不同分娩方式对产妇早期盆底功能障碍的影响

Influence of different delivery ways on early pelvic floor dysfunction in puerperae

目的探讨不同分娩方式对产妇早期盆底功能障碍（PFD）的影响。方法根据就诊时间不同，将480例初产妇分为产后6～8周组388例和产后12～14周组92例。观察2组压力性尿失禁（SUI）、尿潴留、盆腔器官脱垂定量（POP-Q）分级及盆底肌肌力下降的发生情况，比较2组盆底肌表面肌电信号（sEMG）结果。结果2组刮宫产产妇POP—Q Ⅰ～Ⅱ级、盆底肌肌力下降的发生率显著低于阴道分娩者（P〈0．05或P〈0．01），SUI、尿潴留比较无显著差异（p〉0．05）；上述各指标在产后12～14周组发生率略低于产后6～8周组，但无显著差异（P〉0．05）。产后6～8周组剖宫产产妇盆底肌前后静息值、快肌最大值、10S及60S慢肌肌电值均显著高于阴道分娩者（P〈0．01）；与产后6～8周组比较，产后12-14周组阴道分娩产妇快肌最大值、10s和60S慢肌肌电值以及后静息值明显升高（P〈0．05或P〈0．01），但与剖宫产者比较无显著差异（P〉0．05）。结论产妇早期盆底功能受不同分娩方式的影响，其中剖宫产影响较小；产后3个月内应及时行盆底肌肉锻炼，以减少PFD的发生。

Objective To explore the influence of different delivery ways on early pelvic floor dysfunction （PFD） in puerperae. Methods A total of 480 puerperae were divided into post-delivery 6 -8 week group （n = 388） and post-delivery 12 - 14 week group （n = 92） according to the diagnos- tic sequences. Stress urinary incontinence （SUI）, uroschesis, pelvic organ prolapse quantitation （POP-Q） classification and the occurrence of reduced pelvic floor muscle tension were observed in both groups, and surface electromyogram signal （sEMG） results of pelvic floor muscles were com- pared between two groups. Results Women with cesarean delivery were markedly lower in the rates of POP-Q in class Ⅰ - Ⅱ and the reduced pelvic floor muscle tension than those with vaginal delivery in both groups （P 〈0.05 or P 〈0.01 ） , but there was no significant difference in SUI and uroschesis （ P 〉 0.05 ）. Meanwhile, the rates of above indexes were slightly lower in post-delivery 12 - 14 week group than those in post-delivery 6 - 8 week group, but the differences were significant （ P 〉 0.05）. Post-delivery 6 - 8 week group was notably higher in anterior and posterior resting value of pelvic floor muscles, the maximum value of fast muscles and the myoelectricity values of slow muscles within 10 s and 60 s than post-delivery 12 - 14 week group （ P 〈 0.01 ）. Compared with post-delivery 6 N 8 week group, women with vaginal delivery in post-delivery 12 - 14 week group were prominently higher in the maximum value of fast muscles and the myoelectricity values of slow muscles within 10 s and 60 s （P 〈0.05 or P 〈0.01 ） , but there was no significant difference compared with women with cesarean delivery in the same group （P 〉 0.05 ）. Conclusion Early pelvic floor function is influenced by dif- ferent delivery ways, in which the impact of cesarean delivery is less. Moreover, pelvic floor muscles should be trained timely within post-delivery 3 months to reduce the occurrence of PFD.