Pelvic floor ultrasound evaluation of the clinical efficacy of floating needle therapy combined with pressing needle and embedding needle at acupoints in the treatment of patients with stress urinary incontinence
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摘要:
目的 分析浮针疗法联合揿针穴位埋针治疗压力性尿失禁患者的临床疗效,探讨经会阴盆底超声评估其疗效的临床价值。 方法 选取2022年9月—2023年11月宁波市中医院治疗的110例压力性尿失禁患者作为研究对象,采用随机数字表法将其分为对照组(55例)和实验组(55例)。对照组患者应用生物反馈电刺激联合盆底肌训练治疗,实验组应用浮针疗法联合揿针穴位埋针治疗。观察2组患者静息状态下及最大Valsalva动作时超声参数,包括:静息状态下膀胱颈位置、逼尿肌厚度(DWT)、膀胱尿道后角(RVA)及尿道倾斜角(UTA),最大Valsalva动作时膀胱颈移动度(BND)、RVA、尿道旋转角(URA),统计尿道内口漏斗发生率。 结果 治疗后,2组患者静息状态下膀胱颈位置及DWT、RVA比较差异均无统计学意义(P>0.05);实验组UTA高于对照组(P < 0.05)。治疗后,2组患者最大Valsalva动作时,其BND均明显降低(P < 0.05),且实验组低于对照组(P<0.05);2组RVA和URA比较差异均无统计学意义(P>0.05)。实验组患者尿道内口漏斗发生率为87.27%(48/55),显著低于对照组的100.00%(55/55),差异有统计学意义(χ2=5.492,P=0.019)。 结论 压力性尿失禁患者采用浮针疗法联合揿针穴位埋针治疗疗效更佳,更有利于降低尿道内口漏斗发生率,且经会阴盆底超声对其康复效果的评估具有一定临床参考价值。 Abstract:Objective To analyze the clinical efficacy of floating needle therapy combined with pressing needle point embedding therapy in the treatment of patients with stress urinary incontinence, and to explore the clinical value of evaluating its efficacy through perineal pelvic floor ultrasound. Methods A total of 110 patients with stress urinary incontinence admitted to Ningbo Traditional Chinese Medicine Hospital from September 2022 to November 2023 were selected as the study subjects. They were randomly divided into a control group and an experimental group, with 55 cases in each group. The control group was treated with biofeedback electrical stimulation combined with pelvic floor muscle training, and the experimental group was treated with floating needle therapy combined with pressing and embedding acupuncture points. The ultrasound parameters of two groups of patients during resting state and maximum Valsalva maneuver were observed, including bladder neck position, detrusor muscle thickness (DWT), urethral inclination angle (UTA), bladder neck movement (BND), posterior angle of bladder urethra (RVA), and urethral rotation angle (URA). The incidence of urethral infundibulum during the maximum Valsalva maneuver was calculated. Results After the treatment, there was no statistically significant difference in the resting bladder neck position, DWT, and RVA between the two groups (P>0.05), and the UTA in the experimental group was higher than that in the control group (P < 0.05). The BND of both groups of patients significantly decreased during the maximum Valsalva maneuver (P < 0.05), and the BND in the experimental group was lower than that in the control group (P < 0.05) after the treatment. There was no statistically significant difference between the two groups of RVA and URA (P>0.05). The incidence of urethral infundibulum in the experimental group was 87.27% (48/55), significantly lower than 100.00% (55/55) in the control group (P < 0.05). Conclusion The combination of floating needle therapy and pressing needle embedding therapy at acupoints is more effective for patients with stress urinary incontinence, which is more conducive to reducing the incidence of urethral infundibulum. The evaluation of the rehabilitation effect by perineal pelvic floor ultrasound has a certain clinical reference value. -
