不同分娩方式对产后早期盆底功能的影响及康复治疗效果评估

Effect of Different Delivery Methods on the Pelvic Floor Muscle Strength in the Early Postpartum Period and Evaluation on Rehabilitation Therapy

目的探讨2种不刖分娩方式对产后早期盆底功能的影响，评估康复治疗效果在顺产组和剖宫产组之间是否存在差异。方法按入组要求选择湖北省妇幼保健院2011年1月～2012年12月收治的968例产后6周的产妇纳入研究，根据分娩方式将其分为顺产组（n=418）和选择性剖宫产组（n=550）。于产后6周进行问卷调查、妇科检查及盆底肌力测试。对于接受了1个疗程盆底肌肉训练（Glazer方案）的患者在治疗结束时（产后9周）进行盆底相关肌电指数的测定和盆底肌力的检测，评估盆底肌肉训练的效果。结果①产后6周，顺产组和剖宫产组子宫脱垂发生率分别为0．96％（4／418）和0．54％（3／550），两组比较差异无统计学意义（P〉0．05）；阴道前壁I度脱垂发生率分别为55．26％（231／418）和32．00％（176／550），阴道前壁Ⅱ度脱垂发生率分别为13．39％（56／418）和2．73％（156／550），阴道后壁I度脱垂发生率分别为32．77％（137／418）和12．73％（70／550），阴道后壁Ⅱ度脱垂发生率分别为6．45％（27／418）和1．27％（7／550），两组比较差异均有统计学意义（均P〈0．01）；尿失禁发生率分别为5．98％（25／418）和5．09％（28／550），两组比较差异无统计学意义（P〉o．05）。②盆底肌力测试结果显示，顺产组和剖宫产组肌力为0～0’级者分别占82．54％（345／418）和74．91％（412／550），I～I级肌力者分别占16．51％（69／418）和23．。9％（127／550），两组比较差异均有统计学意义（均P〈0．05）；而Ⅱ～Ⅱ’级肌力者分别为0．95％（4／418）和2．00％（11／550），两组比较差异无统计学意义（P〉0．05）。③疗程结束时，两组急迫型患者在疗程结束时，前基线值均有下降（P〈0．01）；压力型患者持续收缩平均值、快速收缩最大值和耐受测试平均值均有上升（均P〈0．05）。治疗前后两组之间检测指标的差异均无统计学意义（均P〉0．05）。结论①选择性剖宫产可降低产后早期阴道脱垂的发生率，但并不减少发生子宫脱垂和压力性尿失禁的风险；②产后早期妇女盆底肌力普遍偏低，顺产组肌力较剖宫产组更低；③康复治疗可以改善产后早期盆底肌力，两种分娩方式之间的疗效没有差异。

Objective To explore the effect of different delivery methods on the pelvic floor muscle strength in the early postpartum period and to evaluate the effect of rehabilitation therapy. Methods From January 2011 to December 2012,968 women were selected 6 weeks after delivery and divided into two groups in terms of delivery methods：natural delivery group （418 cases） and elective cesarean section group （550 cases）. Questionnaire survey, pelvic examination and pelvic floor muscle strength testing were carried out in these women. The pelvic floor surface electromyography （sEMG） and pelvic floor muscle strength were detected 9 weeks after delivery to evaluate the effect of rehabilitation therapy in the patients who underwent Glazer pelvic floor rehabilitation training （one course）. Results （D The rate of uterine prolapse was 0.96% （4/418） and 0.54% （3/550） in natural delivery group and elective cesarean section group,respectively,6 weeks after delivery. There was no significant difference between two groups （P〈0.05）. In the natural delivery group and elective cesarean section group, the rate of prolapse vaginae anterior I was 55. 260//00 （231/418） and 32.00% （176/550）,that of prolapse vaginae anterior Ⅲ 13. 39% （56/ 418） and 2.73% （156/550）,that of prolapse vaginae posterior I 32.77% （137/418） and 12.73% （70/550）,that of prolapse vaginae posterior Ⅱ 6.45% （27/418） and 1.27% （7/550）, respectively. There was significant difference between the two groups （P〈0.01）. The rate of urinary incontinence was 5.98% （25/418） and 5.09% （28/550） in the natural delivery group and elective cesarean section group, respectively, with no significant difference found between the two groups （P〉0.05）. ② The pelvic floor muscle strength testing showed that the percentage of patients with muscle strength grades 0-0^＋ were 82.54% （345/418） and 74.91%（412/550） in natural delivery group and elective cesarean section group, respectively and there was sig- nificant difference between the two groups （P〈0.05）. Those with muscle strength grades I - I ＋ were 16.51 （69/418） and 23.09 % （127/550） in the two groups with significant difference noted between them （P〈0.05）. Those with muscle strength grades Ⅱ- Ⅱ ＋ were 0.95% （4/418）and 2.00% （11/550） in the two group with no significant difference observed between them （P〉0.05）. ③ At 9 weeks postpartum,after the treatment,the mean pre-baseline was decreased in urgent type patients in both groups （P（0.01）. The values of maximum fast contraction,tonic contraction and duration were significantly increased in urgent type patients in both groups （P〈0.05）. There was no significant difference in these values between the two groups （P 〈.05）. Conclusion ①Cesarean section may reduce the occurrence of vaginal prolapse to a certain extent, but can not reduce the occurrence of uterine prolapse and urinary incontinenee;② The early postpartum pelvic floor muscle strength is weak, especially for women receiving cesarean section; ③ Pelvic floor function recovery training is effective in increasing the pelvic floor muscle strength in the early postparturn period for both delivery methods.