分娩会阴侧切和自然裂伤与盆底功能的相关性

Correlation of lateral episiotomy and natural laceration during childbirth with pelvic floor function

目的探讨初产妇分娩时行会阴侧切和自然裂伤与盆底功能近期改变的相关性。方法收集宁波市镇海龙赛医院产科2012年6月至2014年3月确定为阴道生产的初产妇150例,分为会阴侧切组(85例)、自然裂伤组(35例)、自然顺产分娩组(30例),分别对3组同期同时在产后42天后,通过问卷调查、详细的身体检查、盆底相关肌肉检查,评估其盆底功能变化以及分别于自然顺产组相比的OR值。结果分娩时压力性尿失禁、排尿困难的发生率在3组之间的比较差异均无统计学意义(x^2值分别为4.670、1.085,均P>0.05);会阴伤口疼痛、性生活障碍的发生率在3组之间比较差异均有统计学意义(x^2值分别为25.929、27.525,均P<0.05)。盆底肌力分级在3组之间比较差异有统计学意义(x^2=10.869,P<0.05),肌电位的比较差异也具有统计学意义(F=6.689,P<0.05)。盆底肌力分级会阴侧切组与自然顺产组相比OR=1.450,自然裂伤组与自然顺产组相比OR=1.023,盆底功能与会阴侧切、自然裂伤的相关系数(r)分别为1.123和1.458,均P<0.05。结论分娩时会阴侧切、自然裂伤对盆底功能的影响大于自然顺产,但是会阴侧切的影响重于自然裂伤。

ObjectiveTo investigate the correlation of lateral episiotomy and natural laceration during childbirth among primiparas with recent changes of pelvic floor function. Methods From June 2012 to March 2014 totally 150 primiparas of vaginal production were collected from Zhenhailongsai Hospital, and they were divided into lateral episiotomy group （85 cases） , natural laceration group （35 cases） and natural birth group （30 cases ）. Pelvic floor function was evaluated among three groups in the same period at 42d after labor with questionnaires, detailed physical examination and pelvic floor muscle-related inspection. Results Stress urinary incontinence and dysuria were not significantly different among three groups （χ^2 value was 4. 670 and 1. 085, respectively, both P 〉 0.05 ）. There were significant differences in perineal wound pain and sexual disorders among three groups （χ^2 value was 25. 929 and 27. 525, respectively, both P 〈 0.05 ）. The grading of pelvic floor muscle was statistically different among three groups （χ^2 = 10. 869, P 〈 0.05 ） , and the difference in muscle potential was also significant （ F = 6. 689, P 〈 0.05 ）. OR value was 1. 450 in comparison of lateral episiotomy group and natural birth group, and it was 1. 023 in comparison of natural laceration group and natural birth group in terms of grading of pelvic muscle. The correlation coefficient of pelvic floor function with lateral episiotomy and natural laceration was 1. 123 and 1. 458, respectively （ both P 〈 0.05 ）. Conclusion Lateral cpisiotomy and natural laceration during childbirth have greater impact on pelvic floor function than natural birth, and the impact of lateral episiotomy is more severe than natural laceration.