表 1 2组压力性尿失禁患者一般资料比较
Table 1. Comparison of general data of two groups of patients with stress urinary incontinence
组别 例数 年龄
(x±s,岁)病程时间
(x±s,年)BMI
(x±s)产次(例) 分娩方式(例) 尿失禁程度(例) 1次 ≥2次 阴道分娩 剖宫产 轻度 中度 对照组 55 46.58±11.31 2.46±0.43 23.06±1.17 46 9 48 7 26 29 实验组 55 43.29±11.26 2.60±0.52 22.81±1.56 45 10 50 5 22 33 统计量 1.529a 1.539a 0.951a 0.064b 0.374b 0.591b P值 0.129 0.127 0.344 0.801 0.541 0.442 注:a为t值,b为χ2值。 表 2 2组压力性尿失禁患者静息状态下盆底超声参数比较(x±s)
Table 2. Comparison of pelvic floor ultrasound parameters in two groups of patients with stress urinary incontinence at rest(x±s)
组别 例数 膀胱颈位置(mm) DWT(mm) RVA(°) UTA(°) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 55 21.80±7.06 22.31±6.80 3.57±0.65 3.56±0.55 124.35±22.75 118.18±13.98 19.10±13.10 22.35±7.01c 实验组 55 19.49±8.07 21.20±6.58 3.67±0.59 3.66±0.49 132.00±26.81 123.98±18.45 19.20±9.03 25.09±6.65c 统计量 1.598a 0.792b 0.845a 1.035b 1.614a 1.736b 0.047a 2.155b P值 0.113 0.396 0.400 0.324 0.110 0.075 0.963 0.040 注:a为t值,b为F值;与同组治疗前比较,cP < 0.05。 表 3 2组压力性尿失禁患者最大Valsalva动作时盆底超声参数比较(°)
Table 3. Comparison of pelvic floor ultrasound parameters during maximum Valsalva movement in two groups of patients with stress urinary incontinence(°)
组别 例数 BND(x±s) RVA(x±s) URA[M(P25, P75)] 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 55 27.95±7.48 25.07±5.51b 140.96±30.35 133.25±18.04b 43(25,58) 38(29, 42)b 实验组 55 26.22±8.52 22.16±5.95b 147.89±21.44 138.20±14.26b 45(19,59) 38(29, 43)b 统计量 1.132a 2.584c 1.383a 1.215c 0.348d 0.627d P值 0.260 0.017 0.169 0.108 0.766 0.493 注:a为t值,c为F值,d为Z值;与同组治疗前比较,bP < 0.05。 -
[1] 闵洁, 彭国平. 经会阴三维盆底超声评估针灸对阴道分娩产妇压力性尿失禁康复治疗的应用价值[J]. 川北医学院学报, 2023, 38(2): 190-194. doi: 10.3969/j.issn.1005-3697.2023.02.011MIN J, PENG G P. Evaluation of the application value of acupuncture and moxibustion on the rehabilitation treatment of stress urinary incontinence in vaginal delivery women by perineal three-dimensional pelvic floor ultrasound[J]. Journal of North Sichuan Medical College, 2023, 38(2): 190-194. doi: 10.3969/j.issn.1005-3697.2023.02.011 [2] 李燕霞, 申利, 姚弘毅, 等. 隔姜脐灸联合凯格尔训练治疗围绝经期女性压力性尿失禁患者的临床效果[J]. 中国医药导报, 2023, 20(26): 110-113, 189. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202326023.htmLI Y X, SHEN L, YAO H Y, et al. The clinical effect of ginger separated navel moxibustion combined with Kegel training in the treatment of stress urinary incontinence in perimenopausal women[J]. China Medicine Herald, 2023, 20(26): 110-113, 189. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202326023.htm [3] WU X L, ZHENG X, YI X H, et al. Electromyographic biofeedback for stress urinary incontinence or pelvic floor dysfunction in women: a systematic review and meta-analysis[J]. Adv Ther, 2021, 38(8): 4163-4177. doi: 10.1007/s12325-021-01831-6 [4] ZHANG Y Y, ZHOU Z Y, WEI D, et al. Efficacy and safety of moxibustion in the treatment of female stress urinary incontinence: a protocol for systematic review and meta-analysis[J]. Medicine (Baltimore), 2022, 101(7): e28893. DOI: 10.1097/MD.0000000000028893. [5] CHEN H, LIU Y, WU J N, et al. Acupuncture for postprostatectomy incontinence: a systematic review[J]. BMJ Support Palliat Care, 2023, 13(e1): e10-e19. doi: 10.1136/bmjspcare-2020-002450 [6] 张蕊玉, 马玉侠, 成金艳, 等. 