發(fā)布時(shí)間：2018-05-30 01:22

  本文選題：低頻電刺激 + 生物反饋�。� 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景宮頸癌作為女性生殖系統(tǒng)最為大家熟知的常見(jiàn)的惡性腫瘤之一,越來(lái)越引起人們的重視。在我國(guó),隨著宮頸癌篩查的普及,越來(lái)越多的早中期宮頸癌得以發(fā)現(xiàn),并呈年輕化發(fā)展趨勢(shì)。盡管近年國(guó)內(nèi)外發(fā)展以來(lái),早期宮頸癌有縮小手術(shù)范圍的趨勢(shì),但是廣泛全子宮切除術(shù)+盆腔/腹主淋巴結(jié)切除術(shù)(Piver Ⅲ型)仍為常用術(shù)式。因其手術(shù)范圍較大,耗時(shí)長(zhǎng),盆底韌帶、血管及神經(jīng)受到不同程度損傷或切除,導(dǎo)致部分患者出現(xiàn)術(shù)后盆底功能障礙(PFD)高發(fā)情況。主要表現(xiàn)為尿潴留,泌尿系統(tǒng)的感染,排便障礙,以及性功能障礙等。而尿瘺,盆腔感染,淋巴囊腫,較為少見(jiàn)。宮頸癌術(shù)后盆底功能障礙高發(fā),嚴(yán)重影響了人們的生活質(zhì)量,如何提高宮頸癌術(shù)后患者生活質(zhì)量成為了迫切需要解決的問(wèn)題。有研究表明盆底電生理功能的變化與PFD之間有相當(dāng)大的相關(guān)性,盆底電生理出現(xiàn)變化早于PFD的出現(xiàn)。因此盆底組織的相應(yīng)損傷可以通過(guò)早期進(jìn)行電生理檢查得以發(fā)現(xiàn);對(duì)盆底進(jìn)行電生理治療能夠預(yù)防盆底功能障礙性疾病的發(fā)生,并能對(duì)其進(jìn)行治療。有研究表明,電刺激聯(lián)合生物反饋治療盆底功能障礙性疾病的效果優(yōu)于單一治療方案。本文將重點(diǎn)闡述低頻電刺激聯(lián)合生物反饋治療宮頸癌術(shù)后盆底功能障礙的臨床管理及療效。目的本次研究采用前瞻性隨機(jī)對(duì)照研究分析低頻電刺激聯(lián)合生物反饋治療對(duì)早中期宮頸癌患者術(shù)后盆底功能障礙的防治效果以及對(duì)生活質(zhì)量影響情況。材料和方法1研究對(duì)象選自2015年1月至2016年1月在鄭州大學(xué)人民醫(yī)院婦產(chǎn)科收治的行廣泛性子宮全切除術(shù)+盆腔淋巴結(jié)清掃術(shù)并經(jīng)病理結(jié)果證實(shí)為惡性腫瘤的75例宮頸癌患者。入選標(biāo)準(zhǔn):(1)年齡60歲;(2)宮頸癌臨床分期為Ⅰa2-Ⅱa2期;排除標(biāo)準(zhǔn):(1)術(shù)前及術(shù)后放化療者;(2)術(shù)前盆腔臟器脫垂者≥Ⅱ期者;(3)年齡≥60歲;(4)術(shù)前尿潴留者;(5)術(shù)前排便困難者;(6)術(shù)前中度以上尿失禁者;(7)具體影響到隨訪的疾病;(8)不能判定療效或資料不全影響療效判定者;中途撤出標(biāo)準(zhǔn):(1)研究者從醫(yī)學(xué)角度考慮受試者有必要終止試驗(yàn);(2)患者自己要求停止試驗(yàn);(3)試驗(yàn)期間出現(xiàn)嚴(yán)重并發(fā)癥或不良反應(yīng)者。2研究方法2.1分組:隨機(jī)數(shù)字表法將符合納入標(biāo)準(zhǔn)的75例宮頸癌患者分為兩組,實(shí)驗(yàn)組38人,5例失訪,2例轉(zhuǎn)入他科繼續(xù)治療,1例拒絕隨訪;對(duì)照組37人,3例失訪,4例轉(zhuǎn)入他科治療,故收集病例時(shí),為保持隨訪資料的完整性,予以淘汰。盆底治療組:30例,年齡36-59歲,平均年齡(48.93±7.21)歲。對(duì)照組:30例,年齡37-59歲,平均年齡(50.93±4.01)歲。2.2具體方法:盆底治療組和對(duì)照組患者均行廣泛性全子宮全切術(shù)+盆腔淋巴結(jié)清掃術(shù)。2.2.1術(shù)后早期干預(yù)方案:盆底治療組術(shù)后第5天給予PHENIX神經(jīng)肌肉治療儀8-PLUS電刺激治療共2天,尿潴留方案為:頻率35Hz,脈寬200μs,2次/天,時(shí)間為20分鐘。電極片放置位置為:一枚置于S3區(qū),另一枚置于膀胱區(qū)。電極片選用50*50mm粘性電極片。術(shù)后7天拔除尿管查殘余尿≤100ml,停止電刺激治療。殘余尿1OOml視為尿潴留,再次置入尿管,繼續(xù)給予8-PLUS電刺激治療,一日2次,共7天,14天時(shí)再次拔除尿管,測(cè)殘余尿,若殘余尿≥100ml,不再給予8-PLUS電刺激治療,根據(jù)臨床常規(guī)處理。對(duì)照組患者于術(shù)后7天拔除尿管行殘余尿測(cè)定,若殘余尿100ml,不予特殊處理;若殘余尿≥100ml留置尿管,7天后拔除尿管查殘余尿,若殘余尿≥100ml留置尿管,按臨床常規(guī)處理。2.2.2術(shù)后中期干預(yù)方案:盆底治療組術(shù)后9周起給予盆腹電生理治療:PHENIX神經(jīng)肌肉治療儀8-plus盆腹下肢血管平滑肌電刺激(大循環(huán))6周。刺激方案為血?jiǎng)恿せ?2次/周,方案為:頻率4Hz,時(shí)間20min;電極片:50*90mm粘性電極片,兩組(4枚);位置:一組置于左右腳背處,另一組其中一個(gè)置于腹總靜脈右邊處,另一個(gè)置于相應(yīng)的背部同位置。術(shù)后13周給予盆底橫紋肌電刺激加生物反饋6周,1周2次,共12次,時(shí)間30min。電極位置:A1通道盆底肌肉治療頭置于陰道內(nèi),A2通道電極片置于腹部,地線標(biāo)志電極片置于髂骨處。生物反饋:U8內(nèi)置模擬各種場(chǎng)景訓(xùn)練模塊,給予會(huì)陰-腹部協(xié)調(diào)收縮。電極:杉山盆底肌肉治療頭50*50mm粘性電極片。位置:A1通道盆底肌肉治療頭置于陰道內(nèi),A2通道電極片置于腹部,地線標(biāo)志電極片置于髂骨處。對(duì)照組術(shù)后行常規(guī)護(hù)理,余無(wú)特殊干預(yù)措施。2.3具體監(jiān)測(cè)指標(biāo)2.3.1主觀部分:生活質(zhì)量問(wèn)卷之盆底障礙功能調(diào)查表(PFDI-20)PFDI-20是專門為女性盆底疾病所設(shè)計(jì),共有20個(gè)問(wèn)題,分別從排尿癥狀,排便癥狀以及盆腔臟器脫垂癥狀3個(gè)部位了解盆底功能障礙性疾病對(duì)患者生活質(zhì)量的影響及評(píng)價(jià)主觀癥狀的嚴(yán)重程度�？傇u(píng)分為0-300,分?jǐn)?shù)越高,代表對(duì)生活影響越大;盆底障礙影響問(wèn)卷7(PFIQ-7)分別從膀胱,腸道或者陰道影響日常生活三個(gè)方面進(jìn)行檢測(cè),計(jì)算總分,分值越高,代表對(duì)生活影響越大;性功能質(zhì)量調(diào)查問(wèn)卷,總得分100,分?jǐn)?shù)越高,代表其性生活質(zhì)量越好。2.3.2客觀部分:兩組患者術(shù)后尿潴留發(fā)生率比較。