基于互联网的自我管理干预对中老年女性压力性尿失禁患者临床治疗的随机对照研究

doi:10.12114/j.issn.1007-9572.2023.0720

摘要/Abstract

摘要： 背景压力性尿失禁（SUI）是中老年女性的常见疾病之一，严重影响其生活质量和身心健康。互联网医疗具有灵活性、隐私性、可及性等优势可作为尿失禁患者自我管理干预的有效手段，但其在中老年女性SUI患者临床治疗的有效性尚不明确。目的本研究旨在探索基于互联网的自我管理干预对改善中老年女性SUI患者临床症状、自我效能及心理状况的有效性。方法选取2022年在中国人民解放军空军第九八六医院就诊的中老年女性SUI患者120例为研究对象，采用双盲随机数字表法分为对照组和试验组，每组各60例。对照组给予常规盆底肌肉训练物理治疗（PFMT），20 min/d，隔天1次，10次为1个疗程。试验组在电刺激生物反馈进行PFMT的基础上实施持续6个月基于互联网的自我管理干预。对两组患者在治疗前和治疗后3、6个月进行门诊复查和随访，采用国际尿失禁咨询委员会尿失禁问卷简表（ICI-Q-SF）和1 h尿垫试验评估中老年女性SUI患者临床症状的改善情况，并评判临床疗效。采用盆底肌肉锻炼自我效能量表（BPMSES）评估患者自我管理效能，采用焦虑自评量表（SAS）和抑郁自评量表（SDS）评估两组患者心理状态。结果试验组治疗后3、6个月时ICI-Q-SF评分均低于对照组[（6.58±3.91）分与（9.27±3.11）分，P<0.05；（3.37±2.74）分与（7.41±3.55）分，P<0.001]。试验组治疗后3、6个月1 h尿垫试验均小于对照组[（4.83±1.64）g与（5.29±2.34）g，P<0.05；（2.16±0.88）g与（3.87±1.66）g，P<0.01]。对照组临床总有效率为78.33%（47/60）低于试验组的临床总有效率91.67%（55/60）（χ2=6.227，P=0.044）。治疗后3、6个月试验组BPMSES总分高于对照组[（105.70±15.68）分与（77.90±17.52）分，P<0.05；（126.61±16.64）分与（108.12±15.74）分，P<0.05]，治疗后3、6个月时试验组预期自我效能得分高于对照组[（69.27±5.91）分与（59.08±6.84）分，P<0.05；（79.71±10.41）分与（61.17±6.92）分，P<0.001）]。治疗后3、6个月时试验组预期效果得分均高于对照组[（58.17±8.69）分与（50.26±9.04）分，P<0.05；（64.93±7.84）分与（50.17±8.76）分，P<0.001]。试验组与对照组相比，治疗3、6个月时SAS评分[（43.29±7.71）分与（45.25±7.50）分，P<0.05；（39.18±8.32）分与（42.58±8.39）分，P<0.001]和SDS评分[（46.86±10.62）分与（47.17±10.22）分，P<0.05；（38.68±11.24）分与（42.54±10.31）分，P<0.001]降低明显。结论基于互联网的自我管理干预可明显提高中老年女性SUI患者的自我管理效能，并有效减轻中老年女性SUI患者抑郁、焦虑的心理状态，从而提高PFMT对中老年女性SUI患者的临床疗效。基于互联网的自我管理干预在提高中老年女性SUI患者治疗依从性和改善负面心理因素方面具有独特的优势，是中老年女性SUI患者安全有效和经济的干预措施，值得临床推广。

关键词: 自我管理, 中年人, 女性, 尿失禁, 压力性, 治疗

Abstract:

Background

Stress urinary incontinence (SUI) is one of the common diseases in middle-aged and elderly women, which seriously affects their quality of life and physical and mental health. Internet medicine has the advantages of flexibility, privacy and accessibility, which can be used as an effective approach of self-management intervention for urinary incontinence patients. However, its effectiveness on the clinical treatment of middle-aged and elderly female SUI patients is unclear.

