磁刺激治疗盆底功能障碍的效果
Effects of magnetic stimulation in the treatment of pelvic floor dysfunction.
作者信息
Voorham-van der Zalm Petra J, Pelger Rob C M, Stiggelbout Anne M, Elzevier Henk W, Lycklama à Nijeholt Guus A B
机构信息
Department of Urology, Leiden University Medical Center, the Netherlands.
出版信息
BJU Int. 2006 May;97(5):1035-8. doi: 10.1111/j.1464-410X.2006.06131.x.
OBJECTIVE
To correlate, in a pilot study, the clinical results of extracorporeal magnetic innervation therapy (ExMI) of the pelvic floor muscles with functional changes in the pelvic floor musculature, urodynamics and quality of life.
PATIENTS AND METHODS
In all, 74 patients (65 women and nine men) with urge incontinence, urgency/frequency, stress incontinence, mixed incontinence and defecation problems were included in a prospective study of ExMI using a 'electromagnetic chair'. All patients were treated twice weekly for 8 weeks. Digital palpation and biofeedback with a vaginal or anal probe were used for registration of the pelvic floor musculature. A urodynamic evaluation, a voiding diary, a pad-test, the King's Health Questionnaire (KHQ) and a visual analogue scale (VAS) were completed by the patient at baseline and at the end of the study.
RESULTS
In the group as a whole, there were no significant differences in the voiding diary, pad-test, quality of life, VAS score, biofeedback registration and urodynamics before and after treatment. Additional stratification was applied to the total patient group, related to the pretreatment rest tone of the pelvic floor, the basal amplitude registered on electromyography, to age and to previous treatments. However, there were no significant differences in the data before and after treatment within all subgroups (stress incontinence, urge incontinence, urgency/frequency, defecation problems, overactive pelvic floor, age, previous treatments), except for the KHQ domain of 'role limitations', where there was a significant improvement in all groups.
CONCLUSION
ExMI did not change pelvic floor function in the present patients. The varying outcomes of several studies on ExMI stress the need for critical studies on the effect and the mode of action of electrostimulation and magnetic stimulation. In our opinion 'the chair' is suitable to train awareness of the location of the pelvic floor. However, active pelvic floor muscle exercises remain essential.
目的
在一项初步研究中,将盆底肌肉的体外磁神经支配疗法(ExMI)的临床结果与盆底肌肉组织的功能变化、尿动力学及生活质量相关联。
患者与方法
总共74例患者(65名女性和9名男性),患有急迫性尿失禁、尿急/尿频、压力性尿失禁、混合性尿失禁及排便问题,纳入一项使用“电磁椅”进行ExMI的前瞻性研究。所有患者每周接受两次治疗,共治疗8周。使用阴道或肛门探头进行数字触诊和生物反馈,以记录盆底肌肉组织情况。患者在基线期和研究结束时完成尿动力学评估、排尿日记、护垫试验、国王健康问卷(KHQ)及视觉模拟量表(VAS)。
结果
在整个研究组中,治疗前后排尿日记、护垫试验、生活质量、VAS评分、生物反馈记录及尿动力学方面均无显著差异。对整个患者组根据盆底治疗前静息张力、肌电图记录的基础振幅、年龄及既往治疗情况进行了额外分层。然而,在所有亚组(压力性尿失禁、急迫性尿失禁、尿急/尿频、排便问题、盆底过度活跃、年龄、既往治疗)中,治疗前后的数据均无显著差异,但“角色限制”的KHQ领域在所有组中均有显著改善。
结论
ExMI在本研究患者中未改变盆底功能。关于ExMI的多项研究结果各异,这凸显了对电刺激和磁刺激的效果及作用方式进行严谨研究的必要性。我们认为“电磁椅”适用于训练对盆底位置的感知。然而,积极的盆底肌肉锻炼仍然至关重要。