凯格尔训练结合普拉提训练对不同体质量指数前列腺切除术后尿失禁患者尿控恢复的中长期疗效观察

doi:10.3969/j.issn.1006-9771.2025.08.014

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (8): 972-978.doi: 10.3969/j.issn.1006-9771.2025.08.014

凯格尔训练结合普拉提训练对不同体质量指数前列腺切除术后尿失禁患者尿控恢复的中长期疗效观察

安迪^1a^,², 王建霞³, 张帆^1b, 靖华芳^1b, 高轶^1b, 丛惠玲^1b, 苏国栋^1c, 叶淼^1a^,², 胡春英^1a^,², 吴娟^1b, 廖利民^1b()

1.中国康复研究中心北京博爱医院，a. PT2科；b. 泌尿外科；c. PT3科，北京市 100068
2.首都医科大学康复医学院，北京市 100068
3.中国医学科学院肿瘤医院重症医学科，北京市 100021

收稿日期:2024-12-20 修回日期:2025-04-07 出版日期:2025-08-25 发布日期:2025-09-01
通讯作者: 廖利民，E-mail： lmliao@263.net
作者简介:安迪(1987-)，男，汉族，北京市人，硕士，副主任治疗师，主要研究方向：盆底尿控、脊髓损伤和骨科康复。
基金资助:
中国康复研究中心课题基金项目(2023ZX-Q9)

Mid- and long-term effect of Kegel training combined with Pilates training on urinary control recovery in patients with post-prostatectomy incontinence with different body mass index

AN Di^1a^,², WANG Jianxia³, ZHANG Fan^1b, JING Huafang^1b, GAO Yi^1b, CONG Huiling^1b, SU Guodong^1c, YE Miao^1a^,², HU Chunying^1a^,², WU Juan^1b, LIAO Limin^1b()

1. a. Department of PT2; b. Department of Urology; c. Department of PT3, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
2. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
3. Department of ICU, Cancer Hospital, Chinese Academy of Medical Science, Beijing 100021, China

Received:2024-12-20 Revised:2025-04-07 Published:2025-08-25 Online:2025-09-01
Supported by:
China Rehabilitation Research Center Funds(2023ZX-Q9)

摘要/Abstract

摘要：

目的观察凯格尔训练结合普拉提训练对不同的体质量指数(BMI)男性前列腺切除术后尿失禁患者尿控恢复的中长期疗效。

方法 2023年5月至2024年6月，北京博爱医院有效患者48例，依据BMI分为A组(< 25 kg/m²，n = 15)、B组(25~30 kg/m²，n = 18)和C组(> 30 kg/m²，n = 15)。各组均进行凯格尔训练结合普拉提训练，共2个月，第6个月时进行随访。比较治疗前，治疗后第4周、第8周和第6个月时1 h尿垫试验、每日尿失禁次数，国际尿失禁咨询问卷简卷(ICIQ-SF)和改良牛津等级量表结果。

结果 1 h尿垫试验和每日尿失禁次数的组内效应、组间效应和交互效应均显著(F > 2.955, P < 0.05)。事后检验显示，C组两指标结果均大于A组和B组(P < 0.05)，B组每日尿失禁次数大于A组(P < 0.05)。治疗后不同时间点，各组组内ICIQ-SF问卷和牛津等级量表评分比较有非常显著性差异(Z > 3.427, P < 0.01)。除治疗后第4周ICIQ-SF评分外，治疗后各时间点组间比较，C组两指标均最差(Z > 10.476, P < 0.05)。治疗后6个月，BMI (A、B、C组分别赋值为1、2、3)与1 h尿垫试验(r = 0.79, P < 0.001)、每日尿失禁次数(r = 0.68, P < 0.001)、ICIQ-SF评分(r = 0.68, P < 0.001)和牛津等级量表评分(r = -0.47, P = 0.001)均相关。

结论凯格尔训练结合普拉提训练可以促进前列腺术后尿失禁患者尿控恢复。BMI的降低可以促进中长期尿控恢复，改善后期尿失禁症状。

关键词: 前列腺切除术, 尿失禁, 体质量指数, 凯格尔训练, 普拉提训练

Abstract:

Objective To observe the mid- and long-term effects of Kegel training combined with Pilates training on urinary continence recovery in different body mass index (BMI) male patients with urinary incontinence after prostatectomy.

Methods From May, 2023 to June, 2024, 48 patients in Beijing Bo'ai Hospital were recruited and divided into group A (< 25 kg/m², n = 15), group B (25 to 30 kg/m², n = 18) and group C (> 30 kg/m², n = 15) according to their BMI. All the groups performed Kegel training combined with Pilates training for two months, and followed up at six months from baseline. They were evaluated with one hour pad test, the number of daily urinary incontinence, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and modified Oxford Rating Scale before treatment, and four weeks, eight weeks and six months after treatment.

