初产妇生产过程中连续硬膜外镇痛对其产后早期盆底功能的影响

Effects of continuous epidural analgesia during labor on the early postpartum recovery of pelvic floor function

目的 探讨初产妇生产过程中连续硬膜外镇痛对产后早期盆底功能的影响. 方法 回顾性分析分娩产妇共200例,根据其分娩过程中是否提前采取镇痛手段分为分娩镇痛组(57例)和无镇痛分娩组(143例).无镇痛分娩组进行一般手术处理,分娩镇痛组在连续硬膜外麻醉下分娩.比较产后6周两组产妇盆底肌力、疲劳度和肌电值、盆腹动力指标、盆腔器官脱垂的POP-Q分期评估、盆底功能障碍发生情况. 结果 产后6周时:分娩镇痛组产妇盆底肌力等级、Ⅰ类肌纤维和Ⅱ类肌纤维的肌肉疲劳度及Ⅰ类肌纤维的盆底肌电值均高于无镇痛分娩组(P<0.05),分娩镇痛组产妇阴道动态压力、盆底肌静态张力、盆底肌闭合收缩力异常的发生率均低于无镇痛分娩组(P<0.05),分娩镇痛组产妇盆腔器官脱垂POP-Q分期Ⅱ、Ⅲ、Ⅳ期例数均多于无镇痛分娩组(P<0.05),分娩镇痛组患者压力性尿失禁例数少于无镇痛分娩组(P<0.05). 结论 连续硬膜外麻醉应用于初产妇生产过程,对产妇产后早期盆底功能的恢复有积极影响,主要表现在盆底肌力较好、肌肉纤维疲劳度降低和肌电值正常,进而表现在临床各项检测指标和症状上.

Objective To explore the effect of continuous epidural analgesia on the early postpartum recovery of pelvic floor function. Methods This retrospective analysis involves two hundred cases of maternal deliveries in our hospital, including 57 cases received continuous epidural analgesia and 143 cases did not. The pelvic floor muscle strength, fatigue and myoelectric value, pelvic and abdomen dynamics, POP-Q stage assessment of pelvic organ prolapse, and pelvic floor dysfunction were compared between the two groups 6 post partum. Results Postpartum pelvic floor muscle strength was significantly higher in cases received epidural analgesia than in those did not received analgesia. Muscle fatigue of maternal Ⅰ and Ⅱ fibers in the analgesia group was significantly worse than that in the non-analgesic group (P<0.05). The pelvic floor muscle electrical values of maternalⅠfibers in the analgesia group were higher than those of the non-analgesia group (P<0.05). Compared with non-analgesia group, analgesia group showed significantly lower incidence of abnormality in vaginal dynamic pressure, pelvic floor muscle static tension, pelvic floor contraction, maternal pelvic organ prolapse, and pelvic floor function (P<0.05). Conclusions Continuous epidural anesthesia during labor has a positive impact on the early postpartum recovery of pelvic floor function.