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@ 本研究由身體、心裡、社會全面性的探討婦女應力性尿失禁的問題,設
計一套骨盆底肌肉運動教育方案,並探討教育方案在個方面的成效,作為醫
護人員參考,以提升此類患者照護品質. 本研究採準實驗法,在某醫學
中心泌尿科及婦產科門診,以立意取樣及配對方式,將符合收案條件個案分
派實驗組及控制組,有效樣本32位;實驗組研究者給予為期的八週骨盆底肌
肉運動教育方案,控制組則照一般門診的護理。兩組病人皆給予前測並追
蹤八週後失禁症狀、滲尿量、滲尿頻率、心裡社會衝擊、會陰機電圖及尿
路動力學變化.資料分析以DbaseIII Plus 建檔,再利用SAS/PC套裝軟體進
行次數分佈、百分比、平均值、標準 級測驗法、魏克森等級和測驗法、
斯皮爾曼等級相關、 LSD事後檢定等統計方法進行分析。研究結果發
現,應力性尿失禁患者在失禁症狀、滲尿量及滲尿頻率屬於輕至重度不等;
心理社會衝擊程度為輕至中度;會陰肌肉強度為28.61u V、肌肉收縮持續
時間為4.34秒;尿路動力學中最大尿道閉鎖壓平均 81.57 cmH2O、功能性
尿道長度平均為2.56cm。研究也探討患者面對疾病所採取的因應行為,發
現常用多上廁所等積極行動的因應策略;在個人基本變項與各方面的相關
情形,發現失禁嚴重度越嚴重者其滲尿情形越嚴重、心裡社會衝擊越大,而
年齡越大其最大尿道閉鎖壓越低,至於其它方面則較無關係。骨盆底肌肉
運動教育方案在應力性尿失禁患者的失禁症狀、滲尿量、滲尿頻率、心理
社會衝擊及會陰機電圖方面成效最好,只有在尿路動力學方面成效不顯著
。骨盆底肌肉運動教育方案的成效受到失禁症狀、滲尿量、滲尿頻率、心
理社會衝擊、會陰機電圖及尿路動力學等方面改變量互相影響,以及服用
荷爾蒙、失禁嚴重度、失禁病史、過去病史等個人特性影響。整體而言,
骨盆底肌肉運動教育方案是值得臨床上廣為運用的。
The purpose of this study is to develop a pelvic muscle
exercise program and investigate its effect.The results of this
study will help medical personnel understand the problem of
stress incontinence patients and use the pelvic muscle exercise
program to improve quality of care to these patients. A quasi-
experimental design with an accidental sampling was used for
this study.Thirty-two subjects with stress incontinence were
recruited from the urological and gynecological departmemt of
medical center in Taiwan.The control group received only
routine clinical care and the experimental group accepted the
additional 8 weeks of pelvic muscle exercise program.The indi-
cators of the effectiveness of the pelvic muscle exercise was
collected before and after program.Incontinence symptoms,
urinary accident frequency, leakage amount, psychosocial impact
of incontinence, vaginal electromyography, and urodynamic test
was collected as indicator of pelvic muscle exercise on stress
incontinence.Statistical methods used to analyzed data included
frequency distribution,mean,standard deviation,Wilcoxon signed
rank test,and Wilcoxon rank sum test.The stress incontinence
patients showed that mild to severe degree on incontinence
symptoms,urine leakage amount,and frequency of urine loss,and
mild to moderate degree on psychosocial impact.The physical
reaction of patients before exercise programs were:mean vaginal
electromyography pressure 28.61 uV,mean duration 4.34 sec,mean
maximal urethral closing pressure 81.57cmH2O,mean functional
urethral length 2.56cm.Pelvic muscle exercise programs,it
showed significant effect on incontinence symptom,frequency of
urine accident, leakage amount,psychosocial impact of
incontinence,and vaginal electromyography not on urodynamic
testing.In general speaking,pelvic muscle exercise program was
worth propagating.
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