不同分娩方式对产后妇女盆底功能影响的临床分析

Clinical analysis of the effect of different delivery modes on the pelvic floor function of postpartum women

目的通过盆底功能评估了解产后妇女盆底功能障碍状况,分析比较剖宫产与阴道产两种分娩方式对产后盆底功能的影响,为盆底功能障碍性疾病（PFD）的防治提供理论依据。方法选取2014-01∽2014-06间在该院分娩并于产后6∽8周来产后门诊复查的800例产妇,根据分娩方式的不同分为剖宫产组288例和阴道产组512例做盆底功能常规评估,对其评估所获得的指标进行回顾性分析比较。结果手法检查辅以盆底肌评估筛查800例患者中,剖宫产组Ⅰ类肌纤维受损185例,Ⅱ类肌纤维受损168例;阴道产组Ⅰ类肌纤维受损504例,Ⅱ类肌纤维受损502例,两组比较差异有统计学意义（P〈0.01）;阴道产组肌力收缩失调、肛提肌损伤、疲劳度异常、阴道动态压力值〈80 cm H2O均高于剖宫产组（P〈0.01）。结论相对于阴道分娩,剖宫产可在一定程度上降低对产妇盆底功能的影响,但盆底功能可通过进行产后康复锻炼来促进恢复,因此不应以此为依据进行分娩方式的选择。

Objective To evaluate postpartum pelvic floor disorder through assessing the pelvic floor function and compare the effects of two kinds of delivery modes,cesarean section and vaginal delivery on postpartum pelvic floor function and provide a theoretical basis for the prevention and treatment of pelvic floor dysfunction（ PFD）.Methods 800 postpartum women who revisited the outpatient department 6 to 8 weeks after childbirth were collected from January to June 2014 and divided into caesarean delivery group（ n = 288） and vaginal delivery group（ n = 512）according to the different modes of delivery. Routine assessment of pelvic floor function was retrospectively analyzed and compared between the two groups. Results Among 800 patients who were screened by the manual muscle test combined with the assessment of pelvic floor function. The damage of muscle fiber type Ⅰ was found in 185 cases and the damage of muscle fiber type Ⅱ in 168 cases in the cesarean delivery group; the damage of muscle fiber type Ⅰwas found in 504 cases and the damage of muscl fibere type Ⅱ in 502 cases in the vaginal delivery group. There was significant difference between the two groups（ P〈0. 01）. The impaired muscle strength,muscle injury,abnormal muscle fatigue and the vaginal dynamic pressure value 80 cm H2 O were more severe or higher in vagina delivery group than those in the caesarean delivery group（ P〈0. 05）. Conclusion Compared with vaginal delivery,cesarean section has less adverse effects on pelvic floor function. However,the impaired pelvic floor function can be recovered by carrying out postpartum rehabilitation exercise,so it should not be based on the choice of delivery modes.