孕期联合产后盆底锻炼对预防盆底功能障碍性疾病的研究

Study for the prevention of female pelvic floor dysfunction By postpartum pelvic floor exercise during pregnancy

目的探讨持续性盆底锻炼对预防孕产妇盆底功能障碍性疾病的作用。方法选择2013年4月-2015年2月符合入组标准,最终完成研究的产妇252例。随机分为4组,观察1组65例,观察2组64例,观察3组61例及对照组62例,观察1组于孕16周开始行Kegel盆底肌锻炼,产后42d行电刺激联合生物反馈治疗至产后3个月,观察2组于孕28周开始行Kegel盆底肌锻炼,产后42d行电刺激联合生物反馈治疗至产后3个月,观察3组仅于产后42d开始行电刺激联合生物反馈治疗至产后3个月,对照组给予常规的宣教和护理,无任何锻炼指导。分别于首诊(孕16周)、分娩时、产后42d、产后3个月测量4组孕产妇的阴道压力,孕期、产后3个月压力性尿失禁发生率及产后3个月盆腔脏器脱垂测定。结果观察1组孕晚期、产后42d、产后3个月的盆底肌力均高于其它3组,观察2组产后42d、产后3个月盆底肌力均高于观察3组及对照组,观察3组产后3个月盆底肌力高于对照组,比较均有统计学意义(P<0.05);3个观察组在孕期及产后3个月SUI的发生率均低于对照组(P<0.05),观察1组、观察2组产后3个月盆腔脏器脱垂POP-Q分度得分低于对照组,比较有统计意义(P<0.05)。结论孕期Kegel锻炼联合产后电刺激及生物反馈盆底肌持续锻炼可改善因妊娠及分娩引起的盆底肌力减弱,降低尿失禁的发生率,预防因妊娠及分娩引起的盆底功能障碍,妊娠16周开始行Kegel锻炼较妊娠28周开始行Kegel锻炼效果更佳。

Objective To observe the effect of persistent pelvic floor exercise on prevention of maternal pelvic floor dysfunction.Methods 252 pregnant women met the selecting criteria was chosen for the study from April 2013 to February 2015.Patients was randomly divided into 4grounps.65 patients for experimental group 1,64 patients for experimental group 2,61 patient for experimental group 3and 62 patients for control group.Kegel pelvic muscle exercises was conducted in 16 weeks for group 1and 28 weeks after pregnant for group 2,and given Tianxing electric stimulation combined with biological feedback therapy given postpartum 42 days up to postpartum 3 months.Patients in group 3did the same postpartum exercise intervention only and patients in control group was given routine health education and nursing without any exercises training guide.The vaginal pressure at different time points,the incidence of stress urinary incontinence（SUI）and pelvic organ prolapsed（POP）3 months after delivery was deteced and compared between groups.Results the pelvic floor muscle strength for group 1during the third trimester of pregnancy,postpartum 42 days and postpartum 3 months were higher than that of the other three groups.The pelvic floor muscle strength for group 2postpartum 42 days and postpartum 3month were higher than that of group 3and control group.The pelvic floor muscle strength for group 3postpartum 3monts was higher than that of the control group（P 0.05）.The SUI incidence during pregnancy and postpartum period three months for the three experimental groups were lower than those of the control group（P0.05）.The SUI incidence for group 1was lower than that of group 2and group 3（P0.05）.The pelvic organ prolapse POP-Q score for group 1and group 2postpartum3 month was lower than that of the control group（P 0.05）.Conclusion Pregnancy Kegel exercise combined with postpartum electrical stimulation and biological feedback pelvic floor muscle sustained exercise can improve pelvic floor muscle weakness and reduce the incidence of urinary incontinence caused by pregnancy and childbirth,and prevent pelvic floor muscle dysfunctions.The better effect will be achieved for patients started exercise 16 weeks after pregnancy than 28 weeks of pregnancy.