殘余尿"g1OOrrh,尿潴留。2.3.3客觀部分:拔除尿管時(shí)間和住院時(shí)間:宮頸癌術(shù)后一般拔除尿管時(shí)間為7-14天,住院時(shí)間越長(zhǎng),相應(yīng)住院花費(fèi)較高。2.3.4客觀部分:盆底功能檢查:主要包括自由尿流率測(cè)定(最大尿流率,平均尿流率,達(dá)峰時(shí)間,排尿時(shí)間,殘余尿),盆底電生理功能檢查(I類肌纖維肌力,Ⅰ類肌纖維疲勞度,Ⅱ類肌纖維肌力,Ⅱ類肌纖維疲勞度,肌電位),盆底控尿功能(A3反饋),盆底性功能檢查(性功能反射)。2.3.4.1自由尿流率的測(cè)定:最大尿流率Qmax,平均尿流率Qave,排尿時(shí)間,達(dá)峰時(shí)間,以及殘余尿測(cè)定。正常范圍分別是Qmax≥20ml/s,Qave≥20ml/s,排尿時(shí)間為排出尿量100ml則10秒為上限,排出尿量400ml則23秒為上限,殘余尿測(cè)定正常100ml。2.3.4.2盆底電生理功能:Ⅰ類肌纖維肌力分為0-5級(jí),患者陰道內(nèi)肌肉收縮持續(xù)時(shí)間達(dá)到其最大值的40%。持續(xù)0秒為0級(jí),持續(xù)1秒為1級(jí),2秒為2級(jí),3秒為3級(jí),4秒為4級(jí),5秒為5級(jí);Ⅱ類肌纖維肌力,患者以最大的力氣和速度勻速收縮和放松陰道,能達(dá)到最大收縮力1次為1級(jí),2次為2級(jí),3次為3級(jí),4次為4級(jí),5次為5級(jí)。Ⅰ,Ⅱ類肌纖維肌力≥3級(jí)為正常。從最高到6s終點(diǎn)的最高點(diǎn)之間的下降比率的百分比為疲勞度,正常0%,負(fù)值為異常。肌電位正常值為20-30μV,肌電位下降表示參與盆底收縮運(yùn)動(dòng)的肌纖維數(shù)量減少。2.3.4.3盆底控尿功能主要是A3反饋功能,異常時(shí)主要反映的是排尿異常。2.3.4.4盆底性功能檢查主要是盆底性功能反射,性功能反射主要表現(xiàn)為正常和異常。2.4儀器設(shè)備PHENIX神經(jīng)肌肉治療儀8-plus法國(guó)VIVALTIS公司,廣州杉山公司代理神經(jīng)修復(fù)治療儀U8 法國(guó)VIVALTIS公司,廣州杉山公司代理盆底肌肉治療頭 法國(guó)VIVALTIS公司,廣州杉山公司代理彩色多普勒超聲檢查儀 德國(guó)西門子3質(zhì)量控制3.1采用文件管理方法保證數(shù)據(jù)的真實(shí)性和同質(zhì)性。編寫流程圖,編寫標(biāo)準(zhǔn)化操作流程,設(shè)計(jì)統(tǒng)一問(wèn)卷,使用規(guī)范的量表;3.2所有患者均由我科高年資醫(yī)師開(kāi)展廣泛全子宮切除術(shù)加盆腔淋巴結(jié)清掃術(shù);3.3患者統(tǒng)一使用同款PHENIX神經(jīng)肌肉治療儀8-plus及神經(jīng)修復(fù)治療儀U8,均為廣州杉山公司出品。3.4手術(shù)人員、數(shù)據(jù)記錄員,PHENIX神經(jīng)肌肉治療儀8-plus及神經(jīng)修復(fù)治療儀U8操作醫(yī)師,進(jìn)行培訓(xùn),統(tǒng)一標(biāo)準(zhǔn);3.5對(duì)手術(shù)人員、數(shù)據(jù)記錄員施行盲法;3.6由第三方進(jìn)行數(shù)據(jù)的收集、記錄。4醫(yī)學(xué)倫理學(xué)該研究通過(guò)醫(yī)院醫(yī)學(xué)倫理委員會(huì)批審,每一位入組患者均簽署知情同意書。5統(tǒng)計(jì)方法采用Epidata3.0建立數(shù)據(jù)庫(kù),由兩名經(jīng)過(guò)培訓(xùn)的研究人員獨(dú)立錄入,核對(duì)無(wú)誤后使用SAS9.4統(tǒng)計(jì)分析軟件進(jìn)行處理,計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差(x±S)表示集中和離散趨勢(shì),用t檢驗(yàn)或方差分析進(jìn)行差異性檢驗(yàn);計(jì)數(shù)資料采用χ2檢驗(yàn)或者Fisher,s確切概率法;多時(shí)間點(diǎn)觀察資料行重復(fù)測(cè)量資料的方差分析,比較不滿足整體性,采用Kruskal-Wallis秩和檢驗(yàn)方法,重復(fù)測(cè)量方差分析不滿足球?qū)ΨQ性,采用Greenhouse-Geisser法校正P值,設(shè)定檢驗(yàn)水準(zhǔn)為0.05,P0.05差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1.主觀部分盆底治療組(30人),對(duì)照組(30人)兩組患者手術(shù)后6個(gè)月和術(shù)后12個(gè)月PFDI-20,PFIQ-7得分差異顯著,均為P0.0001,有統(tǒng)計(jì)學(xué)意義;兩組患者手術(shù)前后PFDI-20,PFIQ-7得分差異顯著,盆底治療組得分顯著減少,P0.0001,差異有統(tǒng)計(jì)學(xué)意義。兩組患者手術(shù)后12月性生活質(zhì)量得分差異顯著,P0.0001,有統(tǒng)計(jì)學(xué)意義;兩組患者宮頸癌手術(shù)前后對(duì)比性生活質(zhì)量得分差異顯著,P0.0001,盆底治療組性生活質(zhì)量得分明顯優(yōu)于對(duì)照組。2.客觀部分2.1兩組患者術(shù)后尿潴留情況:盆底治療組術(shù)后出現(xiàn)尿潴留人數(shù)為2人(6.7%),對(duì)照組術(shù)后尿潴留患者人數(shù)為12人(40.0%),盆底治療組人數(shù)明顯少于對(duì)照組,P=0.002,差異有統(tǒng)計(jì)學(xué)意義2.2.成功拔除尿管時(shí)間和住院時(shí)間比較盆底治療組(30人),成功拔除尿管時(shí)間為8.63±13.52天;對(duì)照組(30人),成功拔除尿管人數(shù)時(shí)間為10.73±24.40天,兩組成功拔除尿管時(shí)間對(duì)比P=0.0460.05,差異有統(tǒng)計(jì)學(xué)意義。盆底治療組住院時(shí)間為11.80±2.23天,對(duì)照組住院時(shí)間為14.63±3.42天,兩組住院時(shí)間比較P0.001,差異有統(tǒng)計(jì)學(xué)意義。2.3自由尿流率測(cè)定:盆底治療組和對(duì)照組手術(shù)前后自由尿流率比較差異顯著,P0.05,差異有統(tǒng)計(jì)學(xué)意義;兩組患者術(shù)后8周,術(shù)后6月,術(shù)后12月最大尿流率,平均尿流率P0.05,差異有統(tǒng)計(jì)學(xué)意義,兩組排尿時(shí)間和達(dá)峰時(shí)間比較P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。2.4盆底電生理功能:兩組手術(shù)前后盆底電生理功能比較差異顯著,P0.0001;兩組盆底電生理功能術(shù)后6月,術(shù)后12月差異顯著,P0.0001,其中Ⅱ類肌纖維肌力和Ⅱ類肌疲勞度術(shù)前差異顯著,P0.05。