Objective

To explore the effects of Internet-based self-management intervention on improving clinical symptoms, self-efficacy, and psychological status in middle-aged and elderly female SUI patients.

Methods

A total of 120 middle-aged and elderly female SUI patients treated in the Air Force 986 Hospital of PLA from January to December 2022 were recruited. They were randomly assigned into control group (n=60) and experimental group (n=60) by double-blind random number table method. Patients in both groups were given conventional pelvic floor muscle training (PFMT), with 20 minutes per day, once every other day for a course of 10 times of PFMT, and those in the experimental group were additionally given Internet-based self-management intervention for 6 months. Outpatient re-examination and follow-up visits were conducted before treatment and 3 and 6 months after treatment. Clinical symptoms of SUI in middle-aged and elderly female patients were evaluated by surveying the International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF) and 1-hour pad test, thus determining the clinical efficacy. The Broome Pelvic Muscle Self-efficacy Scale (BPMSES) was used to evaluate the self-management efficacy. The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to evaluate the anxiety and depression status, respectively.

Results

The ICI-Q-SF scores of experimental group at 3 months [ (6.58±3.91) points vs. (9.27±3.11) points, P<0.05] and 6 months [ (3.37±2.74) points vs. (7.41±3.55) points, P<0.001] after treatment were significantly lower than those of control group. Urinary loss in 1-hour pad test at 3 months [ (4.83±1.64) g vs. (5.29±2.34) g, P<0.05] and 6 months [ (2.16±0.88) g vs. (3.87±1.66) g, P<0.01] after treatment was significantly less in the experimental group than that of control group. The total clinical effective rate of the control group was significantly lower than that of the experimental group (78.33%, 47/60, vs. 91.67%, 55/60, χ²=6.227, P=0.044). The total scores of BPMSES in the experimental group at 3 months [ (105.70±15.68) points vs. (77.90±17.52) points, P<0.05] and 6 months [ (126.61±16.64) points vs. (108.12±15.74) points, P<0.05] after treatment were significantly higher than those of control group. The expected self-efficacy scores of the experimental group at 3 months [ (69.27±5.91) points vs. (59.08±6.84) points, P<0.05] and 6 months [ (79.71±10.41) points vs. (61.17±6.92) points, P<0.001) ] after treatment were significantly higher than those of control group. The expected efficacy scores at 3 months [ (58.17±8.69) points vs. (50.26±9.04) points, P<0.05] and 6 months [ (64.93±7.84) points vs. (50.17±8.76) points, P<0.001) after treatment were significantly higher in the experimental group than those of the control group. The SAS scores [3 months (43.29±7.71) points vs. (45.25±7.50) points, P<0.05; 6 months (39.18±8.32) points vs. (42.58±8.39) points, P<0.001] and SDS scores [3 months (46.86±10.62) points vs. (47.17±10.22) points, P<0.05; 6 months (38.68±11.24) points vs. (42.54±10.31) points, P<0.001] at 3 months and 6 months were significantly lower in the experimental group than those of the control group.

Conclusion

Internet-based self-management intervention can significantly improve the self-management efficacy of middle-aged and elderly female SUI patients and alleviate psychological states of depression and anxiety, thus enhancing the clinical efficacy of PFMT on middle-aged and elderly female SUI patients. It provides unique advantages in improving treatment compliance and relieving negative psychological factors in middle-aged and elderly female SUI patients. Serving as a safe, effective and economic friendly intervention, Internet-based self-management intervention is worthy of clinical promotion to middle-aged and elderly female SUI patients.

Key words: Self-management, Middle aged, Female, Urinary incontinence, stress, Treatment

梁静,张魁,牛力春,等. 基于互联网的自我管理干预对中老年女性压力性尿失禁患者临床治疗的随机对照研究[J]. 中国全科医学, 2024, 27(36): 4575-4581. DOI: 10.12114/j.issn.1007-9572.2023.0720.
LIANG Jing,ZHANG Kui,NIU Lichun, et al. Application of Internet-based Self-management Intervention in the Clinical Treatment of Middle-aged and Elderly Female Patients with Stress Urinary Incontinence: a Randomized Controlled Trial[J]. Chinese General Practice, 2024, 27(36): 4575-4581. DOI: 10.12114/j.issn.1007-9572.2023.0720.

