盆底肌肉锻炼及锻炼时机对产后盆底功能的影响研究

Effects of Pelvic Floor Muscle Training and Training Opportunity on Postpartum Pelvic Floor Function

目的探讨盆底肌肉锻炼(PFMT)及锻炼时机对产后盆底功能的影响,为女性产后选择合适锻炼时机提供依据。方法选取2014年2—9月于郑州大学第二附属医院足月阴道分娩初产妇354例为研究对象,按病区将其随机分为对照组(121例)、产后49 d组(114例)和产后7 d组(119例)。对照组仅进行常规产后健康教育,产后7 d组与产后49 d组在此基础上,分别于产后第7、49天开始采用Kegel训练进行为期6周的PFMT,并书写家庭训练日志。分别于产后49 d、3个月、6个月、12个月随访盆底肌力、盆腔脏器脱垂及压力性尿失禁(SUI)发生情况。结果随访至产后12个月时,对照组、产后49 d组、产后7 d组分别有16、17、20例失访。3组受试者产后49 d、3个月、6个月、12个月盆底Ⅰ、Ⅱ类肌肌力比较,差异均有统计学意义(P<0.05);其中,产后49 d组产后3个月、6个月、12个月Ⅰ、Ⅱ类肌肌力优于对照组(P<0.016),产后7 d组产后49 d、3个月、6个月、12个月盆底Ⅰ、Ⅱ类肌肌力优于产后49 d组与对照组(P<0.016)。3组受试者产后49 d、3个月、6个月、12个月子宫脱垂、后壁脱垂发生率及前壁脱垂等级比较,差异均无统计学意义(P>0.05)。3组受试者产后49 d、3个月、6个月、12个月SUI发生率比较,差异均有统计学意义(P<0.05);其中产后7 d组产后49 d、3个月、6个月、12个月SUI发生率低于产后49 d组与对照组(P<0.016)。结论产后早期进行PFMT能有效提高盆底肌力,降低SUI发生风险。

Objective To explore the influences of pelvic floor muscle training（ PFMT） and training opportunity on postpartum pelvic floor function,and provide references for females in selecting proper training opportunity. Methods A total of 354 primiparas who had full - term normal vaginal delivery in the Second Affiliated Hospital of Zhengzhou University from February to September in 2014 participated in this study. These patients were randomly divided into control group（121 cases）, 49-day postpartum group（114 cases）and 7 -day postpartum group（119 cases）based on wards. In the control group, patients only received conventional postpartum health education,while 7-day postpartum group and 49-day postpartum group received 6 weeks of PFMT by Kegel training apart from conventional education at the 7th and 49th postpartum respectively. The latter two groups also wrote family training journals. Condition of pelvic floor muscles strength,pelvic organ prolapse,and SUI after 49 days,3 months,6 months,and 12 months postpartum were followed up. Results At the end of follow up,a total of 16,17 and 20 cases had lost in control group,49 - day postpartum group,and 7 - day postpartum group respectively. Differences of pelvic floor muscle strengths of Ⅰ type muscles and Ⅱ type muscles at 49 days,3 months,6 months,and 12 months postpartum for patients in the three groups were statistically significant（P﹤0. 05）;among which,muscle strengths ofⅠand Ⅱ type muscles at 3,6,and 12 months postpartum in 49-day postpartum group were better than those in control group（P ﹤0. 016）;muscle strengths of Ⅰ and Ⅱ type muscles at 49 days,3 months,6 months and 12 months postpartum in 7 -day postpartum group were better than those in the other two groups （ P ﹤0. 016 ）. Differences of all patients in terms of rate of uterine prolapse and descent vaginae posterior,degree of descensus vaginae anterior at 49 days,3 months,6 months and 12 months postpartum were not statistically significant（P﹥0. 05）. The differences of SUI incidence in three groups at 49 days,3 months,6 months,and 12 months postpartum were statistically significant（P ﹤0. 05）;among which,SUI incidence at 49 days,3 months,6 months and 12 months postpartum for 7-day postpartum group were lower than those in other two groups（ P﹤0. 016）. Conclusion Early PFMT postpartum effectively improves pelvic floor muscle strength,and reduce SUI incidence risks.