Li Wenjuan, Hu Qing, Zhang Zhujuan, Shen Fengxian, Xie Zhenwei
Department of Obstetrics and Gynecology, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2020 Apr;99(17):e19863. doi: 10.1097/MD.0000000000019863.
Pregnancy is one of the main risk factor of pelvic floor muscle dysfunction. Postpartum women with extremely weak muscle strength have difficulty to do voluntary pelvic floor muscle training. This study aims to evaluate the effects of different protocols of electrical stimulation in the treatment of postpartum women with extremely weak muscle strength.
A total of 67 women were randomized into 2 groups: group A received transvaginal electrical stimulation (TVES) for 5 times, and group B received TVES for 3 times with electromyogram (EMG)-triggered neuromuscular stimulation twice. Subjects were evaluated before and after treatment. Pelvic muscle strength was measured by both digital vaginal palpation and EMG variables, and quality of life was investigated by 4 kinds of pelvic floor disease-related questionnaires.
According to the intention-to-treat principle, compared with baseline, in group A, EMG of contractile amplitude of endurance phase was significantly elevated (P = .03), variation of contractile amplitude in tonic phase was more stable after treatment (P = .004), and EMG of mean value of final rest was significantly elevated after treatment (P = .047). After 5 times treatments, the incidence of correct pelvic floor muscle contraction in group A was significantly elevated (P = .045). No significant difference of muscle strength test by digital vaginal palpation was detected between the 2 groups, so did questionnaires.
For postpartum women with extremely weak muscle strength, TVES for 5 times might be more benefit for control ability of pelvic muscle contractions and elevating muscle strength even in short-time treatment.
妊娠是盆底肌肉功能障碍的主要危险因素之一。肌肉力量极其薄弱的产后女性难以进行自主盆底肌肉训练。本研究旨在评估不同电刺激方案对肌肉力量极其薄弱的产后女性的治疗效果。
总共67名女性被随机分为两组:A组接受5次经阴道电刺激(TVES),B组接受3次TVES并辅以两次肌电图(EMG)触发的神经肌肉刺激。在治疗前后对受试者进行评估。通过手指阴道触诊和EMG变量测量盆底肌肉力量,并通过4种与盆底疾病相关的问卷调查生活质量。
根据意向性分析原则,与基线相比,A组中,耐力期收缩幅度的EMG显著升高(P = 0.03),治疗后紧张期收缩幅度的变化更稳定(P = 0.004),治疗后最终静息平均值的EMG显著升高(P = 0.047)。经过5次治疗后,A组正确盆底肌肉收缩的发生率显著升高(P = 0.045)。两组之间通过手指阴道触诊进行的肌肉力量测试以及问卷结果均未检测到显著差异。
对于肌肉力量极其薄弱的产后女性,即使在短期治疗中,5次TVES可能更有利于控制盆底肌肉收缩能力并提高肌肉力量。