本文選題：艾灸 + 女性壓力性尿失禁�。� 參考：《湖北中醫(yī)藥大學》2017年碩士論文

【摘要】：目的壓力性尿失禁為臨床常見病,特別是中老年女性。隨著我國社會人口老齡化日益加劇,本病的發(fā)病率呈上升趨勢,嚴重地影響了婦女的正常生活和身心健康。婦女們常認為尿失禁是一種隨年齡增長而出現(xiàn)的正�，F(xiàn)象,羞于向他人提及,更很少主動就診,除非被直接問及,直接影響生活質(zhì)量。因此探尋一種科學有效并且簡便的方法預防和治療本病具有十分積極的意義,本實驗的目的就是探討艾灸聯(lián)合生物反饋與電刺激治療女性壓力性尿失禁的臨床效果。方法收集我院婦產(chǎn)科門診西醫(yī)診斷為輕、中度女性壓力性尿失禁,中醫(yī)辨證屬腎氣虛型的患者120例,根據(jù)隨機抽樣的方法分為治療組和對照組,各60例,對照組通過盆底康復儀進行盆底功能康復治療(生物反饋+電刺激),3天一次,10次為一個療程。治療組在對照組的基礎上聯(lián)合應用艾條灸氣海、關元、中極穴,每處灸5-7分鐘,共20分鐘,隔天一次,20次為一療程。治療前后觀察患者國際尿失禁咨詢委員會尿失禁問卷表簡表(ICI-Q-SF)評分、會陰肌力及三維B超下監(jiān)測膀胱頸移動度(UVJ-M)、膀胱尿道后角(PUVA)和盆膈裂孔前后徑、左右徑、面積的變化,進行臨床療效的評價,并在治療結(jié)束后3個月、6個月進行隨訪。結(jié)果經(jīng)治療后,兩組各項指標較治療前均有改善,治療組與對照組比較,ICI-Q-SF評分明顯降低,并且在3個月、6個月隨訪中ICI-Q-SF評分也較對照組降低。一個療程治療后及3個月、6個月隨訪治療組較對照組I類肌力改善明顯,II類肌力改善不明顯,兩者差別無統(tǒng)計學差異。三維B超結(jié)果提示,經(jīng)一個療程治療后,兩組UVJ-M和PUVA較治療前均降低(P0.05),治療組較對照組兩項指標明顯降低;治療后3個月,治療組與對照組比較,PUVA減小,UVJ-M差異無統(tǒng)計學意義;治療后6個月,治療組UVJ-M和PUVA水平均降低。在靜息期,治療后、3個月、6個月治療組與對照組比較,盆膈裂孔左右徑、前后徑及面積均降低。在縮肛期,一個療程治療后盆膈裂孔前后徑、左右徑均降低,盆膈裂孔面積雖減小,但無統(tǒng)計學意義;療程結(jié)束后3個月隨訪,盆膈裂孔左右徑及面積均降低,但盆膈裂孔左右徑無統(tǒng)計學差異;療程結(jié)束后6個月隨訪,盆膈裂孔左右徑及面積均減小,盆膈裂孔前后徑雖減小,但無統(tǒng)計學差異。臨床療效比較,1個療程治療結(jié)束后、3個月、6個月總有效率分別為96.67%、88.33%、81.67%,與對照組比較差異明顯,臨床療效總有效率優(yōu)于對照組,遠期療效好。結(jié)論艾灸聯(lián)合生物反饋與電刺激和單用生物反饋與電刺激對女性壓力性尿失禁均有治療作用,但聯(lián)合應用優(yōu)于單用生物反饋與電刺激,且遠期療效更佳。
[Abstract]:Objective stress urinary incontinence is a common clinical disease, especially in middle-aged women. With the aging of social population, the incidence of this disease is on the rise, which seriously affects the normal life and physical and mental health of women. Women often think of urinary incontinence as a normal age-related phenomenon, shy of mentioning it to others, and less likely to seek medical attention unless asked directly about it, directly affecting the quality of life. Therefore, it is of great significance to explore a scientific, effective and simple method for the prevention and treatment of this disease. The purpose of this experiment is to explore the clinical effect of moxibustion combined with biofeedback and electrical stimulation in the treatment of female stress urinary incontinence. Methods 120 patients with mild and moderate female stress urinary incontinence diagnosed as mild and moderate female stress urinary incontinence in our outpatient department of gynecology and obstetrics were randomly divided into treatment group (n = 60) and control group (n = 60). The control group was treated with pelvic floor rehabilitation by pelvic floor rehabilitation instrument (biofeedback electrical stimulation was given 10 times a day as a course of treatment). On the basis of the control group, the treatment group was treated with moxibustion at Qihai, Guanyuan and Zhongji points for 5-7 minutes in each place for 20 minutes, 20 times every other day as a course of treatment. Before and after treatment, the ICI-Q-SFscore of urinary incontinence questionnaire of the International Advisory Committee on urinary incontinence (ICI-Q-SF), the changes of bladder neck mobility (UVJ-MN), posterior vesicourethral horn (PUVAA) and the anterior and posterior diameter, left and right diameter and area of pelvic and phrenic fissure were monitored under perineal muscle strength and three dimensional B ultrasound. The clinical efficacy was evaluated and followed up 3 months and 6 months after treatment. Results after treatment, the indexes of the two groups were improved. The ICI-Q-SF score of the treatment group was significantly lower than that of the control group, and the ICI-Q-SF score of the treatment group was lower than that of the control group during the follow-up of 3 months and 6 months. After a course of treatment and 3 months and 6 months follow-up treatment group compared with the control group the improvement of type I muscle strength was not obvious and there was no significant difference between the two groups. The results of three dimensional ultrasound showed that after one course of treatment, both UVJ-M and PUVA in the two groups were significantly lower than those in the control group, and that in the treatment group was significantly lower than that in the control group 3 months after treatment, there was no significant difference between the treatment group and the control group in the reduction of UVJ-M and PUVA. The levels of UVJ-M and PUVA in the treatment group decreased 6 months after treatment. In the rest period, 3 months and 6 months after treatment, the diameter, anterior and posterior diameter and area of the pelvic diaphragm hiatus decreased in the treatment group compared with the control group. In the period of anus contraction, the anterior and posterior diameter, left and right diameter of the pelvic diaphragm hiatus decreased after one course of treatment, but the area of the pelvic diaphragm hiatus decreased, but there was no statistical significance, and the left and right diameter and area of the pelvic diaphragm hole decreased after 3 months follow-up after the end of the course of treatment. But there was no statistical difference in the diameter of the left and right of the pelvic diaphragm hole, and there was no statistical difference in the diameter and area of the left and right of the hole of the pelvic diaphragm after 6 months follow-up, but there was no significant difference in the anterior and posterior diameter of the hole of the pelvic diaphragm. Compared with the control group, the total effective rates of one course of treatment, 3 months and 6 months, were 96.67 and 88.33, respectively. The difference was significant compared with the control group. The total effective rate was better than that of the control group, and the long-term effect was good. Conclusion moxibustion combined with biofeedback and electrical stimulation and single biofeedback and electrical stimulation have therapeutic effects on female stress urinary incontinence, but the combination of moxibustion with biofeedback and electrical stimulation is superior to biofeedback and electrical stimulation alone, and the long-term effect is better.
【學位授予單位】：湖北中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R711.59

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