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摘要: 目的 通过盆底表面肌电的标准化评估，探讨盆底失弛缓所致便秘患者治疗前后盆底肌电特征的变化和与疗效相关的指标，为治疗效果提供证据。方法 采用回顾性研究，选取2018年1月—2021年12月期间在南京中医药大学附属南京中医院盆底中心接受诊断并经过系统治疗的102例盆底失弛缓所致便秘患者为研究对象。患者接受了Glazer盆底表面肌电评估及至少10次的盆底生物反馈联合针刺治疗。将同期与患者人口资料匹配的80例无症状人群作对照组，分析102例患者治疗前后的盆底肌电特征及变化，并比较83例治疗有效和19例治疗无效患者的表面肌电特征性指标与治疗效果之间的相关性。结果 盆底失弛缓所致便秘患者盆底表面肌电表现为静息态肌电活动过度，快肌收缩反应速度慢、波幅低，持续收缩变异系数高，慢肌持续收缩稳定性差等；经过盆底生物反馈和针刺联合治疗后，患者的静息状态肌电活动波幅下降，持续收缩和耐久收缩阶段的变异系数均下降，说明患者慢肌的耐疲劳度改善；治疗有效组持续收缩阶段的变异系数与疗效直接相关。结论 盆底失弛缓所致便秘患者的慢肌持续收缩稳定性与治疗效果直接相关，与收缩波幅无关。通过标准化的表面肌电测量和分析，可以为研究个性化生物反馈治疗方案及评估其他治疗方法的有效性提供循证依据。Abstract: Objective To investigate the pelvic floor sEMG features and the evaluation role of patients with dyssynergic defecation.Methods A retrospective study was conducted, involving 102 patients diagnosed with dyssynergic defecation, who underwent systematic treatment at the Pelvic Floor Center of Nanjing Hospital of Traditional Chinese Medicine from January 2018 to December 2021. The standardized Glazer Protocol for pelvic floor sEMG assessment was employed, concomitant with pelvic floor biofeedback and acupuncture treatment spanning a minimum of 10 sessions. An additional control cohort 80 asymptomatic individuals, matched demographically, was included for comparative analysis. Pre-and post-treatment pelvic floor sEMG characteristics were investigated. The correlation between sEMG characteristic indices and treatment outcomes was compared between the effective group(83 cases) and ineffective group(19 cases).Results Patients demonstrated pelvic floor sEMG hyperactivity, delayed fast-twitch muscle response and low amplitude, slow-twitch muscle tonic contraction coefficient of variation is high, has poor stability, etc. Following combined pelvic floor biofeedback and acupuncture treatment, sEMG baseline amplitude decreased, and variability coefficients during tonic and endurance contractions decreased. In the effective treatment group, the variability coefficient during tonic contraction directly correlated with treatment efficacy.Conclusion The stability of slow-twitch muscle in dyssynergic defecation patients is directly correlated with treatment effectiveness and is independent of amplitude. Standardized sEMG testing and analysis can provide robust evidence for researching personalized biofeedback protocol and evaluating the effectiveness of other treatment methods.
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Key words:
- dyssynergic defecation /
- pelvic floor sEMG /
- biofeedback /
- acupuncture /
- treatment outcome evaluation
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表 1 盆底失弛缓所致便秘患者的盆底表面肌电特征及治疗前后的变化
X±S 检测阶段 检测指标 对照组(n=80) 盆底失弛缓组 治疗前(n=102) 治疗后(n=102) 前基线 波幅/μV 2.72±1.16 4.16±2.531) 2.29±1.492) 变异系数 0.21±0.09 0.17±0.161) 0.20±0.19 快速收缩 收缩反应时间/s 1.99±0.37 2.10±0.281) 2.11±0.27 最大收缩波幅/μV 57.25±34.88 23.99±13.951) 23.56±11.98 持续收缩 收缩波幅/μV 28.72±15.19 25.07±16.02 21.62±10.702) 变异系数 0.32±0.07 0.38±0.091) 0.31±0.072) 中值频率/Hz 89.61±13.27 99.60±16.981) 99.86±9.87 耐久收缩 收缩波幅/μV 22.50±12.35 22.16±19.16 18.79±20.66 变异系数 0.27±0.11 0.26±0.10 0.22±0.092) 中值频率/Hz 90.64±17.36 99.94±22.591) 96.53±17.70 后基线 波幅/μV 2.99±1.57 3.08±2.34 2.42±1.542) 变异系数 0.24±0.18 0.19±0.17 0.20±0.14 与对照组比较，1)P＜0.05；与盆底失弛缓组治疗前比较，2)P＜0.05。 
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表 2 与疗效相关的盆底表面肌电特征
X±S 检测阶段 检测指标 有效组(n=83) 无效组(n=19) 治疗前后差值 治疗前 治疗后 治疗前 治疗后 有效组(n=83) 无效组(n=19) 前基线 波幅/μV 3.92±2.41 2.20±1.241) 5.24±2.84 2.69±2.272) 1.72±1.82 2.55±1.77 变异系数 0.18±0.14 0.21±0.20 0.15±0.04 0.18±0.13 -0.02±0.24 -0.03±0.13 快速收缩 收缩反应时间/s 2.11±0.28 2.09±0.26 2.07±0.28 2.21±0.20 0.02±0.41 -0.14±0.32 最大收缩波幅/μV 23.39±13.31 23.71±11.97 26.64±16.64 22.92±12.35 -0.32±12.97 3.72±11.58 持续收缩 收缩波幅/μV 24.56±15.05 21.57±10.02 27.34±20.05 21.87±13.62 2.99±14.64 5.47±17.19 变异系数 0.39±0.10 0.30±0.071) 0.37±0.09 0.35±0.09 0.09±0.103) 0.02±0.05 中值频率/Hz 99.77±17.49 100.45±13.48 98.90±14.98 97.31±17.87 -0.68±18.26 1.60±15.99 耐久收缩 收缩波幅/μV 21.72±17.78 18.57±9.35 24.06±24.85 19.73±12.11 3.15±16.84 4.33±22.72 变异系数 0.26±0.11 0.22±0.101) 0.23±0.08 0.22±0.45 0.03±0.11 0.02±0.06 中值频率/Hz 99.97±23.98 96.45±18.03 99.78±15.63 96.94±16.68 3.53±24.54 2.84±14.88 后基线 波幅/μV 2.90±2.14 2.43±1.391) 3.89±2.99 2.39±2.132) 0.47±1.96 1.50±2.16 变异系数 0.19±0.18 0.19±0.14 0.16±0.09 0.19±0.15 0.00±0.24 0.02±0.18 与有效组治疗前比较，1)P＜0.05；与无效组治疗前比较，2)P＜0.05；与无效组治疗前后差值比较，3)P＜0.05。
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