2.5.A3反饋:盆底治療組手術(shù)前后對(duì)比差異顯著,P0.0001差異有統(tǒng)計(jì)學(xué)意義,對(duì)照組P=0.141,差異無(wú)統(tǒng)計(jì)學(xué)意義,兩組手術(shù)前后對(duì)比差異顯著,P0.0001有統(tǒng)計(jì)學(xué)意義;兩組在術(shù)后6月,術(shù)后12月A3反饋異常率比較差異顯著,有統(tǒng)計(jì)學(xué)意義。性功能測(cè)定:盆底治療組手術(shù)前后對(duì)比差異顯著,P0.0001差異有統(tǒng)計(jì)學(xué)意義,對(duì)照組P=0.2223,差異無(wú)統(tǒng)計(jì)學(xué)意義,兩組手術(shù)前后對(duì)比差異顯著,盆底治療組性功能反射異常率明顯低于對(duì)照組,P0.0001有統(tǒng)計(jì)學(xué)意義;兩組在術(shù)后6月,術(shù)后12月性功能異常率比較差異顯著,均為P0.05,有統(tǒng)計(jì)學(xué)意義。結(jié)論1.宮頸癌術(shù)后早期給予低頻電刺激加生物反饋等干預(yù)治療,能夠有效的降低其出現(xiàn)尿潴留的機(jī)率,能夠減少患者留置尿管時(shí)間,進(jìn)一步縮短病人住院時(shí)間。2.低頻電刺激聯(lián)合生物反饋治療,可以有效的改善患者術(shù)后盆底自由尿流率功能,電生理功能,控尿功能和性功能反射。3.低頻電刺激聯(lián)合生物反饋治療,可以有效的減少術(shù)后盆底功能障礙對(duì)生活的影響,提高宮頸癌術(shù)后患者生活質(zhì)量和性生活質(zhì)量。
[Abstract]:Background cervical cancer is one of the most commonly known malignant tumors in the female reproductive system, which has attracted more and more attention. In China, with the popularization of cervical cancer screening, more and more early and middle stage cervical cancer can be found, and the trend of development is young. Although the development of early domestic and foreign, early cervical cancer has reduced operation. Extensive total hysterectomy plus pelvic / abdominal main lymph node resection (Piver type III) is still a common operation. The operation range is larger, time consuming, pelvic ligament, blood vessels and nerves are damaged or excised in varying degrees, leading to a high incidence of postoperative pelvic floor dysfunction (PFD) in some patients. The main manifestation is urinary retention. Urinary tract infection, defecation barrier, and sexual dysfunction, etc., while urinary fistula, pelvic infection, and lymphatic cysts are rare. High incidence of pelvic floor dysfunction after cervical cancer has seriously affected people's quality of life. How to improve the quality of life of patients after cervical cancer surgery has become an urgent problem. There is a significant correlation between the changes of function and PFD, and the changes in pelvic floor electrophysiology are earlier than that of PFD. Therefore, the corresponding damage of pelvic floor tissue can be detected by early electrophysiological examination; electrophysiologic treatment of pelvic floor can prevent the occurrence of dysfunctional pelvic diseases and can be treated. The effect of combination of electrical stimulation and biofeedback on pelvic floor dysfunction is better than that of a single treatment. This article will focus on the clinical management and efficacy of low frequency electrical stimulation combined with biofeedback treatment for pelvic floor dysfunction after cervical cancer. Material and methods 1 subjects were selected from January 2015 to January 2016 in the Department of gynaecology and obstetrics of the people's Hospital of Zhengzhou University, which were treated with extensive hysterectomy and pelvic lymph node dissection, and confirmed by pathological results. 