不同分娩方式对盆底功能的影响及产后电刺激对盆底肌康复治疗效果对比研究

A comparative study on the effect of different modes of deliveries on pelvic floor function and postpartum electrical stimulative rehabilitation therapy

目的探讨不同分娩方式对于女性盆底功能的影响,分析盆底肌电刺激康复治疗对于不同分娩方式产妇盆底功能、盆底肌力的干预效果。方法回顾性分析以产科成功分娩的1 056例初产妇作为观察对象,根据分娩方式划分成剖宫产组461例和顺产组595例,在产后6周时使用徒手法联合盆底电诊断行盆底功能测评,同时详细记录产后盆底功能障碍性疾病发生情况,对比两组间产后盆底功能变化,同时将经过盆底功能检测筛选出的盆底功能异常的124例初产妇作为分析病例,分为盆底肌电治疗组63例(盆底肌电刺激)和对照组61例(自行缩提肛康复治疗),疗程1个月,对比组间盆底肌力、肌电压、阴道压力变化。结果剖宫产和顺产均能够引发盆底肌力异常和阴道压力异常,两组间在Ⅰ类肌力异常率、Ⅱ类肌力异常率、盆底肌疲劳度异常、阴道压力异常率上无显著差异(P>0.05);盆底康复治疗后,两组的Ⅰ类肌力平均、Ⅱ类肌力平均、平均肌电压、阴道压力明显优于治疗前,且盆底肌电治疗组明显优于对照组,组间各指标相比差异具有显著性(P<0.05)。结论剖宫产和顺产对于盆底功能损伤程度相仿,早期进行产后盆底肌电刺激康复治疗对于改善产后盆底功能意义非凡。

Objective To explore the effect of different modes of delivery on pelvic floor function and to analyze the intervention effect of electrical stimulation on rehabilitation of pelvic floor function and pelvic floor muscle in different delivery modes. Methods The clinical data of 1056 primiparae were given for retrospective analysis. According to the mode of delivery,they were divided into cesarean section group（ 461 cases）and vaginal delivery group（ 595 cases）. At 6 postpartum weeks,pelvic floor function was evaluated by manual method combined with pelvic floor electrical method,and detailed records of postpartum pelvic floor dysfunction were made. The pelvic floor functions were compared between these two groups. At the same time,124 cases of primipara with postpartum pelvic floor dysfunction were selected as study cases. They were divided into study group with 63 cases（ with electrical stimulation rehabilitation therapy） and control group with 61 cases（ with self rehabilitation of contraction）. Afte treatment for one month,the strength of pelvic floor muscle,muscular voltage and change in vaginal pressure were compared between these two groups. Results The cesarean section and vaginal delivery can both cause the abnormality of pelvic floor function and vaginal pelvic muscle pressure. There was no significant difference between these 2 groups（ P〉0.05） in classesⅠ and Ⅱ muscular abnormality rates,abnormal rate of pelvic floor muscle fatigue and abnormal vaginal pressure. After pelvic floor rehabilitation,the average classes Ⅰ and Ⅱ muscular strength,average muscular voltage and vaginal pressure were significantly improved than those before treatment,and they in pelvic floor electrical treatment group were better than those of control group,and the differnce between these 2 groups was significant（ P〈0.05）. Conclusion The influence of cesarean section or vaginal delivery on pelvic floor function is similar,and the early rehabilitation by electrical stimulation has important significance in improvement of postparteum pelvic floor function.