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中华妇幼临床医学杂志(电子版) ›› 2022, Vol. 18 ›› Issue (01) : 94 -101. doi: 10.3877/cma.j.issn.1673-5250.2022.01.013

论著

盆底肌锻炼改善中老年女性绝经相关症状的临床研究
樊卫敏1,1, 梅小会2,2, 陈记娜2,2, 董富云2,2, 张丽文2,2, 陈亚萍2,2, 周金华1,1, 陈汝君2,†,2()   
  • 收稿日期:2021-05-06 修回日期:2022-01-08 出版日期:2022-02-01
  • 通信作者: 陈汝君

Clinical study of improvement on menopausal symptoms in middle aged and elderly women by pelvic floor muscle training

Weimin Fan1,1, Xiaohui Mei2,2, Jina Chen2,2, Fuyun Dong2,2, Liwen Zhang2,2, Yaping Chen2,2, Jinhua Zhou1,1, Rujun Chen2,2,†()   

  • Received:2021-05-06 Revised:2022-01-08 Published:2022-02-01
  • Corresponding author: Rujun Chen
  • Supported by:
    Scientific Research Project of Health Commission of Minhang District, Shanghai(2019MW05)
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引用本文：

樊卫敏, 梅小会, 陈记娜, 董富云, 张丽文, 陈亚萍, 周金华, 陈汝君. 盆底肌锻炼改善中老年女性绝经相关症状的临床研究[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(01): 94-101.

Weimin Fan, Xiaohui Mei, Jina Chen, Fuyun Dong, Liwen Zhang, Yaping Chen, Jinhua Zhou, Rujun Chen. Clinical study of improvement on menopausal symptoms in middle aged and elderly women by pelvic floor muscle training[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(01): 94-101.

目的

评价盆底肌锻炼(PFMT)对中老年女性绝经相关症状(MS)的作用。

方法

选择2020年1月至2021年1月，因出现MS于复旦大学附属上海市第五人民医院更年期门诊，或盆底中心就诊的165例中老年女性为研究对象。按照生殖衰老分期系统(STRAW+10)分期结果，将其分为绝经前期组(n＝45，为STRAW+10的-3b~-2阶段)，绝经早期组(n＝62，为STRAW+10的-1~+1b阶段)，绝经晚期组(n＝58，为STRAW+10的+1c~+2阶段)。采用前瞻性研究方法，对各组受试者进行PFMT干预12周，并采用绝经指数(KI)量表、绝经期等级评定量表(MRS)、绝经期泌尿生殖系统综合征(GSM)症状评分量表及国际尿失禁咨询委员会尿失禁问卷简表(ICIQ-UI SF)(以下简称为4个量表)，对PFMT干预效果进行综合评估。采用Mann-Whitney U检验，对受试者PFMT干预前、后各量表评分结果进行统计学比较。本研究经复旦大学附属上海市第五人民医院伦理委员会批准[审批文号：(2019)伦审(149)]，并与所有受试者签署临床研究知情同意书。

结果

①绝经前期组采取PFMT干预后，对受试者的4个量表评分均低于干预前，并且差异均有统计学意义(P<0.05)；MRS中的躯体感觉及泌尿生殖道评分、ICIQ-UI SF中对日常生活影响评分，均低于干预前，并且差异均有统计学意义(P<0.05)。②绝经早期组采取PFMT干预后，受试者的KI量表、GSM症状评分量表及ICIQ-UI SF评分，均低于干预前，并且差异均有统计学意义(P<0.05)；MRS中的心理感觉评分，GSM症状评分量表中的阴道干燥及阴道刺痛评分，ICIQ-UI SF中的尿失禁频率及对日常生活影响评分，均低于干预前，并且差异均有统计学意义(P<0.05)；而MRS中的泌尿生殖道症状评分[3分(0~3分)]，则高于干预前[3分(0~3分)]，并且差异有统计学意义(Z＝-2.710、P＝0.007)。③绝经晚期组采取PFMT干预后，对受试者的4个量表评分均低于干预前，并且差异均有统计学意义(P<0.05)；MRS中的躯体感觉、心理感觉及泌尿生殖道评分，GSM症状评分量表中的阴道干燥及性交困难评分，ICIQ-UI SF中的漏尿量及对日常生活影响评分，均低于干预前，并且差异均有统计学意义(P<0.05)。

结论

从绝经前期到绝经晚期，采取PFMT均可改善中老年女性MS。

关键词: 围绝经期, 绝经前期, 绝经后期, 骨盆底, 尿失禁, 绝经期症状, 盆底肌锻炼, 女(雌)性
Objective

To evaluate effects of pelvic floor muscle training (PFMT) on menopausal symptoms (MS) in middle aged and elderly women.