Results The intra-group effect, the inter-group effect and interaction effect were significant in the results of one hour pad test and the daily number of urinary incontinence (F > 2.955, P < 0.05). Post Hoc test showed that they were worse in group C than in groups A and B (P < 0.05), and the number of daily urinary incontinence was more in group B than in group A (P < 0.05). There was significant difference in the scores of ICIQ-SF and modified Oxford Rating Scale among groups in different time points after treatment (Z > 10.476, P < 0.05) except the score of ICIQ-SF four weeks after treatment (P > 0.05), and they were the worst in group C. BMI (group A = 1, group B = 2, group C = 3) was correlated with the results of one hour pad test (r = 0.79, P < 0.001), the number of daily urinary incontinence (r = 0.68, P < 0.001), and the scores of ICIQ-SF (r = 0.68, P < 0.001) and modified Oxford Rating Scale (r = -0.47, P = 0.001) six months after treatment.

Conclusion Kegel training combined with Pilates training could improve the urinary control in patients with urinary incontinence after prostatectomy. The decrease of BMI can promote the recovery of urinary control, and improve the symptoms of later urinary incontinence in mid- and long-term.

Key words: prostatectomy, incontinence, body mass index, Kegel training, Pilates training

中图分类号:

R697.3

安迪, 王建霞, 张帆, 靖华芳, 高轶, 丛惠玲, 苏国栋, 叶淼, 胡春英, 吴娟, 廖利民. 凯格尔训练结合普拉提训练对不同体质量指数前列腺切除术后尿失禁患者尿控恢复的中长期疗效观察[J]. 《中国康复理论与实践》, 2025, 31(8): 972-978.

AN Di, WANG Jianxia, ZHANG Fan, JING Huafang, GAO Yi, CONG Huiling, SU Guodong, YE Miao, HU Chunying, WU Juan, LIAO Limin. Mid- and long-term effect of Kegel training combined with Pilates training on urinary control recovery in patients with post-prostatectomy incontinence with different body mass index[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(8): 972-978.

图/表 7

表1

普拉提训练项目"

名称	口令	时间/周
1.普拉提呼吸(床)	要慢而深地吸气并留心膈肌的下移，呼气时注意收腹	1~2
2.骨盆钟表(床)	向上方提升骨盆(注意：骨盆的前倾和后倾)	1~2
3.搭桥(床)	屈膝关节，抬屁股	1~2
4.滚球训练(床)	双上肢抱膝做前后滚动(注意：脊柱呈圆弧状；双手放于小腿前侧；保持髋、膝关节夹角不变)	1~2
5.足跟滑动(床)	双下肢交替训练(基础运动滑动一侧曲，一侧伸；进阶时类似单腿伸展，注意髋、膝关节屈曲角度最好接近垂直)	1~2
训练	1+2+3+4+5	1~2
6.普拉提呼吸+	普拉提呼吸+上肢运动(双下肢略抬离床面或者脚尖点地，叠加双上肢屈曲或者借助弹力带、木棒等训练)	3~4
7.骨盆钟表+	骨盆钟表结合上肢运动(同上)	3~4
8.搭桥+	搭桥训练结合上肢运动(同上)	3~4
9.足跟滑动+	足跟滑动结合上肢运动(同上)	3~4
训练	6+7+8+9	3~4
10.足部工作(椅子)	脚在椅子上屈伸骨盆运动(椅子是媒介，为了破坏静态稳定转换为动态稳定)	5~6
11.腿交替运动(椅子)	椅子上腿交替运动，一侧屈曲时注意髋、膝关节屈曲90度，手轻触膝关节；另一侧伸直，伸侧足跟尽量不接触地面；交替进行	5~6
12.边桥 (椅子)	侧卧位，不要憋气，一条腿搭在椅子上，另一条腿在椅子下边，嘱患者以单侧上肢撑起躯干(注意头、脖子、躯干在一条直线上，可以用尺子作参考；进阶，双腿下夹球等)	5~6
13.椅子上搭桥	椅上搭桥训练	5~6
训练	10+11+12+13	5~6
14. 侧屈(站立位)	结合上肢运动的侧屈(双手扶头侧屈训练；进阶侧屈配合侧屈侧上下肢伸展，注意躯干位置不能代偿)	7~8
15.躯干旋转(站立位)	结合上肢运动的躯干旋转(注意下肢骨盆不动；双手平举过头并停留，注意配合呼吸，缓慢放下至90度，旋转)	7~8
16.对角线屈伸	左手拍右侧大腿，交替(注意躯干的位置；双下肢略抬离床面，头略抬离)	7~8
17.辅助蹲起	将身体尽量向后贴墙，蹲起	7~8
18.抵抗式蹲起	蹲起时抵抗训练	7~8
19.双腿伸	仰卧位，呼气，双手置于小腿上，腿弯曲；吸气，双上肢平举过头同时双腿伸直，双上肢平移够同时屈曲的小腿	7~8
训练	14+15+16+17+18+19	7~8

