摘要
目的 探讨肌电压力一体化电刺激联合生物反馈治疗对改善女性轻中度压力性尿失禁症状、生活质量及盆底肌功能等方面的临床疗效。方法 该研究最终纳入79名被诊断为轻中度压力性尿失禁的女性患者，平均年龄（34.59±7.09）岁，平均病程（17.20±9.80）个月，平均BMI（22.80±3.20）kg/m2，所有患者均接受肌电压力一体化电刺激联合生物反馈治疗，刺激频率15-60Hz，每周3次，每次治疗30分钟；连续5周，共完成15次治疗。观察治疗前（T0）、治疗结束后（T1）及随访（治疗结束后3个月，T2）不同时间节点国际尿失禁咨询委员会尿失禁问卷简表（ICI-Q-SF）、尿失禁影响问卷简版（IIQ-7）、盆底肌电/压力等指标治疗前后变化。结果 ICI-Q-SF评分从7.15±3.49分（T0）降至0.92±2.51分（T1）、2.20±1.00分（T2）（T1、T2与T0相比较，P<0.05）；临床总有效率为86.1%，治愈率为83.5%；IIQ-7总分从2.89±3.61分（T0）升至0.38±1.20分（T1）和0.28±1.30分（T2）（T1、T2与T0相比较，P<0.05）；盆底肌电/压力评估，盆底肌电总得分从基线（T0）51.01±13.70分提高至治疗结束后（T1）61.86±12.15分，提高幅度为21.3%（P<0.05）；前静息阶段平均值从8.27±5.42μV（T0）降至5.19±3.80μV（T1），降低幅度为37.2%（P<0.05）；I型肌纤维平均值从34.92±20.67μV（T0）提高至37.48±16.70μV（T1），提高幅度为7.3%（P<0.05）；II型肌纤维压力最大值从5.64±4.37cmH2O（T0）提高至8.30±5.65cmH2O（T1），提高幅度为47.2%（P<0.05）；I型肌纤维压力平均值从4.49±3.54cmH2O（T0）提高至7.50±5.04cmH2O（T1），提高幅度为67.0%（P<0.05）；I型肌纤维变异性从0.23±0.10降至0.18±0.08，提示I型肌纤维收缩的稳定性提升幅度为21.7%（P<0.05）；I型肌纤维恢复时间从1.28±1.03s缩短至0.90±0.54s（P<0.05），反映肌肉疲劳恢复能力的改善幅度为29.7%；初始肌电值从8.57±5.55μV降至6.72±4.42μV（P<0.05），耐受肌电值从16.19±8.73μV降至10.44±6.27μV（P<0.05）。治疗结束后（T1），总得分、前静息阶段平均值、II型肌纤维上升时间、I型肌纤维平均值、I型肌纤维恢复时间、II型肌纤维压力最大值、I型肌纤维压力平均值等关键指标均较治疗前显著改善（P<0.05），而II型肌纤维最大值、最大耐受压力值等相关指标治疗前后无显著差异（P>0.05）。结论 肌电压力一体化电刺激联合生物反馈治疗不仅能够显著缓解尿失禁症状，提高生活质量，还能优化盆底肌功能。
关键词： 肌电压力一体化电刺激；生物反馈；压力性尿失禁；盆底肌功能
Abstract
Objective To investigate the clinical efficacy and safety of integrated electromyographic pressure electrical stimulation combined with biofeedback therapy in improving symptoms, pelvic floor muscle function, and quality of life in women with mild to moderate stress urinary incontinence. Methods The study included 79 women diagnosed with mild-to-moderate stress urinary incontinence, the average age was (34.59±7.09) years, the average disease duration was (17.20±9.80) months, and the average BMI was (22.80±3.20) kg/m2.all of them received integrated electromyographic pressure electrical stimulation combined with biofeedback therapy, the stimulation frequency is 15-60Hz, three times a week, with each treatment lasting 30 minutes. A total of 15 treatments were completed for 5 consecutive weeks. Before treatment (T0), after treatment (T1) and follow-up (3 months after treatment, T2) at different time points, the International Consultative Committee on Urinary Incontinence Questionnaire short form (ICI-Q-SF), Incontinence Impact questionnaire short form (IIQ-7), pelvic floor electromyograph/pressure and other indicators were observed before and after treatment. Results The ICI-Q-SF score decreased from 7.15±3.49 points (T0) to 0.92±2.51 points (T1) and 2.20±1.00 points (T2) (compared with T0, T1 and T2, P <0.05). The total clinical effective rate was 86.1%, among which the cure rate was 83.5%. The total score of IIQ-7 increased from 2.89± 3.61 points (T0) to 0.38± 1.20 points (T1) and 0.28± 1.30 points (T2) (compared with T0, T1 and T2, P <0.05). Pelvic floor electromyography/pressure assessment: The total score of pelvic floor electromyography increased from 51.01±13.70 points at baseline (T0) to 61.86±12.15 points at the end of treatment (T1), with an increase of 21.3% (P<0.05). The average value of the pre-resting stage decreased from 8.27±5.42μV (T0) to 5.19±3.80μV (T1), with a decrease of 37.2%(P<0.05). The average value of type I muscle fibers increased from 34.92±20.67μV (T0) to 37.48±16.70μV (T1), with an increase of 7.3% (P<0.05). The maximum pressure of type II muscle fibers increased from 5.64±4.37cmH2O (T0) to 8.30±5.65 cmH2O (T1), with an increase of 47.2% (P<0.05). The average pressure of type I muscle fibers increased from 4.49±3.54cmH2O (T0) to 7.50±5.04 cmH2O (T1), with an increase of 67.0% (P<0.05). The variability of type I muscle fibers decreased from 0.23±0.10 to 0.18±0.08, suggesting that the stability improvement of type I muscle fiber contraction was 21.7% (P<0.05). The recovery time of type I muscle fibers was shortened from 1.28±1.03s to 0.90±0.54s (P<0.05), reflecting an improvement range of 29.7% in muscle fatigue recovery ability. The initial electromyography (EMG) value decreased from 8.57±5.55μV to 6.72±4.42μV (P<0.05), and the tolerated EMG value decreased from 16.19±8.73μV to 10.44±6.27μV (P<0.05). After treatment (T1), key indicators such as the total score, the average value of the pre-resting stage, the rise time of fast muscle, the average value of slow muscle, the recovery time of slow muscle, the maximum value of fast muscle pressure, and the average value of slow muscle pressure were significantly improved compared with those before treatment (P<0.05), while there were no significant differences in related indicators such as the maximum value of fast muscle and the maximum tolerable pressure value before and after treatment (P>0.05). Conclusion Integrated electromyographic pressure electrical stimulation combined with biofeedback therapy can not only significantly relieve the symptoms of urinary incontinence, improve the quality of life, but also optimize the pelvic floor muscle function.
Key words： Integrated electromyographic pressure electrical stimulation; Biofeedback; Stress urinary incontinence; Pelvic floor muscle function
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