發(fā)布時(shí)間：2018-06-08 17:54

  本文選題：盆底二維超聲 + 中晚期妊娠　； 參考：《廣州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：第一部分:中晚期妊娠孕婦盆底二維超聲特點(diǎn)與壓力性尿失禁的相關(guān)性目的本研究旨在比較妊娠中、晚期孕婦經(jīng)會(huì)陰盆底二維超聲的表現(xiàn)特點(diǎn),為研究妊娠與壓力性尿失禁之間的關(guān)系提供影像學(xué)依據(jù)。方法對(duì)2013年5月至2016年6月在廣州醫(yī)科大學(xué)附屬第一醫(yī)院婦產(chǎn)科接受常規(guī)產(chǎn)前檢查,孕齡為14-40周的74例中晚期單胎妊娠孕婦為研究對(duì)象,采用尿失禁(簡表7),納入標(biāo)準(zhǔn)為:孕期有無在打噴嚏、大笑或提重物時(shí)出現(xiàn)不自主尿液漏出,出現(xiàn)次數(shù)至少3次,將其分為尿失禁組(34例)和無尿失禁組(40例)。所有受檢者均接受靜息狀態(tài)和最大Valsalva動(dòng)作時(shí)的經(jīng)會(huì)陰盆底二維超聲檢查,比較觀察中晚期妊娠孕婦盆底二維超聲的表現(xiàn)特點(diǎn)。觀察指標(biāo)有:膀胱頸角度(βr、βs)、膀胱頸旋轉(zhuǎn)角度(△β)、膀胱頸活動(dòng)度(BND)、膀胱尿道后角(θr、θs)、尿道旋轉(zhuǎn)角度(△ɑ)。對(duì)中晚期妊娠尿失禁組和無尿失禁組的各項(xiàng)觀察指標(biāo)進(jìn)行比較分析,進(jìn)行獨(dú)立樣本t檢驗(yàn)、偏相關(guān)分析。PO.05認(rèn)為有統(tǒng)計(jì)學(xué)意義。兩組受檢者的年齡、BMI、孕周、產(chǎn)次等基本資料比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。所有受檢者均簽署知情同意書。結(jié)果1、34例中晚期妊娠尿失禁組孕婦中,在早期妊娠就開始發(fā)生SUI的有5例(14.7%),在中期妊娠就開始發(fā)生SUI的有20例(58.8%),在晚期妊娠開始發(fā)生SUI的有9例(26.5%)。2、中晚期妊娠尿失禁組的膀胱頸旋轉(zhuǎn)角度、膀胱頸活動(dòng)度以及最大Valsalva動(dòng)作時(shí)的膀胱頸角度、膀胱尿道后角均大于無尿失禁組,(t值分別=3.18、3.138、2.765、3.401),其差異均有統(tǒng)計(jì)學(xué)意義,P值均0.05。中晚期妊娠尿失禁組的尿道旋轉(zhuǎn)角度以及靜息狀態(tài)時(shí)的膀胱頸角度、膀胱尿道后角亦大于無尿失禁組,(t值分別=1.602、0.859、1.711),差異無統(tǒng)計(jì)學(xué)意義,P值均0.05。3、中晚期妊娠尿失禁組的尿道旋轉(zhuǎn)角度與孕周呈中度相關(guān),偏相關(guān)系數(shù)=0.378(P0.05),有統(tǒng)計(jì)學(xué)意義。結(jié)論患有SUI的中晚期妊娠孕婦膀胱尿道周圍支持結(jié)構(gòu)有明顯改變。會(huì)陰盆底二維超聲的膀胱頸旋轉(zhuǎn)角度、膀胱頸活動(dòng)度以及最大Valsalva動(dòng)作時(shí)的膀胱頸角度、膀胱尿道后角對(duì)中晚期妊娠孕婦SUI的診斷具有一定的參考價(jià)值。妊娠期行會(huì)陰盆底超聲安全可行。第二部分:輕、中度壓力性尿失禁盆底康復(fù)治療的療效評(píng)估目的本研究旨在探討電刺激+生物反饋治療聯(lián)合kegel訓(xùn)練對(duì)女性輕、中度壓力性尿失禁患者盆底功能的康復(fù)療效。方法對(duì)2013年5月至2016年6月在廣州醫(yī)科大學(xué)附屬第一醫(yī)院婦產(chǎn)科門診就診的78例輕、中度壓力性尿失禁患者為研究對(duì)象。將患者隨機(jī)分成2組,治療組(39例)進(jìn)行電刺激+生物反饋+kegel訓(xùn)練,對(duì)照組(39例)進(jìn)行單純kegel訓(xùn)練。通過問卷調(diào)查、盆底肌力測定、尿流率檢查、護(hù)墊試驗(yàn)、會(huì)陰盆底二維超聲檢查比較輕、中度SUI患者電刺激+生物反饋+kegel訓(xùn)練和單純kegel訓(xùn)練在治療前、治療后3個(gè)月、6個(gè)月的療效。應(yīng)用SPSS 19.0統(tǒng)計(jì)軟件,對(duì)定量資料,組間比較采用獨(dú)立樣本t檢驗(yàn);組內(nèi)比較采用配對(duì)樣本t檢驗(yàn),結(jié)果用(?)±s表示。定性資料采用Х2檢驗(yàn)和秩和檢驗(yàn)進(jìn)行分析。P0.05為差異有統(tǒng)計(jì)學(xué)意義。所有受檢者均簽署知情同意書。結(jié)果1、治療組和對(duì)照組患者治療前與治療后3個(gè)月、6個(gè)月的比較,問卷評(píng)分較治療前均減少,生活質(zhì)量較治療前均有改善,差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。2、治療組和對(duì)照組治療前與治療后3個(gè)月、治療后6個(gè)月比較,肌力較治療前增加,差異均有統(tǒng)計(jì)學(xué)意義,(P0.05)。對(duì)照組治療后6個(gè)月比治療后3個(gè)月肌力較前改善,差異有統(tǒng)計(jì)學(xué)意義,(P0.05)。3、治療組和對(duì)照組治療前、治療后3個(gè)月、治療后6個(gè)月的峰值尿流率、平均尿流率和到達(dá)峰值尿流率時(shí)間比較,差異均無統(tǒng)計(jì)學(xué)意義,(P0.05)。4、治療組中治療前與治療后6個(gè)月比較,護(hù)墊試驗(yàn)的漏尿量較治療前明顯減少,差異有統(tǒng)計(jì)學(xué)意義,(P0.05)。對(duì)照組護(hù)墊試驗(yàn)的漏尿量治療前與治療后3個(gè)月、治療后6個(gè)月比較,差異均無統(tǒng)計(jì)學(xué)意義,(P0.05)。5、組內(nèi)比較,治療組的尿道旋轉(zhuǎn)角度、膀胱頸移動(dòng)度、靜息狀態(tài)下膀胱尿道后角在治療后3個(gè)月、治療后6個(gè)月較治療前均減小;治療組Valsalva動(dòng)作下膀胱尿道后角在治療6個(gè)月后較治療前減小,差異均有統(tǒng)計(jì)學(xué)意義,(P0.05)。對(duì)照組的尿道旋轉(zhuǎn)角度在治療后3個(gè)月、治療后6個(gè)月較治療前均減小;對(duì)照組靜息狀態(tài)下膀胱尿道后角在治療6個(gè)月后較治療前減小,差異均有統(tǒng)計(jì)學(xué)意義,(P0.05)。治療組中,膀胱頸移動(dòng)度、Valsalva動(dòng)作下的膀胱尿道后角的治療前后的改變,效果持續(xù)6個(gè)月,優(yōu)于對(duì)照組。組間比較,治療組與對(duì)照組的膀胱頸角度、膀胱頸旋轉(zhuǎn)角度、膀胱頸移動(dòng)度、膀胱尿道后角、尿道旋轉(zhuǎn)角度分別在治療前、治療后3個(gè)月、治療后6個(gè)月比較,差異均無統(tǒng)計(jì)學(xué)意義,(P0.05)。結(jié)論電刺激+生物反饋治療聯(lián)合kegel訓(xùn)練及單純kegel訓(xùn)練均能改善膀胱尿道周圍支持結(jié)構(gòu)。電刺激+生物反饋治療聯(lián)合kegel訓(xùn)練,效果持續(xù)6個(gè)月,優(yōu)于單純kegel訓(xùn)練。