Methods

From January 2020 to January 2021, a total of 165 middle aged and elderly women who were treated in menopause clinic or pelvic floor center of Shanghai Fifth People′s Hospital, Fudan University due to MS were selected as research subjects. According to stages of reproductive aging workshop + 10 (STRAW+ 10), they were divided into premenopausal group (n=45, with -3b to -2 stage of STRAW+ 10), early menopausal group (n=62, with -1 to + 1b stage of STRAW+ 10) and late menopausal group (n=58, with + 1C to + 2 stage of STRAW+ 10). Using prospective research methods, PFMT intervention measure was performed on subjects in each group for 12 weeks. The intervention effects of PFMT was comprehensively evaluated by Kupperman Index (KI) Scale, Menopause Rating Scale (MRS), Genitourinary Syndrome of Menopause (GSM) Symptom Score Scale and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) (hereinafter referred to as four scales). Mann-Whitney U test was used to statistically compare scores of various scales between before and after PFMT intervention. This study was approved by the Ethics Committee of Shanghai Fifth People′s Hospital, Fudan University [Approval No. (2019) lunshen (149)]. All subjects signed the clinical study informed consent forms.

Results

① Scores of four scales after PFMT intervention in premenopausal group were all lower than those before intervention, and the differences were statistically significant (P<0.05). Scores of somatosensory and urogenital tract in MRS, and scores of impact on daily life in ICIQ-UI SF after PFMT intervention, were all lower than those before intervention, and the differences were statistically significant (P<0.05). ② Scores of KI Scale, GSM Symptom Score Scale and ICIQ-UI SF after PFMT intervention in early menopausal group were all lower than those before intervention, and the differences were statistically significant (P<0.05). Scores of psychological sensation in MRS, scores of vaginal dryness and vaginal tingling in GSM Symptom Score Scale, scores of the frequency of urinary incontinence and its impact on daily life in ICIQ-UI SF after PFMT intervention, were all lower than those before intervention, and the differences were statistically significant (P<0.05); While the urogenital symptom score in MRS after PFMT intervention was 3 scores (0-3 scores), which was higher than that of 3 scores (0-3 scores) before intervention, and the difference was statistically significant (Z=-2.710, P=0.007). ③ Scores of four scales after PFMT intervention in late menopausal group were all lower than those before intervention, and the differences were statistically significant (P<0.05). Scores of somatic sensation, psychological sensation and urogenital tract in MRS, scores of vaginal dryness and dyspareunia in GSM Symptom Score Scale, scores of amount of urine leakage and impact on daily life in ICIQ-UI SF after PFMT intervention, were all lower than those before intervention, and the differences were statistically significant (P<0.05).

Conclusion

From premenopausal to late menopause, PFMT can improve MS in middle aged and elderly women.

