早期盆底肌肉锻炼对回肠原位膀胱术后尿失禁和生活质量的影响

张红琴; 刘贝贝; 汪斐; 路盈利; 李建

doi:10.16766/j.cnki.issn.1674-4152.003780

早期盆底肌肉锻炼对回肠原位膀胱术后尿失禁和生活质量的影响

doi: 10.16766/j.cnki.issn.1674-4152.003780

蚌埠医科大学第一附属医院泌尿外科，安徽蚌埠 233004

基金项目:

安徽省教育厅重点研究项目 KJ2019A0308

安徽省高等学校自然科学研究项目 KJ2018A0999

蚌埠医学院科技发展基金项目 BYKF1770

详细信息

通讯作者:
李建，E-mail：lijian99109@hotmail.com

中图分类号: R737.14 R473.6
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- 文章访问数: 16
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- 被引次数: 0
出版历程
- 收稿日期: 2024-03-15
- 网络出版日期: 2024-12-31

Effect of early pelvic floor muscle exercises on urinary incontinence and quality of life after orthotopic ileal neobladder surgery

Department of Urology, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨早期盆底肌肉锻炼护理对全膀胱切除回肠原位膀胱术后患者尿失禁和生活质量的影响。方法选取2017年10月—2020年10月蚌埠医科大学第一附属医院就诊符合本研究标准的膀胱癌行全膀胱切除回肠原位膀胱术56例患者为研究对象，根据随机数字表法将56例患者分为观察组(28例)和对照组(28例)。所有患者均接受规范的盆底肌锻炼护理，其中观察组患者于入院后第2天至手术前及术后1周起带尿管早期实施规范性的盆底肌锻炼护理，对照组患者术后3周拔出尿管后实施规范盆底肌锻炼护理。术后3个月，分别采用膀胱癌特异性量表(FACT-BL)和满意度调查表对患者生活质量和对护理的满意度进行评估，同时记录2组患者的尿失禁发生情况。结果术后3个月，观察组患者尿失禁发生率为28.57%(8/28)，明显低于对照组的60.71%(17/28, P < 0.05)；观察组FACT-BL总分、功能状况评分、膀胱癌特异性模块评分分别为(134.65±8.16)分、(21.59±2.01)分、(39.56±3.15)分均显著高于对照组[(126.71±6.92)分，(19.07±2.06)分，(37.63±3.54)分，P < 0.05]；观察组患者对护理的满意度明显高于对照组(P=0.023)。结论早期盆底肌肉锻炼护理能够明显改善全膀胱切除回肠原位膀胱术后控尿情况，提高患者的康复期生活质量，值得临床推广应用。
- 盆底肌肉锻炼 /
- 回肠原位膀胱术 /
- 膀胱癌 /
- 尿失禁 /
- 生活质量
Abstract: Objective To study the effect of early pelvic floor muscle exercises on urinary incontinence and quality of life in patients undergoing orthotopic ileal neobladder surgery for bladder cancer. Methods Fifty-six patients with bladder cancer treated in the First Affiliated Hospital of Bengbu Medical University from October 2017 to October 2020 who met the criteria of this study and underwent total cystectomy with orthotopic ileal neobladder surgery were selected as the study objects. According to random number table method, 56 patients were divided into the observation group (n=28) and the control group (n=28). All patients received standardized pelvic floor muscle exercise nursing. Patients in the observation group received standardized pelvic floor muscle exercise nursing from the second day after admission until one week post-surgery, while patients in the control group received standardized pelvic floor muscle exercise nursing from three weeks after catheter removal. The quality of life and nursing satisfaction were evaluated with function asses-ment of cancer therapy-bladder cancer form (FACT-BL) and a satisfaction questionnaire after three months. The incidence of urinary incontinence was recorded in the two groups. Results After three months, the incidence of urinary incontinence in the observation group (28.57%, 8/28) was significantly lower than that in the control group 60.17% (17/28, P < 0.05). The total FACT-BL score, functional status scores, and bladder cancer-specific module scores of the observation group were 134.65±8.16, 21.59±2.01, and 39.56±3.15, respectively, which were significantly higher than those of the control group (126.71±6.92, 19.07±2.06, 37.63±3.54, P < 0.05). The satisfaction rate of patients in the observation group with nursing was significantly higher than in the control group (P < 0.05). Conclusion Early pelvic floor muscle exercise nursing can improve urination function and quality of life in patients following orthotopic ileal neobladder surgery for bladder cancer. This approach is highly recommended for clinical practice.
- Pelvic floor muscle exercise /
- Orthotopic ileal neobladder surgery /
- Bladder cancer /
- Urinary incontinence /
- Quality of life