[Abstract]:The first part: the correlation between the two dimensional ultrasound characteristics of pelvic floor and stress urinary incontinence in pregnant women with middle and late pregnancy. The purpose of this study was to compare the characteristics of the pelvic floor two-dimensional ultrasound in the pregnant and late pregnant women, and to provide the imaging basis for the study of the relationship between pregnancy and stress urinary incontinence. Methods from May 2013 to June 2016 were in Guangzhou. The First Hospital Affiliated First Hospital of the medical university received routine prenatal examination, and 74 cases of middle and late single pregnancy pregnant women with 14-40 weeks of gestational age were studied. Urinary incontinence (Table 7) was adopted as the standard: unregulated urine leakage occurred during pregnancy during sneezing, laughter or weight lifting, at least 3 times, which was divided into urinary incontinence group (34 Cases (40 cases) and anuria group (40 cases). The two dimensional ultrasound examination of the pelvic floor in the rest of the patients received the resting state and the maximum movement of the perineal pelvic floor. The characteristics of the pelvic floor two-dimensional ultrasound in the middle and late pregnant women were compared. The observation indexes were the angle of the bladder neck (beta R, beta s), the rotation angle of the bladder neck (delta beta), the bladder neck activity (BND), cysturia. Posterior horn (theta R, theta s), urethral rotation angle (delta). Compare and analyze the observation indexes of urinary incontinence group and incontinence group in middle and late pregnancy group, independent sample t test, partial correlation analysis.PO.05 think there is statistical significance. There is no significant difference between the two groups of age, BMI, gestational week, and secondary production, P0 .05) all subjects signed informed consent. Results in the 1,34 cases of middle and late pregnancy urinary incontinence, there were 5 cases of SUI in early pregnancy (14.7%), 20 cases (58.8%) in the mid-term pregnancy, 9 cases (26.5%).2, and the angle of bladder neck rotation in middle and late pregnancy urinary incontinence group. The bladder neck movement and the bladder neck angle at the maximum Valsalva movement were greater than those in the anuria group (t value =3.18,3.138,2.765,3.401), and the difference was statistically significant. The P values were both the urethral rotation angle of the middle and late pregnancy urinary incontinence group and the bladder neck angle at resting state, and the posterior urethra posterior angle of the vesical urethra. More than no incontinence group, (t value =1.602,0.859,1.711), the difference was not statistically significant, the P value was 0.05.3. The urethral rotation angle of the middle and late pregnancy urinary incontinence group was moderately correlated with the gestational age, and the partial correlation coefficient =0.378 (P0.05) was statistically significant. Conclusion the support structure of the urinary bladder and urethra around the middle and late pregnant women with SUI has a significant change. The bladder neck rotation angle of the pelvic floor of the perineum, the activity of the bladder neck and the angle of the bladder neck at the maximum Valsalva movement, the posterior angle of the bladder and urethra has a certain reference value for the diagnosis of SUI in pregnant women with middle and late pregnancy. The pelvic floor ultrasound of pregnancy is safe and feasible. Second parts: light and moderate stress urinary incontinence pelvic floor rehabilitation therapy The purpose of this study was to explore the curative effect of electrical stimulation plus biofeedback therapy combined with Kegel training on pelvic floor function in women with mild and moderate stress urinary incontinence. Methods 78 cases of mild, moderate stress urinary incontinence from May 2013 to June 2016 in the Department of Obstetrics and Gynecology, Affiliated First Hospital of Guangzhou Medical University, were investigated. The patients were randomly divided into 2 groups, the treatment group (39 cases) was trained with electrical stimulation + biofeedback +kegel, and