75 cases of cervical cancer for malignant tumor: (1) age 60 years; (2) clinical stage of cervical cancer I a2- II A2 stage; exclusion criteria: (1) preoperative and postoperative radiotherapy and chemotherapy; (2) preoperative pelvic organ prolapse more than II stage; (3) age > 60 years of age; (4) preoperative urine retention; (5) preoperative difficulty defecation; (6) moderate urinary incontinence before operation; (7) Specific effects on follow up diseases; (8) failure to determine the effect of the effect or incomplete information on the outcome of the outcome; (1) the researchers considered the need to terminate the test from the medical point of view; (2) the patient himself asked to stop the test; (3) a 2.1 group of.2 research methods for severe complications or adverse reactions during the trial: a random number table 75 patients with cervical cancer were divided into two groups, 38 in the experimental group, 5 in the absence of visits, 2 in his department to continue the treatment, 1 in the refusal of follow-up, 37 in the control group, 3 in the loss of visits and 4 in the treatment of his family, so that the cases were collected to keep the integrity of the follow-up data and be eliminated. 30 cases, 36-59 years of age (48), average age (48) .93 + 7.21 years old. Control group: 30 cases, age 37-59 years old, the average age (50.93 + 4.01) years old.2.2 specific methods: pelvic floor treatment group and the control group were all underwent extensive total hysterectomy plus pelvic lymph node dissection.2.2.1 early intervention program after the pelvic floor treatment group fifth days after the operation to give PHENIX neuromuscular therapy instrument 8-PLUS electrical stimulation therapy 2 Day, the urine retention scheme is: frequency 35Hz, pulse width 200 mu s, 2 times / day, time 20 minutes. The position of electrode placement is: one is placed in S3 area, the other is placed in the bladder area. The electrode plate is selected with 50*50mm sticky electrode. After 7 days of removal, the residual urine is less than 100ml and the electric stimulation treatment is stopped. Residual urine 1OOml is considered as retention of urine and again placed in urinary catheter. Continue to give 8-PLUS electrical stimulation treatment, 2 times a day, a total of 7 days, 14 days to remove the urethral catheter again, test residual urine, if residual urine more than 100ml, no longer give 8-PLUS electrical stimulation treatment, according to the clinical routine treatment. The control group after 7 days after the removal of urethral residual urine determination, if residual urine 100ml, no special treatment; residual urine more than 100ml indwelling catheter, if residual urine is more than 100ml, indwelling catheter, 7 days after the removal of urethral residual urine, if residual urine was more than 100ml and indwelling catheter, the medium-term intervention program after.2.2.2 was treated according to clinical routine: pelvic floor treatment group was given pelvic abdominal electrophysiologic therapy for 9 weeks after operation: PHENIX neuromuscular therapy instrument 8-plus pelvic abdominal and lower limb vascular smooth muscle electrical stimulation (large circulation) for 6 weeks. The stimulus program was activated by blood power, 2 times / week, The scheme was: frequency 4Hz, time 20min; electrode patch: 50*90mm sticky electrode, two groups (4); one group was placed on the back of the left and right feet, the other was placed on the right side of the abdominal total vein, the other was placed in the corresponding back position. 