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表 1 2组腹腔镜下回肠原位膀胱术治疗的患者一般资料比较

Table 1. Comparison of general data of patients treated with laparoscopic ileal orthotopic bladder surgery between the two groups

组别	例数	年龄(x±s, 岁)	CT分期(例)			肿瘤类型(例)
组别	例数	年龄(x±s, 岁)	2b	T3	T4	腺癌	移行细胞癌
观察组	28	53.67±4.06	16	8	4	3	25
对照组	28	54.02±3.83	16	7	5	4	24
统计量		0.347^a	0.178^b
P值		0.540	0.915			0.999^c
注：^a为t值，^b为Z值；^c采用Fisher精确检验。

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表 2 2组腹腔镜下回肠原位膀胱术治疗的患者术后3个月尿失禁发生率和失禁程度比较

Table 2. Comparison of the incidence and severity of urinary incontinence three months after laparoscopic ileal orthotopic bladder surgery between the two groups

组别	例数	排尿情况[例(%)]		尿失禁程度(例)
组别	例数	尿失禁	排尿正常	Ⅰ	Ⅱ	Ⅲ	Ⅳ
观察组	28	8(28.57)	20(71.43)	7	1	0	0
对照组	28	17(60.71)	11(39.29)	3	9	3	2
统计量		5.862^a		3.640^b
P值		0.016		0.016
注：^a为χ²值，^b为Z值。

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表 3 2组腹腔镜下回肠原位膀胱术治疗的患者干预前后FACT-BL各维度评分比较(x±s，分)

Table 3. Comparison of FACT-BL scores between the two groups before and after intervention (x±s, points)

组别	例数	身体状况		t值	P值	家庭社会状况		t值	P值	精神状况		t值	P值
组别	例数	干预前	干预后	t值	P值	干预前	干预后	t值	P值	干预前	干预后	t值	P值
观察组	28	20.12±2.35	22.18±2.65	-2.260	0.032	19.15±2.05	21.22±1.85	-2.311	0.029	19.12±1.65	19.86±1.58	-0.326	0.363
对照组	28	20.25±2.87	21.35±2.25	-1.221	0.312	19.28±2.10	20.65±1.92	-1.819	0.272	18.93±1.71	19.75±1.60	-1.321	0.301
统计量		-0.954^a	1.837^b			-0.281^a	2.041^b			0.921^a	1.740^b
P值		0.215	0.169			0.613	0.083			0.157	0.714

组别	例数	功能状况		t值	P值	膀胱癌特异性模块		t值	P值	总分		t值	P值
组别	例数	干预前	干预后	t值	P值	干预前	干预后	t值	P值	干预前	干预后	t值	P值
观察组	28	18.07±2.38	21.59±2.01	-2.642	0.021	36.42±2.45	39.56±3.15	-2.694	0.016	121.43±5.67	134.65±8.16	-2.548	0.018
对照组	28	17.88±2.46	19.07±2.06	-0.447	0.392	36.12±2.27	37.63±3.54	-0.765	0.305	120.32±6.04	126.71±6.92	-0.254	0.853
统计量		0.942^a	6.634^b			0.384^a	4.539^b			0.768^a	7.529^b
P值		0.457	0.005			0.922	0.018			0.549	< 0.001
注：^a为t值，^b为F值。

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表 4 2组腹腔镜下回肠原位膀胱术治疗的患者满意度比较[例(%)]

Table 4. Comparison of patient satisfaction between the two groups of laparoscopic ileal orthotopic bladder surgery [cases (%)]

组别	例数	人文关怀	护理技术	训练效果	护理效果	总评
观察组	28	28(100.00)	28(100.00)	28(100.00)	28(100.00)	28(100.00)
对照组	28	22(78.57)	25(89.29)	23(82.14)	23(82.14)	22(78.57)
P值^a		0.023	0.236	0.05	0.05	0.023
注：^a为采用Fisher精确检验。

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