顺产和选择性剖宫产和盆底肌肉训练对初产妇产后早期盆底功能障碍的影响

The effects of different delivery modes and pelvic floor muscle training on pelvic floor function

目的了解不同分娩方式和盆底肌肉训练对产后早期盆底功能障碍的影响。方法选取内蒙古医科大学附属医院2015年4月至2017年4月期间收治的1 928例初产妇为研究对象,根据分娩方式分为顺产组832例;选择性剖宫产组1 096例。所有初产妇在产后第6周进行盆底肌力和妇科检查,接受1个盆底肌肉训练疗程(产后第9周时)后,进行盆底肌力和肌电指数测定,记录相应结果。结果顺产组阴道前、后壁脱垂Ⅰ、Ⅱ度的发生率分别为55.29%、13.46%和32.69%、6.49%,显著高于选择性剖宫产组的32.11%、2.74%和12.77%、1.28%(均P <0.05);顺产组盆底肌力为0～0+级的初产妇占82.69%,显著高于选择性剖宫产组的75.00%(P <0.05);顺产组盆底肌力为Ⅰ～Ⅰ+级的初产妇占16.35%,显著低于选择性剖宫产组的22.99%(P <0.05)。两组急迫型产妇治疗后的基线值为(2.673±1.394)、(2.847±1.593),显著低于治疗前的(5.495±1.637)、(5.934±1.784),差异有统计学意义(均P <0.05)。顺产组、选择性剖宫产组的压力型产妇治疗后的耐受、持续收缩值,以及快速收缩最大值较治疗前有显著改善,具有统计学意义(均P <0.05)。结论选择性剖宫产可降低产后早期阴道脱垂的发生率,不能避免压力性尿失禁、子宫脱垂的风险;产妇早期盆底肌力功能障碍,可以通过康复治疗进行改善。

Objective To investigate the effects of different delivery modes of parturition and pelvic ìoor muscle training on the pelvic ìoor function in early postpartum. Methods 1 928 cases of puerpera delivery during April 2015 to April 2017 were selected and divided into two groups: 832 cases of virginal delivery patients as group A and 1096 cases of selective cesarean section patients as group B. All patients performed examination sixth weeks postpartum and pelvic ìoor muscle training ninth weeks postpartum. A questionnaire survey was conducted and the pelvic ìoor muscle test, pelvic ìoor correlation and electromyography index were measured. Results The incidence of degree Ⅰ and degree Ⅱ prolapse of anterior and posterior vaginal wall in group A were 55.29%, 13.46%, 32.69% and 6.49% respectively, which were significantly higher than 32.11%, 2.74%, 12.77% and 1.28% of the group B(P < 0.05). The pelvic ìoor muscle strength of grade 0 to 0+ in group A was 82.69%, signiícantly higher than 75.00% of group B(P < 0.05). The baseline values of acute urinary incontinence parturients after treatment were(2.673 + 1.394) in group A and(2.847 + 1.593) in group B, which were both significantly lower than(5.495 + 1.637) and(5.934 + 1.784) before treatment(P < 0.05). The tolerance, sustained contraction, and maximum rapid contraction of the stress urinary incontinence parturients in the two group were significantly improved after treatment(P < 0.05). Conclusions Selective cesarean section can effectively reduce the incidence of early postpartum vaginal prolapse, but can not reduce the risk of maternal stress urinary incontinence and uterine prolapse. The pelvic ìoor function can be effectively improved through rehabilitation treatment.