早期盆底肌锻炼对产后压力性尿失禁的影响

Early pelvic floor muscle exercise for postpartum stress urinary incontinence

目的探讨妊娠分娩前、后全程行盆底肌功能锻炼对女性产后压力性尿失禁的影响。方法选取孕产妇204例，68例自孕28周开始盆底肌功能锻炼至产后3个月（全程组），68例于产后行盆底肌功能锻炼至3个月（产后组），68例按常规妊娠分娩处理，（对照组）。观察阴道分娩前、分娩后3个月盆底肌张力和产后3、6、12个月尿垫试验阳性率。结果孕28周，各组盆底肌张力对比无统计学差异（P〉0．05）；阴道分娩前，全程组产妇Ⅱ级〈肌张力≤Ⅲ级与I级〈肌张力≤Ⅱ级的比率均高于产后组与对照组（P〈0．05），肌张力≤I级的明显低于产后组与对照组（P〈0．005）；阴道分娩后3个月，全程组产妇Ⅱ级〈肌张力≤HI级的比率明显高于产后组与对照组（P〈0．005），I级〈肌张力≤II级与肌张力≤I级的比率均低于产后组与对照组（P〈0．05和P〈0．005）。全程组产后3、6、12个月的尿垫试验阳性率均低于产后组与对照组（全程组：14．7％、7．3％、1．4％，产后组：23．5％、16．1％、7．4％，对照组：39．7％、30．9％、20．6％，P均〈0．005）。结论早期全程行盆底肌功能锻炼能增强盆底肌收缩力，有助于盆底肌功能恢复，预防产后压力性尿失禁。

Objective To explore the effect of pelvic floor muscle exercise on postpartum stress urinary incontinence before and after childbirth. Methods 204 pregnant women were divided into three groups. The first group （ 68 women ） started pelvic floor muscle exercises from 28 weeks of gestation to postpartum 3 months （ full-course group ） the second group （ 68 women ） received postpartum pelvic floor muscles exercis for 3 months （ postpartum group ） and the third group （ 68 women ）received conventional care for childbirth （ control group ）. The tension of pelvic floor muscles was observed before and 3 month after vaginal delivery and the positive rate of urine pad tests were observed 3, 6, and 12 months after childbirth. Results There were no differences among the three groups in muscle tension at 28 weeks （ P 〉 0.05 ）. But after that, the result of the full-course group was different, Ⅱ 〈 muscle tension ≤ Ⅲ of the vagina was obviously higher than postpartum group and full-course group （ P 〈 0.05 ）, muscle tension level less than ] was obviously lower in full-course group than in postpartum group and control group （ P〈 0.005 ）; three months after vaginal delivery, Ⅱ 〈 muscle tension level≤Ⅲ, it was significantly higher than postpartum group and control ,group （ P〈 0. 005 ）, Ⅰ 〈 muscle tension level ≤Ⅱ , and muscle tension level ≤ Ⅰ were lower than those in postpartum group and control group （ P 〈 0.05 and P 〈 0.005 ）. The positive rate of urine pad tests at months 3, 6, and 12 months after the childbirth was higher in the full-course group than in the postpartum and the control group （ P 〈 0.005 ）. Results Early pelvic floor muscle exercis during the perinatal period can increase tension of the pelvic floor muscles, It is helpful for the recovery of function of pelvic floor muscles and prevents postpartum stress urinary incontinence.