产后盆底肌力筛查及其临床意义

Clinical significance of pelvic floor muscle strength screening in postpartum women

目的探讨产妇产后盆底肌力改变及其临床意义。方法选择2011年3月至2011年9月在北京大学第一医院产科分娩并于产后6～8周复查的产妇1008例,其中阴道分娩产妇551例(阴道分娩组),剖宫产457例(剖宫产组),分别对其进行盆底肌力筛查,观察各影响因素与盆底肌力的相关性。结果阴道分娩组与剖宫产组产妇I类肌纤维肌力异常率分别为36.3%(200/551)和39.4%(180/457),Ⅱ类肌纤维肌力异常率分别为36.5%(201/551)和39.4%(180/457),两组比较,差异无统计学意义(P>0.05);产妇分娩前体质指数是I类肌纤维肌力异常的相关因素(OR=-0.095,P<0.05);产妇年龄、新生儿出生体质量、第二产程时间、产次、产钳助产及会阴情况等与盆底肌力测量值无相关性(P>0.05);第二产程延长组及高龄组I类肌纤维肌力异常率分别为55.6%(5/9)和39.3%(57/145),Ⅱ类肌纤维肌力异常率分别为55.6%(5/9)和38.6%(56/145),两组I类、Ⅱ类肌纤维肌力异常率均有升高趋势;会阴裂伤组I类、Ⅱ类肌纤维肌力异常率分别为35.7%(15/42)和31.0%(13/42),均较会阴侧切组和会阴侧切+产钳组有下降趋势;进入产程剖宫产组I类肌纤维肌力异常率为44.1%(52/118),Ⅱ类肌纤维肌力异常率为44.1%(52/118),均较选择性剖宫产组有升高趋势,但差异均无统计学意义(P>0.05)。结论剖宫产对盆底组织无明显保护作用;分娩前体质指数过大是影响盆底功能的因素,应避免孕期体质量增长过多。

Objective To investigate the changes of pelvic floor muscle strength and its clinical significance in postpartum women.Methods There totally 1 008 healthy women who delivered in our hospital from March 2011 to Sepetember 2011 involved in this study.All women underwent pelvic floor muscle strength screen in 6~8 weeks postpartum and their obstetric factors were recorded.Results In vaginal delivery group and cesarean section group,the abnormal rates of type I muscle fiber strength were 36.3%（200/551） and 39.4%（180/457）;the abnormal rates of type II muscle fiber strength were 36.5%（201/551） and 39.4%（180/457）.There were no significant difference between the two groups（P0.05）.Prenatal body mass index（BMI） before labor was related to the type I muscle fiber（OR=-0.095,P0.05）.Age,neonatal birth weight,duration of the second stage of labor,parity,instrument delivery and the status of perineum were not relative with pelvic floor muscle strength.Women who were older or had longer duration of second stage tended to have higher abnormal ratio of Type I,II muscle fiber.Women with no episiotomy tended to have lower abnormal ratio of type I,II muscle fiber.The selective cesarean section group had lower abnormal ratio of type I,II muscle fiber compared with emergency cesarean section group,but there were no statistic difference.Conclusions Cesarean section can not protect the pelvic floor;prenatal maternal body mass index can affect postpartum pelvic floor muscle fiber type I muscle strength,weight control during pregnancy should be recommended.