图/表 5

参考文献 22

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组别	例数	年龄（岁）	受教育程度[例（%）]			产次[例（%）]		分娩方式[例（%）]		BMI （kg/m²）	病情程度[例（%）]
组别	例数	年龄（岁）	初中以下	初中~高中	大专以上	1次	≥2次	经阴道分娩	剖宫产	BMI （kg/m²）	轻度	中度
对照组	60	49.8±12.4	15（25.0）	19（31.7）	26（43.3）	22（36.7）	38（63.3）	48（80.0）	12（20.0）	23.5±4.6	38（63.3）	22（36.7）
试验组	60	50.5±12.9	21（35.0）	22（36.7）	17（28.3）	25（41.7）	35（58.3）	50（83.3）	10（16.7）	24.2±4.6	43（71.7）	17（28.3）
χ²（t）值		0.199^a	3.103			0.315		0.223		-0.142^a	0.950
P值		0.843	0.212			0.575		0.637		0.149	0.330

组别	例数	年龄（岁）	受教育程度[例（%）]			产次[例（%）]		分娩方式[例（%）]		BMI （kg/m²）	病情程度[例（%）]
组别	例数	年龄（岁）	初中以下	初中~高中	大专以上	1次	≥2次	经阴道分娩	剖宫产	BMI （kg/m²）	轻度	中度
对照组	60	49.8±12.4	15（25.0）	19（31.7）	26（43.3）	22（36.7）	38（63.3）	48（80.0）	12（20.0）	23.5±4.6	38（63.3）	22（36.7）
试验组	60	50.5±12.9	21（35.0）	22（36.7）	17（28.3）	25（41.7）	35（58.3）	50（83.3）	10（16.7）	24.2±4.6	43（71.7）	17（28.3）
χ²（t）值		0.199^a	3.103			0.315		0.223		-0.142^a	0.950
P值		0.843	0.212			0.575		0.637		0.149	0.330

组别	例数	ICI-Q-SF评分（分）			1 h尿垫试验（g）
组别	例数	治疗前	治疗后3个月	治疗后6个月	治疗前	治疗后3个月	治疗后6个月
对照组	60	10.87±4.14	9.27±3.11	7.41±3.55	7.65±3.18	5.29±2.34	3.87±1.66
试验组	60	10.64±3.72	6.58±3.91	3.37±2.74	7.57±3.15	4.83±1.64	2.16±0.88
F值		F_交互=0.774，F_组间=6.268，F_时间=5.419			F_交互=2.093，F_组间=5.208，F_时间=9.058
P值		P_交互=0.645，P_组间=0.014，P_时间=0.026			P_交互=0.132，P_组间=0.026，P_时间<0.001

组别	例数	ICI-Q-SF评分（分）			1 h尿垫试验（g）
组别	例数	治疗前	治疗后3个月	治疗后6个月	治疗前	治疗后3个月	治疗后6个月
对照组	60	10.87±4.14	9.27±3.11	7.41±3.55	7.65±3.18	5.29±2.34	3.87±1.66
试验组	60	10.64±3.72	6.58±3.91	3.37±2.74	7.57±3.15	4.83±1.64	2.16±0.88
F值		F_交互=0.774，F_组间=6.268，F_时间=5.419			F_交互=2.093，F_组间=5.208，F_时间=9.058
P值		P_交互=0.645，P_组间=0.014，P_时间=0.026			P_交互=0.132，P_组间=0.026，P_时间<0.001

组别	例数	治愈	有效	无效
对照组	60	26（43.33）	21（35.00）	13（21.67）
试验组	60	38（63.33）	17（28.33）	5（8.33）