分娩方式对阴道静息压和盆底强度及耐力的影响

Effect of different delivery methods on vaginal resting pressure andpelvic floor muscle strength and endurance

目的:本研究主要分析分娩方式对阴道静息压、盆底强度和耐力有何影响。方法:本研究收集了2009年1月至2010年8月之间初产妇276例,对其进行回顾性队列调查研究。研究运用压力法在妊娠中期和产后6周两个阶段分别测定产妇阴道静息压、盆底强度和耐力,以探讨其影响。结果:不同分娩方式组内比较发现,剖宫产产妇阴道静息压显著降低7.73%(t=127.321,P=0.005),而盆底强度和耐力无显著变化(P>0.05);自然分娩和阴道助产分娩后,产妇阴道静息压、盆底强度和耐力均显著降低(P<0.001)。剖宫产与阴道分娩(自然分娩和阴道助产分娩)产后6周的VRP与PFM强度及耐力差异显著(P<0.001),但自然分娩和阴道助产分娩之间无显著差异。回归分析表明剖宫产的分娩方式与ΔVRP(回归系数B:-8.3,95%CI:-11.8^-4.9,P<0.001)、ΔPMF耐力(回归系数B:-111.7,95%CI:-157.1^-66.1,P<0.001)、ΔPMF强度(回归系数B:-16.4,95%CI:-21.1^-10.5,P<0.001)显著负相关。结论:阴道分娩显著降低产妇阴道静息压、盆底强度和耐力,而剖宫产对其影响较小。

Objectives： To describe the effect of different delivery ways on vaginal resting pressure（ VRP）and pelvic floor muscle（ PFM） strength and endurance. Methods： 276 mulliparous women from 2009 to 2010 were selected. Retrospective cohort study was done. In order to analyze the effect,manometer to measure vaginal resting pressure,pelvic floor muscle strength,pelvic floor muscle endurance at midpregnancy and 6 weeks postpartum were used. Results： Comparing with different delivery methods,vaginal resting pressure significantly reduced 7. 73%（ t= 127. 321,P = 0. 005） for cesarean delivery of maternal,but pelvic floor muscle strength and endurance had no significant difference（ P〉0. 05）; After normal vaginal delivery and instrumental vaginal delivery,maternal vaginal resting pressure,pelvic floor strength and endurance were significantly reduced（ P〈 0. 001）. Vaginal resting pressure,pelvic floor strength and endurance of cesarean section maternal and vaginal delivery maternal（ normal vaginal delivery and instrumental vaginal delivery） 6 weeks postpartum had significant difference. But there was no significant difference between normal vaginal delivery and instrumental vaginal delivery. Regression analysis showed that delivery ways and ΔVRP（ B coefficient：-8. 3,95% CI：-11. 8 --4. 9,P〈0. 001）,ΔPMF endurance（ B coefficient：-111. 7,95% CI：-157. 1 --66. 1,P〈0. 001）,ΔPMF strength（ B coefficient：-16. 4,95%CI：-21. 1 --10. 5,P〈0. 001） were significantly negative correlation. Conclusion： Vaginal delivery can significantly reduce maternal vaginal resting pressure,pelvic floor strength and endurance. Cesarean section has smaller effects on these indexes.