Curative effect of biofeedback electrical stimulation on the treatment of pelvic floor functional rehabilitation after total abdominal hysterectomy

doi:10.3877/cma.j.issn.1673-5250.2016.04.011

Objective

To explore the curative effect of biofeedback electrical stimulation on pelvic floor functional rehabilitation after total abdominal hysterectomy.

Methods

A total of 90 patients after total abdominal hysterectomy in the Gynecology and Obstetrics Department of Renmin Hospital of Wuhan University from January 1 to December 31 in 2013 were chosen as study objects. According to admission odd and even numbers, they were divided into experimental group and control group, and 45 patients in each group. The patients in experimental group were treated by biofeedback electrical stimulation and pelvic floor muscles training, while patients in control group were treated only by pelvic floor muscles training.After 3 months and 6 months of total abdominal hysterectomy, pelvic floor muscle strength levels, vaginal pressures, degrees of staging pelvic organ prolapse quantification (POP-Q), degrees of stress urinary incontinence(SUI) and overall sexual satisfaction rates were compared between two groups statistically.There were no significant differences between two groups of patients in general clinical data including age, mode of delivery and body mass index etc.(P>0.05). This study followed the procedures in line with Renmin Hospital of Wuhan University Ethics Committee to develop human trials of the standard, approved by the committee, and all the patients signed the informed consents.

Results

①There were no significant differences between two groups of patients in pelvic floor muscle tension levels, vaginal resting and squeeze pressures, durations of vaginal contraction, and SUI degrees after 3 months of total abdominal hysterectomy(P>0.05). ② After 6 months of total abdominal hysterectomy, the pelvic floor muscle strength levels and SUI degrees of patients in experimental group were better than those of control group(Z=-5.220, P=0.000; Z=6.429, P=0.011), vaginal resting and squeeze pressures were higher than those of control group[(31.9±7.2) cmH₂O vs (23.8±7.0) cmH₂O, t=-4.312, P=0.000; (34.6±9.4) cmH₂O vs (25.1±9.6) cmH₂O, t=-4.210, P=0.000](1 cmH₂O=0.098 1 kPa), duration of vaginal contraction was longer than that of control group[(4.2±1.1) s vs (2.7±1.8) s, t=-4.045, P=0.000], overall sexual satisfaction rate was higher than that of control group (86.7% vs 60.0%, χ²=8.182, P=0.004), and all the differences above were statistically significant (P<0.05). ③There were no significant differences between two groups of patients in POP-Q extents after 3 and 6 months of total abdominal hysterectomy(P>0.05).

Conclusions

Biofeedback electrical stimulation for pelvic floor functional rehabilitation after total abdominal hysterectomy has significant effect, and can effectively prevent the pelvic floor dysfunction after hysterectomy.

Key words: Hysterectomy, Total abdominal hysterectomy, Pelvic floor, Muscle exercises, Biofeedback, electric stimulation, Physical therapy, Female

表1 两组患者盆底肌力级别比较[例数(%)]

组别		例数	盆底肌力级别					Z值	P值
组别		例数	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	Ⅴ级	Z值	P值
术后3个月时		?	?	?	?	?	?	－0.401	0.688
?	实验组	45	0(0)	19(42.2)	20(44.4)	6(13.4)	0(0)	?	?
?	对照组	45	0(0)	22(48.9)	16(35.5)	7(15.6)	0(0)	?	?
术后6个月时		?	?	?	?	?	?	－5.220	0.000
?	实验组	45	0(0)	4(8.9)	7(15.6)	28(62.2)	6(13.3)	?	?
?	对照组	45	1(2.2)	15(33.3)	21(46.7)	8(17.8)	0(0)	?	?

表1 两组患者盆底肌力级别比较[例数(%)]

组别		例数	盆底肌力级别					Z值	P值
组别		例数	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	Ⅴ级	Z值	P值
术后3个月时		?	?	?	?	?	?	－0.401	0.688
?	实验组	45	0(0)	19(42.2)	20(44.4)	6(13.4)	0(0)	?	?
?	对照组	45	0(0)	22(48.9)	16(35.5)	7(15.6)	0(0)	?	?
术后6个月时		?	?	?	?	?	?	－5.220	0.000
?	实验组	45	0(0)	4(8.9)	7(15.6)	28(62.2)	6(13.3)	?	?
?	对照组	45	1(2.2)	15(33.3)	21(46.7)	8(17.8)	0(0)	?	?