揿针在患者术后辅助治疗中的应用研究进展[J]. 中国中医急症, 2022, 31(10): 1873-1876, 1880. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJZ202210048.htmZHANG R Y, MA Y X, CHENG J Y, et al. Research progress on the application of pressing needle in postoperative adjuvant therapy for patients[J]. Chinese Medicine Emergency, 2022, 31(10): 1873-1876, 1880. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJZ202210048.htm [7] 中华医学会妇产科学分会妇科盆底学组. 女性压力性尿失禁诊断和治疗指南(2017)[J]. 中华妇产科杂志, 2017, 52(5): 289-293. https://www.cnki.com.cn/Article/CJFDTOTAL-TJIY201806003.htmGynecology and Pelvic Fundus Group, Obstetrics and Gynecology Branch, Chinese Medical Association Diagnosis and treatment guidelines for female stress urinary incontinence (2017)[J]. Chinese Journal of Obstetrics and Gynecology, 2017, 52(5): 289-293. https://www.cnki.com.cn/Article/CJFDTOTAL-TJIY201806003.htm [8] 乌日罕. 盆底超声检查对产妇产后压力性尿失禁的评估作用研究[J]. 现代医学与健康研究电子杂志, 2023, 7(9): 19-21. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJD202309007.htmWU R H. A study on the evaluation effect of pelvic floor ultrasound examination on postpartum stress urinary incontinence in parturients[J]. Modern Medicine and Health Research (Electronic Edition), 2023, 7(9): 19-21. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJD202309007.htm [9] 朱韵, 姜丽英, 胡萍, 等. 盆底超声评估经闭孔无张力尿道中段悬吊术治疗压力性尿失禁中吊带与治疗效果的关系[J]. 中国超声医学杂志, 2023, 39(1): 74-77. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCY202301020.htmZHU Y, JIANG L Y, HU P, et al. Pelvic floor ultrasound evaluation of the relationship between sling and treatment effect in the treatment of stress urinary incontinence using tension-free transurethral suspension surgery[J]. Chinese Journal of Ultrasound Medicine, 2023, 39(1): 74-77. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCY202301020.htm [10] JAMARD E, BLOUET M, THUBERT T, et al. Utility of 2D-ultrasound in pelvic floor muscle contraction and bladder neck mobility assessment in women with urinary incontinence[J]. J Gynecol Obstet Hum Reprod, 2020, 49(1): 101629. DOI: 10.1016/j.jogoh.2019.101629. [11] XU Z H, HE H L, YU B B, et al. Application of transperineal pelvic floor ultrasound in changes of pelvic floor structure and function between pregnant and non-pregnant women[J]. Int J Womens Health, 2022, 14: 1149-1159. doi: 10.2147/IJWH.S361755 [12] 周春美, 孟侠, 吴垠, 等. 经会阴盆底实时三维超声评估不同分娩方式对产妇盆膈裂孔解剖结构及膀胱颈移动度的影响[J]. 中国计划生育学杂志, 2023, 31(1): 163-167. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY202301035.htmZHOU C M, MENG X, WU Y, et al. Effects of different delivery methods on the anatomical structure of pelvic diaphragmatic hiatus and bladder neck mobility in postpartum women evaluated by transperineal pelvic floor real-time three-dimensional ultrasound[J]. Chinese Journal of Family Planning, 2023, 31(1): 163-167. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY202301035.htm [13] 石力, 周振坤, 姜敏. 基于经筋理论浅析针灸治疗女性压力性尿失禁[J]. 中医杂志, 2023, 64(18): 1922-1925. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202318016.htmSHI L, ZHOU Z K, JIANG M. Discussion on Acupuncture in the Treatment of Female Stress Urinary Incontinence Based on the Theory of Channel Sinew[J]. Journal of Traditional Chinese Medicine, 2023, 64(18): 1922-1925. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202318016.htm [14] 周敏, 胡建英, 陈晶晶, 等. 募俞配穴思路的电子隔药灸联合腹针揿针法治疗产后压力性尿失禁疗效观察[J]. 现代中西医结合杂志, 2021, 30(11): 1217-1220. https://www.cnki.com.cn/Article/CJFDTOTAL-XDJH202111018.htmZHOU M, HU J Y, CHEN J J, et al. Observation on the therapeutic effect of electronic medicinal moxibustion combined with abdominal acupuncture and pressing needling method on postpartum stress urinary incontinence based on the concept of Moyu acupoint combination[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2021, 30(11): 1217-1220. https://www.cnki.com.cn/Article/CJFDTOTAL-XDJH202111018.htm [15] 苏进展, 徐英姿, 杜嘉, 等. 盆底超声联合MRI在浮针治疗压力性尿失禁中的应用[J]. 中华全科医学, 2022, 20(11): 1916-1919, 1937. doi: 10.16766/j.cnki.issn.1674-4152.002735SU J Z, XU Y Z, DU J, et al. Application of pelvic floor ultrasound combined with MRI in treating stress urinary incontinence with Fu ' s subcutaneous needling[J]. Chinese Journal of General Practice, 2022, 20(11): 1916-1919, 1937. doi: 10.16766/j.cnki.issn.1674-4152.002735 [16] 陈慧杰, 李保龙, 李宇婷, 等. 浮针结合Kegel训练治疗女性压力性尿失禁临床研究[J]. 针灸临床杂志, 2021, 37(10): 19-23. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJLC202110005.htmCHEN H J, LI B L, LI Y T, et al. Clinical Study of Fu ' s Subcutaneous Needling Combined with Kegel Training in Treatment of SUI in Female[J]. Journal of Clinical Acupuncture and Moxibustion, 2021, 37(10): 19-23. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJLC202110005.htm [17] 周敏, 胡建英, 陈晶晶, 等. 升气温肾方联合针灸治疗产后压力性尿失禁临床研究[J]. 山东中医杂志, 2021, 40(11): 1203-1207. https://www.cnki.com.cn/Article/CJFDTOTAL-SDZY202111003.htmZHOU M, HU J Y, CHEN J J, et al. Clinical Study on Shengqi Wenshen Formula(升气温肾方)Combined with Acupuncture in the Treatment of Postpartum Stress Urinary Incontinence[J]. Shandong Journal of Traditional Chinese Medicine, 2021, 40(11): 1203-1207. https://www.cnki.com.cn/Article/CJFDTOTAL-SDZY202111003.htm [18] 屈媛媛, 冯楚文, 孙忠人, 等. 基于集合可视化分析系统探索针灸治疗产后压力性尿失禁的选穴规律[J]. 针灸临床杂志, 2023, 39(8): 52-60. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJLC202308011.htmQU Y Y, FNEG C W, SUN Z R, et al. Law of Acupoints Selection for Treating PSUI by Acupuncture and Moxibustion Based on Set Visual Analysis System[J]. Journal of Clinical Acupuncture and Moxibustion, 2023, 39(8): 52-60. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJLC202308011.htm [19] 顾微波, 杨杭, 王晓颖. 针刺疗法配合盆底电生理治疗压力性尿失禁临床研究[J]. 新中医, 2021, 53(6): 109-112. https://www.cnki.com.cn/Article/CJFDTOTAL-REND202106029.htmGU W B, YANG H, WANG X Y. Clinical Study on Acupuncture Combined with Pelvic Floor Electrophysiology for Stress Incontinence[J]. New Chinese Medicine, 2021, 53(6): 109-112. https://www.cnki.com.cn/Article/CJFDTOTAL-REND202106029.htm [20] ZHOU Z L, ZHANG Y, DENG H W, et al. Comparison of acupuncture and moxibustion related non-surgical therapies for women with stress urinary incontinence: a systematic review and network meta-analysis of randomized controlled trials[J]. Explore (NY), 2023, 26: S1550-8307(23)00269-0. DOI: 10.1016/j.explore.2023.11.010. -
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