表1

表2

表3

表4

表5

表6

表7

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项目	A组(n = 15)	B组(n = 18)	C组(n = 15)	F值/χ²值	P值
年龄/岁	75.13±5.71	72.50±5.66	72.73±6.07	0.982	0.382
身高/m	1.73±0.05	1.73±0.05	1.73±0.06	0.264	0.769
手术时长/h	4.20±1.20	4.22±1.36	4.20±1.00	0.002	0.998
是否患有高血压或糖尿病/n				3.567	0.059
是	8	12	12
否	7	6	3
手术后到开始训练的时间/n				0.651	0.420
< 4个月	4	3	2
4~6个月	8	9	9
> 6个月	3	6	4
手术类型/n				0.537	0.464
开放手术	10	10	8
腹腔镜手术	5	8	7
是否有神经血管束保留/n				0.143	0.706
是	10	12	9
否	5	6	6
Gleason 评分/n				0.131	0.718
≤ 7	7	11	6
> 7	8	7	9

指标	组别	n	治疗前		第4周		第8周		第6个月
指标	组别	n	均值	标准差	均值	标准差	均值	标准差	均值	标准差
1 h尿垫试验/g	A组	15	81.73	9.76	73.93	8.04	31.93	5.64	36.47	5.51
	B组	18	80.17	8.63	74.33	5.75	36.44	5.79	44.17	4.48
	C组	15	82.87	8.95	77.53	7.39	39.87	6.47	52.40	6.02
每天尿失禁次数/n	A组	15	9.40	1.30	7.33	0.62	3.20	0.56	3.80	0.56
	B组	18	8.83	1.25	8.00	0.91	3.72	0.75	4.61	0.61
	C组	15	9.33	1.29	8.27	0.59	4.13	0.64	5.13	0.64

指标		平方和	自由度	均方	F值	P值
1 h尿垫试验	组内	72161.260	3	53010.74	1058.508	< 0.001
	组间	1563.484	2	781.742	6.111	0.004
	组内×组间	996.801	6	366.132	7.311	< 0.001
每天尿失禁次数	组内	992.178	3	507.325	493.000	< 0.001
	组间	18.458	2	9.229	9.593	< 0.001
	组内×组间	11.894	6	3.041	2.955	0.025

指标	组别	组别	平均值差	P值	95% CI
指标	组别	组别	平均值差	P值	下限	上限
1 h尿垫试验	A组	B组	-2.761	0.169	-6.743	1.221
	A组	C组	-7.150	0.001	-11.309	-2.991
	B组	C组	-4.389	0.032	-8.371	-0.407
每天尿失禁次数	A组	B组	-0.358	0.042	-0.704	-0.013
	A组	C组	-0.783	< 0.001	-1.144	-0.423
	B组	C组	-0.425	0.017	-0.770	-0.080

组别	n	治疗前	第4周	第8周	第6个月	Z值	P值
A组	15	18(18,20)	17(16, 17)	7(6, 8)	7(7, 8)	3.427	0.001
B组	18	18(18,19)	17(17, 17)	8(7, 8)	8(8, 9)	3.767	< 0.001
C组	15	19(18,19)	18(17, 19)	8(7, 9)	9(9,9)	3.453	0.001
Z值		0.709	5.029	10.873	22.116
P值		0.702	0.081	0.004	< 0.001

凯格尔训练结合普拉提训练对不同体质量指数前列腺切除术后尿失禁患者尿控恢复的中长期疗效观察

Mid- and long-term effect of Kegel training combined with Pilates training on urinary control recovery in patients with post-prostatectomy incontinence with different body mass index

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组别	n	治疗前	第4周	第8周	第6个月	Z值	P值
A组	15	1(0, 1)	2(2, 2)	4(4, 5)	4(4, 4)	3.447	0.001
B组	18	1(0, 1)	1(1, 2)	4(4, 4)	4(3, 4)	3.780	< 0.001
C组	15	1(0, 1)	1(1, 2)	3(3, 4)	3(3, 3)	3.502	< 0.001
Z值		2.711	11.968	13.193	10.476
P值		0.258	0.002	0.001	0.005

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[2]	刘兰群, 李惠兰, 陈爽, 徐基民. 电针中极和关元治疗脑卒中后急迫性尿失禁的效果[J]. 《中国康复理论与实践》, 2020, 26(1): 93-97.
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