13 weeks after the operation, the electromyography of the pelvic floor and biofeedback for 6 weeks, 1 weeks 2 times, 12 times, time 30min. electrode. Position: A1 channel pelvic floor muscle therapy head is placed in the vagina, A2 channel electrode is placed on the abdomen, and ground wire electrode is placed on the iliac bone. Biofeedback: U8 is built to simulate various scene training modules and give the perineoabdominal coordination contraction. Electrode: the pelvic floor muscle for the treatment of the head 50* 50mm sticky electrode. Position: A1 channel pelvic floor muscle treatment head placement In the vagina, the A2 channel electrode was placed on the abdomen and the ground line marker was placed on the iliac bone. The control group received routine care after the operation, and there was no specific intervention measure of the specific.2.3 monitoring index 2.3.1 subjective part: the quality of life questionnaire (PFDI-20) PFDI-20 was specially designed for the female pelvic floor disease, with 20 problems in total. The effect of pelvic floor dysfunction on the quality of life of the patients and the severity of subjective symptoms were evaluated from 3 parts of urination symptoms, defecation symptoms and pelvic organ prolapse. The total score was 0-300, the higher the score, the greater the impact on life, and the effect of the pelvic floor disorder questionnaire 7 (PFIQ-7) from the bladder, intestine, or Yin, respectively. The greater the total score, the higher the score, the higher the score, the higher the score, the higher the score of the three aspects of daily life. The sexual function quality questionnaire, the total score of 100, the higher the score, the better the objective part of the quality of life of the.2.3.2: the comparison of the postoperative urinary retention in the two groups of patients. The residual urine "g1OOrrh, the objective part of urinary retention.2.3.3: extraction. Urinary catheter time and hospitalization time: 7-14 days after cervical cancer surgery, the longer the hospitalization time, the longer the hospitalization time, the higher the cost of hospitalization.2.3.4 objective part: pelvic floor function examination: mainly including the free urine flow rate (maximum urine flow rate, average urine flow rate, peak time, urination time, residual urine), pelvic floor electrophysiological function examination (I muscle class muscle) Fiber muscle strength, type I muscle fiber fatigue, class II muscle fiber strength, class II muscle fiber fatigue, muscle potential, pelvic floor control (A3 feedback), pelvic floor function examination (sexual function reflex).2.3.4.1 free urine flow rate: maximum urinary flow rate Qmax, mean urine flow rate Qave, urination time, peak time, and residual urine determination. Normal range score. Qmax > 20ml/s, Qave > 20ml/s, urination time of excretion urine volume 