本研究目的在探討藥物治療三個月以上之膀胱過動症（Overactive Bladder, OAB）患者，合併骨盆底肌肉運動二個月後，是否能進一步改善其急尿、日間頻尿、夜尿、急迫性尿失禁症狀、症狀困擾程度，以及提升治療滿意度與生活品質。本研究採實驗設計法，將門診接受三個月以上藥物治療之膀胱過動症個案隨機分配至單純藥物治療組（藥物組）與藥物合併骨盆底肌肉運動組（運動組）。藥物組只接受OAB相關護理指導與原來之藥物治療；實驗組額外給予骨盆底肌肉運動衛教單張及口頭指導，並輔以會陰部表面肌電圖確認收縮之正確性，並指導每日執行三次運動，每次做十五次收縮，持續二個月（八週）。測量變項包括：每日日間排尿次數、急尿次數、夜尿次數、急迫性尿失禁次數、治療滿意度、症狀困擾程度，以及健康相關生活品質。研究工具包括個案基本資料表、三日排尿日誌、「治療益處、滿意度、意願」調查問卷，以及膀胱過動症調查問卷。使用SPSS 11.5進行資料建檔與分析，統計方法包括描述性統計與推論性統計：independent-samples t test、paired-samples t test、Pearson chi-square test，與無母數檢定。研究結果：共收案32名，最後完成研究者共29名，流失率9.4%。藥物組共14名，平均年齡72.86 ± 7.59歲；運動組共15名，平均年齡69.23 ± 11.58歲，二組個案之重要人口學變項無顯著差異。二個月後，運動組之每日急尿、日間頻尿、急迫性尿失禁症狀均有顯著改善，夜尿症狀及平均排尿量則無顯著改善；組間比較，運動組與藥物組之每日急尿次數改善百分比（-80.07% vs. -10.31%, p = .042）與日間排尿次數改善百分比（-10.72% vs. +4.94%, p = .044）有顯著差異。治療滿意度與繼續接受治療之意願二組無顯著差異，運動組個案一個月後之自覺改善度顯著優於藥物組（73.3% vs. 28.6%, p = .027），二個月後則無顯著差異。二個月後，二組之症狀困擾程度與生活品質均有顯著改善，運動組之症狀困擾程度（-42.63%, p = .004）、情緒（+58.71%, p = .002）、睡眠（+45.85%, p = .048），與生活品質總分（+20.61%, p = .011）均顯著改善；藥物組之症狀困擾程度（-38.82%, p = .039）、疾病因應（+34.27%, p = .006）與生活品質總分（+15.19%, p = .019）亦有顯著改善；但比較二組生活品質改善程度則各層面均無顯著差異。結論：藥物治療三個月以上、仍有症狀困擾之OAB個案，合併骨盆底肌肉運動二個月後，能更進一步改善其急尿、日間頻尿、急迫性尿失禁症狀、增加自覺改善度、減低症狀困擾程度，及增進健康相關生活品質，但急迫性尿失禁症狀、症狀困擾程度及健康相關生活品質之改善程度與單純藥物治療組比較無顯著差異。

The purpose of the study was to compare the effectiveness of a combined pelvic floor muscle exercise (PFME) with drug treatment to that of a drug treatment alone on the management of patients with overactive bladder (OAB). Methods: Eligible clinical diagnosed OAB participants who have had at least a three month drug treatment were recruited and randomly assigned to the combined treatment or the drug alone treatment group. The drug alone group was solely given the routine drug treatment, while the subjects in the combined treatment group received a perineal surface electromyography assisted PFME in addition to the drug treatment. The PFME program was implemented and taught, instructing the participants to perform 15 PFM contractions per set, 3 sets a day, continuously at home for 8 weeks. A 3-day voiding diary, the Benefit, Satisfaction, and Willingness questionnaire, and the Overactive Bladder questionnaire were used to measure the comparative effectiveness between the two groups. Statistical software SPSS for Windows version 11.5 was used to analyze the data through descriptive statistics, independent-samples t test, paired-samples t test, Pearson chi-square test, and nonparametric test. Results: From the total 29 participants who completed the study, 14 were in the drug alone group and 15 were in the combined group. The average ages of the two groups were 72.86 ± 7.59 and 69.23 ± 11.58 years old, respectively. No significant differences in the demographic data were found between the two groups. After 8 weeks, the urgency episodes per 24 hours, daytime frequency per 24 hours, and episode of urge urinary incontinence per 24 hours in the combined treatment group were significantly reduced but there was no significantly reduced in the nocturia episodes per 24 hours and mean voiding volume. There was significant difference between the combined group and the drug alone group in the change percentage of urge (-80.07% vs. -10.31%, p = .042) and daytime frequency (-10.72% vs. +4.94%, p = .044). There was no significant difference between the two groups in the treatment satisfaction, and treatment willingness. Significant differences were reported between the two groups in the benefit of the treatment after 4 weeks post-treatment. The treatment benefit was 73.3% in the combined group and 28.6% in the drug alone group (p = .027). Additionally, there were significant reductions in the symptom bothersome score and significant increases in health-related quality of life among the two groups. Scores in the symptom bothersome domain was reduced by 42.63% in the combined group (p = .004) and by 38.82% in the drug alone group (p = .039). Scores in the concern and sleeping domain in the quality of life significantly gained a 58.71% and 45.85% increase in the combined group (p = .025 and p = .048), and scores in the coping domain significantly gained a 34.27% increase in the drug alone group (p = .006). Overall, the total score in the quality of life was significantly improved in the combined group and the drug alone group with an increase of 20.61% (p = .011) and 15.17% (p = .019), respectively. But, there was no significant difference in any OAB-q scores of change percentage between the two groups. Conclusion: This study demonstrated that incorporating the pelvic floor muscle exercise program into the treatment of OAB patients with unsatisfactory therapeutic effects could reduce urgency, daytime frequency, and urge urinary incontinence symptoms, and increase subjective treatment benefits. However, there was no significant difference between the combined group and the drug alone group in the change percentages of urge urinary incontinence episodes, symptom bothersome and scores in the quality of life.

中文部份
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