the control group (39 cases) was trained with simple Kegel. Through questionnaire survey, pelvic floor muscle strength measurement, urine flow rate examination, padding test, pelvic floor two-dimensional ultrasound examination of perineum, moderate SUI patients and biofeedback +kegel training and single The effect of pure Kegel training before treatment was 3 months and 6 months after treatment. SPSS 19 statistical software was applied to quantitative data and independent sample t test was used for comparison between groups. The paired sample t test was used in the group. The result was (?) + s. Qualitative data using 2 test and rank sum test to analyze.P0.05 was statistically significant. Results 1, 1, the treatment group and the control group before treatment and 3 months after the treatment, 6 months after the comparison, the questionnaire scores were less than before treatment, the quality of life improved before treatment, the difference was statistically significant (P0.01).2, the treatment group and the group before and after treatment 3 months after the treatment, 6 months after the treatment, muscle. The difference was statistically significant before treatment, (P0.05). The difference was statistically significant in the control group 6 months after treatment compared with the 3 months after treatment. (P0.05).3, before treatment and 3 months after treatment, the peak urine flow rate, the average urine flow rate and the peak urine flow rate were compared between the treatment group and the control group before the treatment, and the difference between the average urine flow rate and the peak urine flow rate was compared. No statistical significance, (P0.05).4, the treatment group before treatment and 6 months after treatment compared with the treatment before treatment, the leakage urine volume decreased significantly than before the treatment, the difference was statistically significant, (P0.05). The control group before the treatment of leak urine test and 3 months after treatment, 6 months after treatment, the difference was not statistically significant, (P0.05).5, group comparison, In the treatment group, the urethral rotation angle, the bladder neck mobility, the resting state of the bladder and the posterior urethral angle were 3 months after treatment, and the 6 months after treatment decreased compared with those before the treatment. The treatment group was less than before the treatment for 6 months after the treatment of Valsalva, and the difference was statistically significant, (P0.05). The urethral rotation angle of the control group was treated. 3 months after treatment, the 6 months after treatment decreased compared with that before treatment, and the control group was less than before treatment after 6 months of treatment. The difference was statistically significant, (P0.05). In the treatment group, the change of bladder neck mobility and the posterior urethral angle of the bladder and urethra under the action of Valsalva lasted for 6 months, superior to the control group. Comparison between the treatment group and the control group of bladder neck angle, bladder neck rotation angle, bladder neck mobility, bladder urethral angle, urethral rotation angle before treatment, 3 months after treatment, 6 months after treatment, the difference was not statistically significant, (P0.05). Conclusion electrical stimulation plus biofeedback therapy combined with Kegel training and simple Kegel training are all It can improve the supporting structure of bladder and urethra. Electrical stimulation plus biofeedback therapy combined with Kegel training lasted for 6 months, better than Kegel training alone.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.2;R445.1

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