動(dòng)態(tài)神經(jīng)肌肉穩(wěn)定技術(shù)胸腹聯(lián)合呼吸控制在功能性便秘治療中的療效研究

楊寬女 胡金娜 李建華 吳方超 郝彥 張凱 王達(dá)

[摘要]目的：探索動(dòng)態(tài)神經(jīng)肌肉穩(wěn)定技術(shù)（DNS）胸腹聯(lián)合呼吸控制在功能性便秘治療中的療效。方法：本試驗(yàn)采取前瞻性研究，選取2018年7月-2019年2月筆者科室門診行康復(fù)治療的功能性便秘患者40例，按照電腦隨機(jī)化方法將所有患者分為實(shí)驗(yàn)組和對照組，每組各20例，由于試驗(yàn)過程中兩組中各有4例患者終止了治療，故樣本脫落后實(shí)際參與實(shí)驗(yàn)的樣本量為每組各16例。對照組患者采用常規(guī)盆底肌電刺激治療，實(shí)驗(yàn)組在對照組基礎(chǔ)上進(jìn)行DNS胸腹聯(lián)合呼吸訓(xùn)練，每周5次，連續(xù)2周。對兩組分別進(jìn)行Knowles-Eccersley-Scott癥狀評分（KESS）、Glazer法評估盆底表面肌電指標(biāo)。結(jié)果：兩組排便功能均有改善，實(shí)驗(yàn)組治療后KESS量表評分較治療前改善，且較對照組明顯降低，癥狀改善明顯，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。通過Glazer指標(biāo)對比，實(shí)驗(yàn)組第3、4階段的平均肌電值均較對照組改善，盆底肌耐力較對照組增加，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論：DNS胸腹聯(lián)合呼吸控制訓(xùn)練有助于改善功能性便秘患者的排便功能，進(jìn)一步完善了功能性便患者的保守治療方案以及提供了該類患者自我管理有效性的證據(jù)，也為DNS呼吸技術(shù)用于治療功能性便秘奠定了研究基礎(chǔ)。

[關(guān)鍵詞]功能性便秘;動(dòng)態(tài)神經(jīng)肌肉穩(wěn)定技術(shù)（DNS）;胸腹聯(lián)合呼吸;低頻電刺激

[中圖分類號]R57? ? [文獻(xiàn)標(biāo)志碼]A? ? [文章編號]1008-6455（2019）06-0012-05

Abstract： Objective? To explore the efficacy of dynamic neuromuscular stabilization technique （DNS） combined with thoracic and abdominal breathing control in the treatment of functional constipation. Methods? In this prospective study， 40 patients with functional constipation who received rehabilitation treatment in our department from July 2018 to February 2019 were selected， and all patients were assigned to the experimental group and the control group with 20 cases each according to the computer randomization method， and 4 patients in the control group and the experimental group were separated during the experiment. Patients in the control group received conventional pelvic floor electrical stimulation therapy， and patients in the experimental group received DNS combined thoracic and abdominal breathing training on the basis of the experimental group. Practice five times a week for two weeks. The two groups were evaluated by Glazer method in terms of pelvic floor surface electromyography， knowles-eccersley-scott symptom score （KESS）， depression and anxiety scale， etc. Results? The defecation function of the two groups was improved. After treatment， the score of KESS scale in the experimental group was significantly lower than that in the control group， and the symptoms were significantly improved， the difference was statistically significant （P<0.05）. According to Glazer index comparison， the average emg of the experimental group at the third and fourth stages was improved compared with that of the control group， and the difference was statistically significant （P<0.05）. The pelvic floor muscle endurance of the experimental group was increased compared with that of the control group， and the difference was statistically significant （P<0.05）. Conclusion? DNS thoracic and abdominal combined breathing control training is helpful to improve the defecation function of patients with functional constipation， further improve the conservative treatment program for functional constipation patients and provide evidence for the effectiveness of self-management of such patients， and also lay a research foundation for the application of DNS breathing technology in the treatment of functional constipation.