分娩镇痛产妇第二产程时间与盆底功能关系研究

Relationship between delivery time of second stage of labor under analgesia and pelvic floor function

目的探讨分娩镇痛产妇第二产程时间长短对女性盆底功能的近期影响。方法回顾分析2014年9月至2015年2月大连市妇幼保健院经分娩镇痛辅助自然分娩的单胎足月妊娠初产妇共272例。分为A（第二产程时间〈2 h）、B（2 h≤第二产程时间〈3 h）两组,其中A组187例,B组85例。两组产妇均无内、外科合并症,无阴道侧切与助产,年龄（25~35岁）、孕周（37~42周）、第一产程时间（≤24h）、产妇分娩前后体重指数（19~25）、新生儿出生体重（2500~4000g）等差异均无统计学意义（P〉0.05）。B组分娩后6~8周由专人对产妇临床症状、盆底功能进行检测评估。结果 B组压力性尿失禁发生率高于A组（P〈0.05）;B组盆腔器官脱垂发生率高于A组（P〈0.05）。Ⅰ类肌纤维损伤：B组阴道压力、肌力损伤及疲劳度重于A组（P〈0.05）。Ⅱ类肌纤维损伤：B组阴道压力明显低于A组（P〈0.05）,A组与B组肌力损伤及疲劳度差异无统计学意义（P〉0.05）。结论分娩镇痛有效缓解分娩疼痛,改善产程质量,第二产程时间相对延长,虽提高阴道分娩成功率,但加剧女性盆底功能损伤,产后盆底功能检查及恢复非常必要。

Objective To explore the effect of delivery time of second stage of labor on the pelvic floor function in labor analgesia＇ s women.Methods Two hundred and seventy-two healthy primipara women were interviewed at 6-8weeks postpartum ,who delivered naturally in Maternity Hospital of Dalian from Sep.2014 to Feb.2015, 187 cases in group A （second stage of labor 〈 2h）, 85 cases in group B（2h〈second stage of labor 〈 3h）. The two groups were compared concerning post-natal clinical symptoms and pelvic floor function at 6-8 weeks postpartum. Results The prevalence of stress urinary incontinence （SUI）after delivery in the group B was higher than that in group A （P〈0.05）; the prevalence of pel- vic organ prolapse （POP） after delivery in the group B was higher than the group A （P〈0.05） ; Class I muscle fibers after delivery： vaginal pressure, muscle damage and fatigue of the group B were more serious than group A （P〈O.05）; Class II muscle fibers damage after delivery： vaginal pressure of the group B was lower than the group A （P〈0.05）. Muscle damage and fatigue had no significant difference between the group B and the group A（P〉 0.05）. Conclusion Labor analgesia can alleviate the pain of delivery effectively and improve the quality of labor. Although it relatively extends time of second stage of labor ,but it improves the rate of successful delivery; however, it can injure the pelvic floor function more seriously.The examination and recovery of pelvic floor function in postpartum women is very necessary.