Wang Keke,Song Cuiping,Zhang HaiYang,et al.Application of biofeedback and pelvic floor exercise in the treatment of functional fecal incontinence in children[J].Journal of Clinical Pediatric Surgery,2022,21(04):358-363.[doi:10.3760/cma.j.cn101785-202011036-012]
生物反馈治疗联合盆底肌锻炼对小儿功能性大便失禁的疗效与治疗价值探讨
- Title:
- Application of biofeedback and pelvic floor exercise in the treatment of functional fecal incontinence in children
- Keywords:
- Biofeedback; Pelvic Floor Exercise; Functional Fecal; Treatment Outcome; Child
- 摘要:
- 目的探讨生物反馈治疗联合盆底肌锻炼对小儿功能性大便失禁的疗效与治疗价值。方法收集2018年6月至2020年6月由河南省新乡医学院第一附属医院收治的32例功能性大便失禁患儿作为研究对象,男19例,女13例;年龄6~13岁,平均年龄7.93岁。均采用Laborie生物反馈仪进行生物反馈治疗,每日1次,每次治疗40 min,10 d为一个疗程,均予1个疗程治疗;同时每日行不少于200次的盆底肌收缩锻炼(为治疗组)。对比分析治疗前、一个疗程治疗结束时、治疗后1个月及治疗后1年患儿肛管电流强度(mA)、肛管基础运动肌电值(μv)、肛管收缩肌电差值(μv)以及肛门持续收缩时间(s)。选取10例肛门直肠功能正常的同龄儿童作为对照组。随访时间为1年。结果1个疗程结束后,32例功能性大便失禁患儿污粪症状均消失,肛管电流强度由治疗前[(15.87±2.59) mA]下降至治疗后[(12.00±2.16) mA],治疗前、治疗后结果与对照组[(7.10±1.93) mA]相比,差异均有统计学意义(P＜0.05);肛管基础运动肌电值由治疗前[(209.47±33.13)μv]下降至治疗后[(138.31±46.99)μv],治疗前、治疗后结果与对照组[(85.86±34.73)μv]相比,差异均有统计学意义(P＜0.05);肛管收缩肌电差值由治疗前[(45.27±27.6)μv]上升至治疗后[(92.91±45.06)μv],治疗前、治疗后结果与对照组[(127.29±51.89)μv]相比,差异均有统计学意义(P＜0.05);肛门持续收缩时间由治疗前[(1.21±0.57) s]上升至治疗后[(2.07±0.79) s],治疗前、治疗后结果与对照组[(2.62±0.64) s]相比,差异均有统计学意义(P＜0.05)。治疗组治疗后1个月无一例出现污粪,肛管电流强度[(8.00±0.93) mA]、肛管基础运动肌电值[(90.56±19.11)μv]、肛管收缩肌电差值[(110.22±36.71)μv]及肛门持续收缩时间[(2.47±0.66) s]与对照组相比,差异均无统计学意义(P＞0.05)。治疗后1年,治疗组失访5例,余27例无一例出现污粪;与对照组相比,肛管电流强度[(7.44±1.42) mA]、肛管基础运动肌电值[(87.11±34.10)μv]、肛管收缩肌电差值[(125.56±36.44)μv]及肛门持续收缩时间[(2.57±0.54) s]差异无统计学意义(P＞0.05)。结论生物反馈治疗联合盆底肌锻炼治疗小儿功能性大便失禁安全、有效,值得临床推广应用。
- Abstract:
- ObjectiveTo explore the effect and therapeutic value of biofeedback and pelvic floor exercise on functional fecal incontinence in children.MethodsFrom June 2018 to June 2020,a total of 32 children of functional fecal incontinence were recruited,There were 19 boys and 13 girls with a mean age of 7.93(6-13) years.Daily 40-min biofeedback therapy of pelvic floor muscle was provided by Laborie biofeedback instrument.One cycle was composed of 10 sessions and all given 1 course of treatment.At the same time contraction training of pelvic floor muscle was offered over 200 times daily.Anal canal current intensity (mA),anal basic motor electromyography (μv),anal contraction myoelectric difference (μv) and anal continuous contraction time (s) were collected and compared before treatment,after the end of 1 course,1 month and 1 year after treatment respectively.Ten normal age-matched children were selected as control group.The follow-up period was1 year.ResultsAfter one course of treatment,all fecal symptoms (100%) disappeared.The current intensity of anal canal declined from[(15.87±2.59) mA]to[(12.00±2.16) mA].Results before and after treatment were compared to the control group[(7.10±1.93) mA],the differences were statistically significant (P<0.05).The EMG value of basic movement of anal canal declined from[(209.47±33.13) μv]to[(138.31±46.99) μv].Results before and after treatment were compared to the control group[(85.86±34.73) μv],the differences were statistically significant (P<0.05).The contractile muscle’s electrical difference of anal canal rose from[(45.27±27.6) μv]to[(92.91±45.06) μv].Results before and after treatment were compared to the control group[(127.29±51.89) μv],the differences were statistically significant (P<0.05).The duration of continuous anal contraction spiked from[(1.21±0.57) s]to[(2.07±0.79) s].Results before and after treatment were compared to the control group[(2.62±0.64) s],the differences were statistically significant (P<0.05).After 1-month treatment,all fecal symptoms disappeared.Anal canal current intensity[(8.00±0.93) mA],anal canal basal motor electromyography[(90.56±19.11) μv],anal canal contraction electromyography difference[(110.22±36.71)μv]and anal continuous contraction time[(2.47±0.66)s],Compared with control group,there was no significant difference (P>0.05).At 1 year after treatment,Five cases were lost,The rest of the children were free of soiling,Anal canal current intensity[(7.44±1.42)mA],anal canal basal motor electromyography[(87.11±34.10) μv],anal canal contraction electromyography difference[(125.56±36.44) μv]and anal continuous contraction time[(2.57±0.54) s],Compared with control group,there was no significant difference (P>0.05).ConclusionBiofeedback plus pelvic floor exercise are both safe and effective in the treatment of functional fecal incontinence in children.And it is worth clinically promotion and application.
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备注/Memo
收稿日期:2020-11-23;改回日期:。
基金项目:新乡市科技计划项目(CXGG17006)
通讯作者:宋翠萍,Email:scp1965@163.com
通讯作者:宋翠萍,Email:scp1965@163.com