表2 两组患者阴道压力及收缩持续时间比较(±s)

组别	例数	术后3个月时			术后6个月时
		阴道静息压(cmH₂O)	阴道收缩压(cmH₂O)	阴道收缩持续时间(s)	阴道静息压(cmH₂O)	阴道收缩压(cmH₂O)	阴道收缩持续时间(s)
		实验组	45	21.5±7.3	23.9±10.6	2.6±1.5	31.9±7.2	34.6±9.4	4.2±1.1
对照组	45	20.4±7.0	22.5±9.1	2.8±1.3	23.8±7.0	25.1±9.6	2.7±1.8
t值	?	－0.578	－0.413	－0.518	－4.312	－4.210	－4.045
P值	?	0.690	0.867	1.429	0.000	0.000	0.000

表2 两组患者阴道压力及收缩持续时间比较(±s)

组别	例数	术后3个月时			术后6个月时
		阴道静息压(cmH₂O)	阴道收缩压(cmH₂O)	阴道收缩持续时间(s)	阴道静息压(cmH₂O)	阴道收缩压(cmH₂O)	阴道收缩持续时间(s)
		实验组	45	21.5±7.3	23.9±10.6	2.6±1.5	31.9±7.2	34.6±9.4	4.2±1.1
对照组	45	20.4±7.0	22.5±9.1	2.8±1.3	23.8±7.0	25.1±9.6	2.7±1.8
t值	?	－0.578	－0.413	－0.518	－4.312	－4.210	－4.045
P值	?	0.690	0.867	1.429	0.000	0.000	0.000

表3 两组患者POP-Q分度比较[例数(%)]

组别		例数	POP-Q分度			Z值	P值
组别		例数	0度	Ⅰ度	Ⅱ度	Z值	P值
术后3个月时		?	?	?	?	0.714	0.398
?	实验组	45	43(95.6)	2(4.4)	0(0)	?	?
?	对照组	45	41(91.1)	4(8.9)	0(0)	?	?
术后6个月时		?	?	?	?	1.160	0.281
?	实验组	45	39(86.7)	5(11.1)	1(2.2)	?	?
?	对照组	45	34(75.6)	6(13.3)	5(11.1)	?	?

表3 两组患者POP-Q分度比较[例数(%)]

组别		例数	POP-Q分度			Z值	P值
组别		例数	0度	Ⅰ度	Ⅱ度	Z值	P值
术后3个月时		?	?	?	?	0.714	0.398
?	实验组	45	43(95.6)	2(4.4)	0(0)	?	?
?	对照组	45	41(91.1)	4(8.9)	0(0)	?	?
术后6个月时		?	?	?	?	1.160	0.281
?	实验组	45	39(86.7)	5(11.1)	1(2.2)	?	?
?	对照组	45	34(75.6)	6(13.3)	5(11.1)	?	?

表4 两组患者SUI分度比较[例数(%)]

组别		例数	SUI分度			Z值	P值
组别		例数	Ⅰ度	Ⅱ度	Ⅲ度	Z值	P值
术后3个月时		?	?	?	?	0.359	0.592
?	实验组	45	9(20.0)	0(0)	0(0)	?	?
?	对照组	45	6(13.3)	1(2.2)	0(0)	?	?
术后6个月时		?	?	?	?	6.429	0.011
?	实验组	45	4 (8.9)	1(2.2)	0(0)	?	?
?	对照组	45	11(24.4)	4(8.9)	0(0)	?	?

表4 两组患者SUI分度比较[例数(%)]

组别		例数	SUI分度			Z值	P值
组别		例数	Ⅰ度	Ⅱ度	Ⅲ度	Z值	P值
术后3个月时		?	?	?	?	0.359	0.592
?	实验组	45	9(20.0)	0(0)	0(0)	?	?
?	对照组	45	6(13.3)	1(2.2)	0(0)	?	?
术后6个月时		?	?	?	?	6.429	0.011
?	实验组	45	4 (8.9)	1(2.2)	0(0)	?	?
?	对照组	45	11(24.4)	4(8.9)	0(0)	?	?

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