不同分娩方式对盆底功能障碍性疾病康复治疗效果的影响

Effects of different delivery modes on rehabilitation treatment of postpartum pelvic floor dysfunction

目的通过比较康复治疗前后的产后妇女压力性尿失禁（SUI）、盆腔脏器脱垂（POP）和盆底肌肉收缩强度的变化,探讨不同分娩方式对盆底功能障碍性疾病（PFD）康复治疗效果的影响。方法选取2012年10月-2014年6月在厦门市妇幼保健院产后门诊就诊的初产妇236例,分为阴道分娩组170例,剖宫产组66例。于产后6周进行盆底功能检测,测定盆底肌力以及POP-Q数值,确定其存在盆底功能障碍,之后遵循自愿原则进行10-15次治疗,治疗结束后再次进行盆底功能检测。由专人询问及填写治疗前后的SUI问卷调查表,并对结果进行统计学分析。结果治疗前,阴道分娩组和剖宫产组SUI和POP发生率比较差异有统计学意义（P〈0.05）。阴道分娩组、剖宫产组治疗前和治疗后SUI和POP发生率比较差异有统计学意义（P〈0.05）。治疗后,阴道分娩组和剖宫产组SUI和POP发生率比较差异无统计学意义（P〉0.05）。治疗前,阴道分娩组和剖宫产组肌纤维肌力下降程度比较差异无统计学意义（P〉0.05）。阴道分娩组、剖宫产组治疗前和治疗后肌纤维肌力下降程度比较差异有统计学意义（P〈0.05）。治疗后,阴道分娩组和剖宫产组肌纤维肌力下降程度比较差异无统计学意义（P〉0.05）。结论阴道分娩及剖宫产均对产后早期盆底肌力有影响,阴道分娩产妇盆底功能更差,各种PFD症状明显,而经过盆底康复治疗后,PFD症状明显减少,患者盆底功能改善,说明盆底康复治疗对产后盆底功能障碍具有防治作用,不同分娩方式的影响无差别,疗效与盆底功能障碍程度、患者依从性有关。

Objective To explore the effects of different delivery modes on rehabilitation treatment of postpartum pelvic floor dysfunction by comparing the changes of stress urinary incontinence,pelvic organ prolapse,and pelvic floor muscle strength before and after rehabilitation treatment in postpartum women. Methods A total of 236 primiparous women were selected from Outpatient Department in the hospital from October 2012 to June 2014,then they were divided into vaginal delivery group（170 primiparous women） and cesarean section group（66primiparous women）,pelvic floor function examination was performed after six weeks of delivery,pelvic floor muscle strength and POP- Q were measured to confirm pelvic floor dysfunction,then subsequent treatment was condutced for 10- 15 times,pelvic floor function examination was performed after the end of treatment. Stress urinary incontinence questionnaire was filled before and after treatment,then the data was analyzed statistically. Results Before treatment,there were statistically significant differences in the incidence rates of stress urinary incontinence and pelvic organ prolapse between vaginal delivery group and cesarean section group（ P〈0. 05）. In vaginal delivery group and cesarean section group,there were statistically significant differences in the incidence rates of stress urinary incontinence and pelvic organ prolapse between before and after treatment（ P〈0. 05）. After treatment,there was no statistically significant difference in the incidence rates of stress urinary incontinence and pelvic organ prolapse between vaginal delivery group and cesarean section group（ P〈0. 05）. Before treatment,there was no statistically significant difference in the decreasing degree of pelvic floor muscle fibers strength between vaginal delivery group and cesarean section group（ P〈0. 05）. In vaginal delivery group and cesarean section group,there were statistically significant differences in the decreasing degree of pelvic floor muscle fibers strength between before and after treatment（ P〈0. 05）. After treatment,there was no statistically significant difference in the decreasing degree of pelvic floor muscle fibers strength between vaginal delivery group and cesarean section group（ P〉0. 05）. Conclusion Both vaginal delivery and cesarean section have impacts on early pelvic floor muscle strength after delivery,pelvic floor function is poor in primiparous women after vaginal delivery,postpartum pelvic floor dysfunction symptoms are obvious,postpartum pelvic floor dysfunction symptoms decrease after pelvic floor rehabilitation treatment,and pelvic floor function is improved.This study indicates that pelvic floor rehabilitation treatment can prevent and treat postpartum pelvic floor dysfunction,the effects of different delivery modes have no difference,the curative effect is correlated with the degree of pelvic floor dysfunction and compliance.