Four-dimensional pelvic floor ultrasound can evaluate the curative effect of electrical stimulation biofeedback in female patients with pelvic floor dysfunction
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摘要:
目的 探讨基于盆底四维超声评估女性盆底肌功能障碍患者电刺激生物反馈治疗的疗效。 方法 选取2021年1月~2023年1月在我院收治的120例产后女性盆底肌功能障碍患者作为研究对象, 所有患者均予以电刺激生物反馈治疗4个疗程, 并在治疗前、治疗结束后行盆底四维超声检查。评估入组患者的临床疗效, 比较治疗前、治疗后盆底肌力分级、1 h尿垫试验、盆底肌收缩压、四维超声参数(静息时、Valsalva动作时)、膀胱颈移动度和尿道旋转角, 采用Pearson相关性分析治疗后膀胱颈移动度、尿道旋转角与盆底肌力分级、盆底肌收缩压的关系。 结果 120例患者经电刺激生物反馈治疗, 总有效率为84.17%。治疗后盆底肌力分级、盆底肌收缩压比治疗前明显升高, 1 h尿垫试验较之治疗前均明显下降, 差异均有统计学意义(P < 0.001)。治疗后肛提肌厚度(静息时、Valsalva动作时)较之治疗前均明显升高, 肛提肌裂孔左右径、肛提肌裂孔面积、膀胱后角、膀胱颈移动度、尿道旋转角较之治疗前均明显下降, 差异有统计学意义(P < 0.001)。治疗后膀胱颈移动度与盆底肌力分级、盆底肌收缩压呈负相关关系(r=-0.746、-0.781, P < 0.001);尿道旋转角与盆底肌力分级、盆底肌收缩压呈负相关关系(r=-0.779、-0.792, P < 0.001)。 结论 经盆底四维超声可以较好评估盆底肌功能障碍患者电刺激生物反馈治疗前后盆底肌功能, 值得临床推广。 Abstract:Objective To evaluate the curative effect of electrical stimulation biofeedback in female patients with pelvic floor dysfunction (PFD) based on four-dimensional pelvic floor ultrasound. Methods A total of 120 female patients with postpartum PFD who underwent electrical stimulation biofeedback for 4 courses in the hospital were enrolled as the research objects from January 2021 to January 2023.All underwent four-dimensional pelvic floor ultrasound examination before and after treatment.The clinical curative effect was evaluated.The grading of pelvic floor muscle strength, 1 h urine pad test, systolic blood pressure of pelvic floor muscle and four-dimensional ultrasound parameters (bladder neck movement and urethral rotation angle under rest and Valsalva maneuver state) were compared before and after treatment.The relationship between bladder neck movement, urethral rotation angle and grading of pelvic floor muscle strength, systolic blood pressure of pelvic floor muscle was analyzed by Pearson correlation analysis. Results In the 120 patients, total response rate of electrical stimulation biofeedback was 84.17%.After treatment, grading of pelvic floor muscle strength and systolic blood pressure of pelvic floor muscle were significantly increased, score of 1 h urine pad test was significantly decreased, the difference was statistically significant (P < 0.001).After treatment, levator ani thickness (under rest and Valsalva maneuver state) was significantly increased, left-right diameter and area of levator hiatus, posterior bladder angle, bladder neck movement and urethral rotation angle were significantly decreased, the difference was statistically significant (P < 0.001).After treatment, bladder neck movement was negatively correlated with grading of pelvic floor muscle strength and systolic blood pressure of pelvic floor muscle (r=-0.746, -0.781, P < 0.001), and urethral rotation angle was also negatively correlated with them (r=-0.779, -0.792, P < 0.001). Conclusion Four-dimensional pelvic floor ultrasound can better evaluate pelvic floor muscle function in PFD patients before and after electrical stimulation biofeedback. -
图 1 压力性尿失禁患者治疗前、4个疗程结束后的盆底四维超声图
Figure 1. Four-dimensional pelvic floor ultrasound images for patients with stress urinary incontinence before treatment and after 4 courses of treatment.
表 1 治疗前、治疗后盆底肌力分级、1 h尿垫试验和盆底肌收缩压比较
Table 1. Comparison of pelvic floor muscle strength grading, 1 h urine pad test and systolic blood pressure of pelvic floor muscle before and after treatment (n=120, Mean±SD)
Time Grading of pelvic floor muscle strength 1 h urine pad test (g) Systolic blood pressure of pelvic floor muscle (cmH2O) Before treatment 2.32±0.52 4.25±0.57 35.14±6.49 After treatment 3.14±0.68 1.36±0.31 41.88±5.72 t 10.493 48.791 8.534 P < 0.001 < 0.001 < 0.001 
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表 2 治疗前、治疗后静息时、Valsalva动作时四维超声参数比较
Table 2. Comparison of four-dimensional ultrasound parameters under rest and Valsalva maneuver state before and after treatment (n=120, Mean±SD)
Ultrasound parameters Before treatment After treatment t P Levator ani thickness Rest state 0.52±0.08 0.64±0.10 10.264 < 0.001 Valsalva maneuver state 0.50±0.06 0.59±0.08 9.859 < 0.001 left-right diameter of levator hiatus Rest state 3.75±0.65 3.24±0.78 5.502 < 0.001 Valsalva maneuver state 4.21±0.51 3.87±0.48 5.318 < 0.001 Area of levator hiatus (cm2) Rest state 23.14±3.52 19.35±3.69 8.141 < 0.001 Valsalva maneuver state 26.70±3.65 22.33±3.42 9.570 < 0.001 Posterior bladder angle (°) Rest state 112.37±20.46 80.34±16.58 13.323 < 0.001 Valsalva maneuver state 125.67±15.76 85.32±14.60 20.574 < 0.001
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表 3 治疗前、治疗后膀胱颈移动度、尿道旋转角比较
Table 3. Comparison of bladder neck movement and urethral rotation angle before and after treatment (n=120, Mean±SD)
Time Bladder neck movement
(mm)Urethral rotation angle (°) Before treatment 21.66±5.64 38.10±6.25 After treatment 14.18±5.35 27.42±5.71 t 10.540 13.819 P < 0.001 < 0.001
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表 4 治疗后膀胱颈移动度、尿道旋转角与盆底肌力分级、盆底肌收缩压的关系
Table 4. The relationship between bladder neck movement, urethral rotation angle and grading of pelvic floor muscle strength, systolic blood pressure of pelvic floor muscle after treatment
Detection parameters Grading of pelvic floor muscle strength Systolic blood pressure of pelvic floor muscle r P r P Bladder neck movement -0.746 < 0.001 -0.781 < 0.001 Urethral rotation angle -0.779 < 0.001 -0.792 < 0.001
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