100ml, upper limit of 10 seconds, 23 seconds of excretion urine as upper limit, residual urine for normal 100ml.2.3.4.2 pelvic electrophysiological function: class I muscle muscle strength is divided into 0-5 levels, and the duration of muscle contraction in the vagina to the maximum value of 40%. continues for 0 seconds to 0, sustained 1 Second is 1, 2 seconds is 2, 3 seconds is 3, 4 seconds is 4, 5 seconds is 5. The percentage of descending ratio between points is fatigue, normal 0%, negative value is abnormal. The normal value of muscle potential is 20-30 V. The decrease of muscle potential indicates the decrease of muscle fiber number participating in pelvic floor contraction movement. The function of.2.3.4.3 pelvic floor control is mainly A3 feedback function, and abnormal.2.3.4.4 pelvic floor function examination is mainly reflected in abnormal urination. It is a reflection of pelvic floor function, the main manifestation of sexual function reflex is normal and abnormal.2.4 instrument and equipment PHENIX neuromuscular therapy instrument 8-plus France VIVALTIS, Guangzhou fir hill company agent nerve repair therapy instrument U8 France VIVALTIS company, Guangzhou fir hill company agent pelvic floor muscle treatment head France VIVALTIS company, Guangzhou fir hill company generation Color Doppler ultrasonography, SIEMENS 3, Germany 3 quality control 3.1 used file management to ensure the authenticity and homogeneity of the data. Write flow charts, write standardized operating procedures, design a unified questionnaire, use a standardized scale; 3.2 all patients were performed extensive total hysterectomy and pelvic lymphadenectomy by my senior senior physician. The 3.3 patients used the same PHENIX neuromuscular therapy instrument 8-plus and the nerve repair instrument U8, all of which were the.3.4 operators, the data recorder, the PHENIX neuromuscular therapy instrument 8-plus and the U8 operator of the nerve repair therapy instrument, the training, the unified standard, and the 3.5 for the operator and the data recorder. 3.6 of the data collected by third parties recorded.4 medical ethics. The medical ethics of the hospital was approved by the medical ethics committee of the hospital. Each group of patients signed the informed consent book.5 statistical method using Epidata3.0 to establish the database, and two trained researchers were recorded independently, and the SAS9.4 statistical analysis was used after the verification was unmistakable. The software was processed, and the measurement data used mean number + standard deviation (x + S) to indicate the trend of concentration and dispersion, using t test or variance analysis to test the difference. The counting data were analyzed by x 2 test or Fisher, s exact probability, and the multiple time observation data were analyzed by the variance analysis of repeated measurement data, and Kruskal-Wallis was not satisfied as a whole, and Kruskal-Wallis was used. The rank sum test method, repeated measurement of variance analysis dissatisfied football symmetry, using Greenhouse-Geisser method to correct P value, set test level 0.05, P0.05 difference was