产后盆底康复锻炼对女性盆底功能障碍性疾病的预防作用

Postpartum pelvic floor rehabilitation on prevention of female pelvic floor dysfunction： a multicenter prospective randomized controlled study

目的探讨产后盆底康复锻炼对中国妇女的盆底电生理指标的影响及对盆底功能障碍性疾病的预防效果。方法自2011年10月起全国12家医疗单位开展多中心前瞻性随机对照研究，将产妇随机分成治疗组与对照组，治疗组产后6周开始进行电刺激＋生物反馈治疗，对照组在家自行进行盆底肌训练。在产后6周、产后6个月、产后1年比较两组患者的盆底电生理指标、盆腔器官脱垂定量（POP-Q）分度法以及盆底功能影响问卷简表（PFIQ-7；评估生命质量）、盆腔器官脱垂－尿失禁性功能问卷（PISQ．12；评估性生活质量）评分。结果截止于2013年6月共入组324例产妇，其中对照组124例，治疗组200例。产后6个月和1年的随访结果显示，治疗组盆底电生理指标均较对照组有显著改善，I类肌纤维肌力和Ⅱ类肌纤维肌力Ⅲ级及以上所占的比率，治疗组产后6个月由产后6周的41．5％（83／200）和40．5％（81／200）分别提高到76．3％（145／190）和79．5％（151／190），产后1年分别提高到80．6％（58／72）和80．6％（58／72），对照组产后6个月由产后6周的66．1％（78／118）和56．8％（67／118）分别提高到71．8％（84／117）和78．7％（92／117），产后1年分别提高到73．3％（33／45）和80．0％（36／45），与对照组比较，差异有统计学意义（P〈O．01）。POP．Q分度Aa指示点在盆底康复锻炼后有改善，治疗组与对照组在产后6周时分别为（－2．2±0．7）、（－2．4±0．6）cm，在产后1年时分别为（－2．5±1．1）、（－2．7±0．6）cm，两组分别比较，差异有统计学意义（P〈０．01）；其他各指示点两组间无差异（P〉０．05）。PFIQ－7评分和PISQ－12评分在对照组与治疗组之间分别比较，差异均无统计学意义（P〉０．05）。结论产后妇女早期进行神经肌肉电刺激＋生物反馈治疗，在1年内可明显改善产后妇女的盆底电生理指标，并对预防盆底功能障碍性疾病的发生有益。

Objective To study the postpartum pelvic floor rehabilitation on the improvement of pelvic floor electrical physiological indexes and the prevention of female pelvic floor dysfunction in China. Methods A muhicenter prospective randomized controlled study was carried out. From October 2011,postpartum women in five provinces were randomly assigned into treatment group and control group, The women in treatment group received electrical stimulation and biofeedback treatment. The women in control group performed pelvic floor muscle exercise at home. When 6 months and 12 months after delivery, comparing two groups of patients with pelvic floor electrical physiological indexes and pelvic organ prolapse quantitation measurements （POP-Q）, to evaluate the effect of postpartum pelvic floor rehabilitation on the prevention of pelvic floor dysfunction. Pelvic floor impact questionnaire short form （PFIQ-7） and pelvic organ prolapse/incontinence sexual questionnaire-12 （PISQ-12） were used to evaluate the influence on quality of life and sexual life. Results Until June 2013, 324 women were participated, 124 in control group, 200 in treatment group. According to the baseline results, there was statistical significance in the results of pelvic floor electrical physiological indexes between the treatment and control groups in postpartum 6 months and 12 months; the proportion above level Ⅲ of type I and type Ⅱ muscle fibers strength in the treatment group, it was from 41.5% （83/200） and 40.5% （81/200） to 76.3% （145/190） and 79.5% （151/190） in postpartum 6 weeks and postpartum 6 months, increased to 80.6% （58/72） and 80.6% （58/72） in postpartum 12 months, improved significantly comparing with the control group （P〈0.01）. According to Point Aa, treatment group and control group in the postpartum 6 weeks was （- 2.2±0.7） versus （- 2.4±0.6） cm, in postpartum 12 months （- 2.5 ± 1.1） versus （- 2.7 ± 0.6） cm, the improvement in treatment group was statistically significant （P〈0.01）. And the other points were not significantly different （P〉0.05）. There was no significant difference in the questionnaires in quality of life and quality of sexual life （P〉0.05）. Conclusion Neuromuscular electrical stimulation and biofeedback therapy in the early postpartum period could obviously improve pelvic floor electrical physiological indexes, and is beneficial to prevent the pelvic floor dysfunction.