Key words: Perimenopause, Premenopause, Postmenopause, Pelvic floor, Urinary incontinence, Menopausal symptoms, Pelvic floor muscle training, Female
表1 3组受试者一般临床资料比较
组别 例数 年龄(岁，±s) BMI(kg/m2，±s) 文化程度[例数(%)]a 孕次(次，±s)
本科以下 本科
①绝经前期组 45 43.7±2.9 23.7±2.8 26(57.8) 19(42.2) 3.2±2.5
②绝经早期组 62 49.9±2.1 23.8±1.8 55(88.7) 7(11.3) 3.0±1.7
③绝经晚期组 58 58.0±2.9 23.9±2.8 51(87.9) 7(12.1) 2.1±1.2
总体比较(检验值/P值)   F＝393.600/<0.001 F＝0.045/0.956 χ2＝19.109/<0.001 F＝5.730/0.004
两两比较(检验值/P值)            
  ① vs ②   t＝-12.272/<0.001 — χ2＝11.933/<0.001 t＝0.544/0.588
  ① vs ③   t＝-25.039/<0.001 — χ2＝10.663/<0.001 t＝2.780/0.007
  ② vs ③   t＝-17.696/<0.001 — χ2<0.001/>0.999 t＝3.271/0.001
组别 例数 产次(次，±s) 血清FSH水平(IU/L，±s) 最大新生儿出生体重(g，±s)b 距末次分娩时间(年，±s)
绝经前期组 45 1.4±0.5 5.9±3.1 3 500±250 15.8±10.2
绝经早期组 62 2.0±1.1 26.9±1.7 3 381±439 22.8±7.6
绝经晚期组 58 1.6±0.8 38.0±6.7 3 392±457 31.7±8.4
总体比较(检验值/P值)   F＝5.782/0.004 F＝682.600/<0.001 F＝1.143/0.322 F＝41.290/<0.001
两两比较(检验值/P值)          
  ① vs ②   t＝-3.472/0.001 t＝-41.405/<0.001 — t＝-3.636/<0.001
  ① vs ③   t＝-1.142/0.256 t＝-32.473/<0.001 — t＝-8.105/<0.001
  ② vs ③   t＝2.236/0.027 t＝-12.258/<0.001 — t＝-5.945/<0.001
表2 绝经前期组受试者PFMT干预前、后KI量表和MRS评分结果比较[分，M(P25~P75)]
项目 例数 KI量表评分 MRS评分 躯体感觉评分 心理感觉评分 泌尿生殖道评分
干预前 45 2(2~9) 4(3~20) 0(0~4) 4(0~8) 3(0~9)
干预后 45 2(2~6) 4(3~12) 0(0~4) 3(0~4) 3(0~3)
Z值   2.020 3.310 2.560 1.800 2.450
P值   0.046 0.001 0.013 0.079 0.020
表3 绝经早期组受试者PFMT干预前、后KI量表和MRS评分结果比较[分，M(P25~P75)]
项目 例数 KI量表评分 MRS评分 躯体感觉评分 心理感觉评分 泌尿生殖道评分
干预前 62 6(2~12) 12(4~16) 8(0~8) 4(0~8) 3(0~3)
干预后 62 4(2~10) 12(4~15) 7(0~8) 4(0~4) 3(0~3)
Z值   4.620 1.580 1.840 2.650 -2.710
P值   <0.001 0.121 0.077 0.011 0.007
表4 绝经晚期组受试者PFMT干预前、后KI量表和MRS评分结果比较[分，M(P25~P75)]
项目 例数 KI量表评分 MRS评分 躯体感觉评分 心理感觉评分 泌尿生殖道评分
干预前 58 8(4~12) 19(12~26) 8(4~16) 8(4~8) 3(3~6)
干预后 58 6(4~7) 12(7~14) 4(4~8) 4(0~4) 2(0~3)
Z值   5.090 4.550 2.450 4.100 4.400
P值   <0.001 <0.001 0.020 <0.001 <0.001
表5 绝经前期组受试者PFMT干预前、后GSM症状评分量表结果比较[分，M(P25~P75)]
项目 例数 GSM症状评分量表评分 阴道干燥评分 阴道刺痛评分 排尿困难评分 性交困难评分
干预前 45 3(1~4) 1(0~2) 0(0~1) 0(0~1) 0(0~1)
干预后 45 2(1~4) 1(0~2) 0(0~0) 0(0~0) 0(0~1)
Z值   2.860 1.860 1.730 1.410 1.000
P值   0.005 0.095 0.149 0.203 0.424
表6 绝经早期组受试者PFMT干预前、后GSM症状评分量表结果比较[分，M(P25~P75)]
项目 例数 GSM症状评分量表评分 阴道干燥评分 阴道刺痛评分 排尿困难评分 性交困难评分
干预前 62 3(2~4) 1(0~2) 0(0~1) 0(0~1) 1(0~2)
干预后 62 3(1~3) 1(0~1) 0(0~1) 0(0~1) 1(0~1)
Z值   3.380 2.270 2.240 1.000 1.930
P值   <0.001 0.031 0.037 0.424 0.065
表7 绝经晚期组受试者PFMT干预前、后GSM症状评分量表结果比较[分，M(P25~P75)]
项目 例数 GSM症状评分量表评分 阴道干燥评分 阴道刺痛评分 排尿困难评分 性交困难评分
干预前 58 3(2~5) 1(1~2) 0(0~0) 0(0~1) 1(1~2)
干预后 58 3(2~4) 1(1~2) 0(0~0) 0(0~1) 1(0~2)
Z值   3.190 2.460 0.450 -1.410 2.330
P值   <0.001 0.018 0.766 0.182 0.026
表8 绝经前期组受试者PFMT干预前、后ICIQ-UI SF评分比较[分，M(P25~P75)]
项目 例数 ICIQ-UI SF评分 尿失禁频率评分 漏尿量评分 对日常生活影响评分
干预前 45 0(0~4) 0(0~1) 0(0~2) 0(0~1)
干预后 45 0(0~3) 0(0~1) 0(0~1) 0(0~1)
Z值   3.070 1.730 2.000 2.460
P值   0.003 0.149 0.072 0.018
表9 绝经早期组受试者PFMT干预前、后ICIQ-UI SF评分比较[分，M(P25~P75)]
项目 例数 ICIQ-UI SF评分 尿失禁频率评分 漏尿量评分 对日常生活影响评分
干预前 62 3(0~4) 1(0~1) 1(0~1) 1(0~2)
干预后 62 3(0~4) 1(0~1) 1(0~1) 1(0~1)
Z值   3.300 2.270 2.000 2.640
P值   0.001 0.031 0.072 0.010
表10 绝经晚期组受试者PFMT干预前、后ICIQ-UI SF评分比较[分，M(P25~P75)]
项目 例数 ICIQ-UI SF评分 尿失禁频率评分 漏尿量评分 对日常生活影响评分
干预前 58 0(0~4) 0(0~2) 0(0~1) 0(0~1)
干预后 58 0(0~3) 0(0~1) 0(0~1) 0(0~1)
Z值   3.070 2.070 2.740 2.390
P值   0.002 0.053 0.007 0.021
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