statistically significant. Results 1. subjective part of pelvic floor treatment group (30 people), control group (30 people) two groups of patients after 6 months after operation and 12 months after the operation, PFDI-20, PFIQ-7 scores were significantly different, all For P0.0001, there was statistical significance; the scores of PFDI-20 and PFIQ-7 in the two groups were significantly different before and after the operation. The score of the pelvic floor treatment group was significantly reduced, and the difference was statistically significant. The scores of the sex quality of life in the two groups were significantly different in December, P0.0001, and statistically significant; the two groups of patients with cervical cancer before and after operation were of comparative quality of life. The score of P0.0001, pelvic floor treatment group was significantly better than that of the control group.2. in the objective part of the 2.1 group. The urinary retention was 2 (6.7%) after operation in the pelvic floor treatment group, and the number of patients in the control group was 12 (40%), and the number of the pelvic floor treatment group was significantly less than the control group, P=0.002, the difference. There were statistically significant 2.2. extraction time and time of hospitalization compared with the pelvic floor treatment group (30 people), the successful extraction of urethral catheter time was 8.63 + 13.52 days; the control group (30 people), the number of successful extraction of urinary catheter time was 10.73 + 24.40 days, two groups of successful extraction of urinary catheter time compared P= 0.0460.05, the difference was statistically significant. The time of hospitalization in the pelvic floor treatment group. For 11.80 + 2.23 days, the control group was hospitalized at 14.63 + 3.42 days, the two groups of hospitalization time were P0.001, the difference was statistically significant.2.3 free urine flow rate measurement: the pelvic floor treatment group and the control group were significantly different in the free urine flow rate before and after the operation, P0.05, the difference was statistically significant; the two groups were 8 weeks after operation, June after operation, and the maximum urine flow in December after the operation. Rate, average urinary flow rate P0.05, the difference was statistically significant, two groups of urination time and peak time compared P0.05, the difference was not statistically significant.2.4 pelvic floor electrophysiological function: two groups of pelvic floor electrophysiological function before and after operation was significantly different, P0.0001; two groups of pelvic floor electrophysiological function in June, postoperative December difference was significant, P0.0001, of class II muscle fiber There was a significant difference in dimensional muscle strength and type II muscle fatigue before operation. P0.05.2.5.A3 feedback: there was significant difference in the pelvic floor treatment group before and after operation, P0.0001 difference.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33

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