盆底肌肉锻炼对盆底功能的影响分析

Impact of pelvic floor muscle training exercise on pelvic floor function

目的探讨不同时期进行盆底肌肉锻炼对盆底功能的影响。方法选择2013年1—12月就诊的孕妇,分为妊娠28周开始锻炼组157人(产前锻炼组),产后开始锻炼组192人(产后锻炼组)。选择同期未参加孕妇学校课程学习并经阴道分娩的初产妇为对照组131人。产后42 d、6个月对比三组盆底肌肉肌力、阴道前/后壁膨出、尿失禁、阴道脱垂情况。采用Fisher确切概率法,P<0.05为差异有统计学意义。结果锻炼组盆底肌肉张力在产后42 d、6个月评分均高于对照组(均P<0.05),锻炼组盆底肌肉张力在产后42 d、6个月评分无统计学差异(P>0.05);锻炼组压力性尿失禁在产后42 d、6个月明显低于对照组(均P<0.05),锻炼组压力性尿失禁在产后42 d、6个月相比无统计学差异(均P>0.05);产前锻炼组效果优于产后锻炼组(P<0.05)。结论盆底肌肉锻炼对盆底功能障碍有防治作用,有利于产后康复,产前妊娠28周开始锻炼效果更好。

Objective To study the impact of pelvic floor muscle training exercise on pelvic floor function at different gestation and postpartum periods. Methods From January to December in 2013, a total of 349 pregnant women treated in our hospital were divided into prenatal exercise group （ 157 cases, starting pelvic floor muscle training exercise from the 28th week of gestation） and postnatal exercise group （ 192 cases, starting pelvic floor muscle training exercise after childbirth）. Meanwhile, 131 primiparae who did not participate in the pregnancy school and learn any knowledge of vaginal delivery were selected as control group. AU the cases were compared for pelvic floor muscle strength, anterior/posterior vaginal wall prolapse, urinary incontinence and vaginal prolapse 42 days and 6 months after childbirth. Fisher＇s exact test was used to process the data, the result of P 〈 0.05 was considered statistically significant. Results The two exercise groups had higher scores than the controls 42days and 6 months after childbirth（ P 〈 0.05 ）. However, no significant difference was found between the two exercise groups in pelvic floor muscle strength 42days and 6 months after childbirth （P 〉 0. 05 ）. The two exercise groups had lower incidence of stress urinary incontinence than the controls 42days and 6 months after childbirth（ P 〈 0. 05） ; and there was no significant difference between the two exercise groups in stress urinary incontinence 42days and 6 months after childbirth （ P 〉 0.05 ）. Prenatal exercise group was superior to postnatal exercise group in clinical efficacy （P 〈 0.05）. Conclusions PFMT has preventive and therapeutic effects on pelvic floor dysfunction and is conducive to postpartum recovery, which may have better efficacy if it starts from the 28th week of gestation.