摘要
【目的】观察盆底肌肉训练、中医益气升提法及两者联合运用对全子宫切除术(TH)后患者性功能的作用。【方法】将124例患有妇科良性病变而行TH的非脱垂患者随机分为空白对照组(空白组)、锻炼组、中医组和联合组,每组各31例,分别于术后给予常规随访、盆底肌肉锻炼、中医益气升提法[内服补中益气丸+穴位艾灸(气海、关元、百会穴)]、盆底肌肉锻炼和益气升提法联合治疗,从患者性欲、性兴奋度、性高潮、阴道痉挛或松弛、性交疼痛评分和性生活总分等方面客观评价各组患者术前和术后每3个月共12个月的性功能情况。【结果】4组患者术后均随访1年。术后3个月,4组患者上述各项性功能指标均较术前下降(P<0.05)。空白组术后各时点的各项性功能指标均较术前下降(P<0.05);锻炼组分别在术后12个月或9个月、中医组分别在术后12个月或6个月或9个月、联合组分别在术后9个月或6个月上述各项指标基本恢复至术前水平(P>0.05),甚至锻炼组在术后12个月的性兴奋度,以及中医组和联合组在术后9个月或12个月的各项性功能指标均较术前提高(P<0.05)。组间比较:各干预组术后各时点的性欲、性兴奋度、性生活总分和术后6、9、12个月的性高潮、阴道痉挛评分,以及术后9、12个月的性交疼痛评分均高于空白组(P<0.05);联合组术后各时点的性欲、性高潮、阴道痉挛评分和性生活总分又高于锻炼组和中医组(P<0.05),而中医组和联合组术后12个月的性兴奋度评分及术后各时点的性交疼痛评分高于锻炼组(P<0.05)。【结论】TH对女性盆底功能的近期影响是引起阴道松弛、降低盆底肌肉肌力及性生活质量。术后早期给予积极干预措施如盆底肌肉锻炼可以预防术后盆底功能障碍性疾病的发生,运用中医益气升提疗法或两者联合可以提高TH术后性生活质量。
Objective To observe the effect of pelvic floor muscle training exercises,traditional Chinese medicine(TCM)Qi-replenishing and elevating therapy and their combination on sexual function of women after totalhysterectomy(TH). Methods One hundred and twenty-four cases of gynecological benign diseases withoutprolapse of the uterus who received TH were randomly divided into four groups, namely blank control group,exercises group,TCM therapy group and combined treatment group,31 cases in each group. Blank control groupwas routinely followed up after TH, exercises group took pelvic floor muscle training exercises, TCM therapygroup was treated with TCM Qi-replenishing and elevating therapy including oral use of Buzhong Yiqi Pills(Pillsfor Tonifying Middle Energizer and Replenishing Qi)and moxibustion on Qihai(RN6),Guanyuan(RN4)and Baihui(DU20),and combined treatment group was treated with pelvic floor muscle training exercises plus TCMQi-replenishing and elevating therapy. Before TH and every 3 months in a total of 12 months after TH,the scoresof sexual function indexes including sexual desire, sexual excitation, orgasm, vaginal spasms or vaginallaxation,and sexual pain as well as sexual life overall scores were examined. Results All of the patients in the four groups were followed up for one year after surgery. The scores of various sexual function indexes in the 4 groupswere decreased 3 months after TH(P < 0.05 compared with those before treatment). The scores of various sexualfunction indexes in the blank control group at various time points after TH were lower than those before treatment(P<0.05). The scores of sexual function indexes recovered to pre-operative levels in exercises group at post-operative month 12,9,in TCM therapy group at post-operative month 12,9,6,and in combined treatmentgroup at post-operative month 9,6(P>0.05),respectively. The scores of sexual excitation in exercises group atpost-operative month 12 were higher than the pre-operative level, and the scores of various sexual functionindexes in TCM therapy group and combined treatment group at post-operative month 9,12 were higher than thepre-operative levels(P<0.05). The inter-group comparison results showed that the intervention groups had higherscores of sexual desire and sexual excitation and sexual life overall scores at various post-operative time points,had higher scores of orgasm and vaginal spasms at post-operative month 6,9,12,and also had higher scores ofsexual pain at post-operative month 9, 12 than the blank control group(P<0.05);the combined treatmentgroup had higher scores of sexual desire,orgasm and vaginal spasms as well as sexual life overall scores at variouspost-operative time points than exercises group and TCM therapy group(P<0.05);TCM therapy group andcombined treatment group had higher scores of sexual excitation at post-operative month 12 and had higher scoresof sexual pain at various post-operative time points than exercises group(P<0.05). Conclusion TH results intoshort-term effect on pelvic floor function of women, manifesting as vaginal laxation, reduction of pelvic floormuscle strength and decrease of sexual life quality. Early post-operative intervention measures such as pelvic floormuscle training exercises can prevent the occurrence of post-operative pelvic floor dysfunction diseases,and TCMQi-replenishing and elevating therapy or its combination with pelvic floor muscle training exercises can increasethe quality of sexual life.
作者
刘敏
彭慧娟
程思
LIU Min;PENG Hui-Juan;CHENG Si(The Second Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China)
出处
《广州中医药大学学报》
CAS
2019年第3期353-359,共7页
Journal of Guangzhou University of Traditional Chinese Medicine
基金
广东省中医药局科研基金资助项目(编号:20141131)
全国名老中医专家司徒仪传承工作室
关键词
益气升提法
补中益气丸
针灸疗法
盆底肌锻炼
子宫全切除术
性功能
穴
气海穴
穴
关元
穴
百会
Qi-replenishing and elevating therapy
Buzhong Yiqi Pills
acup-moxibustion therapy
pelvic floor muscle training exercises
total hysterectomy
sexual function
point,Qihai(RN6)
point,Guanyuan(RN4)
point,Baihui(DU20)
作者简介
刘敏(1978-),女,医学硕士,主治医师;E-mail:13424143161@qq.com
