(4): 462-466.
[6]	徐东红, 何雅琳, 朱云霞, 丁怡, 夏松成, 王惠芳. 综合性呼吸训练对颈髓损伤患者呼吸功能的效果[J]. 《中国康复理论与实践》, 2018, 24(4): 467-471.
[7]	范星月, 闫博馨, 丁家喻, 高强, 徐若男, 刘波, 王雪. 呼吸训练对非特异性腰痛的疗效[J]. 《中国康复理论与实践》, 2018, 24(1): 93-96.
[8]	兰蕴平, 吴娅秋, 黎嘉嘉, 刘蓉安, 罗小秀, 黄晓波. 早期呼吸训练器治疗对冠脉搭桥术后低氧血症患者肺部并发症的影响[J]. 《中国康复理论与实践》, 2017, 23(6): 709-713.
[9]	皮周凯，张盘德，周惠嫦，陈惠琼，徐坤玉，冯顺燕. 阴道压力反馈盆底肌抗阻肌力训练治疗女性压力性尿失禁的疗效观察①[J]. 《中国康复理论与实践》, 2016, 22(2): 194-197.
[10]	苏久龙1a，潘翠环1a，曹腾飞1b，缪萍1a. 抗阻呼吸训练对乳腺癌术后上肢淋巴水肿的疗效①[J]. 《中国康复理论与实践》, 2016, 22(11): 1318-1321.
[11]	张琼;管玉涛;郑伟;吕杰强. 生物反馈联合盆底肌锻炼治疗女性压力性尿失禁的疗效评价[J]. 《中国康复理论与实践》, 2011, 17(2): 173-175.
[12]	苏国栋;张琦;. 呼吸训练在预防地震后伤员肺部感染中的应用 [J]. 《中国康复理论与实践》, 2008, 14(07): 670-672.
[13]	吴弦光 . 慢性阻塞性肺疾患的康复 [J]. 《中国康复理论与实践》, 2002, 8(06): 327-329.