自控镇痛无痛分娩与传统阴道分娩对盆底组织功能近期影响的临床研究

Early postpartum pelvic floor function of patient-controlled epidural analgesia painless delivery and traditional vaginal delivery

目的:探讨自控镇痛无痛分娩对产后盆底功能的近期影响。方法:选择我院产科门诊单胎、初产、足月、年龄25~34岁、早孕期BMI 18~24kg/m^2、无产科及内科合并症者且早孕期建档并在我院分娩的产妇,无痛分娩组103例、自然分娩组93例,另选择同期初产计划性剖宫产组94例为对照。对无痛分娩组、自然分娩组及剖宫产组三组的基本情况进行统计学分析。阴道分娩者记录第一、第二产程所需时间,产时出血量,新生儿体重、新生儿Apgar评分等。产后6~8周进行盆底功能的评估:包括盆腔器官脱垂的POP-Q分期评估、1h尿垫试验对产后尿失禁进行评估、利用生物刺激反馈仪对盆底肌群Ⅰ、Ⅱ型肌纤维的功能进行Glazer评估,同时按照盆底肌力牛津分级系统对盆底肌进行手测。结果:(1)无痛分娩组盆底肌持续收缩值和快速收缩值均明显高于自然分娩组(P<0.05)、剖宫产组持续收缩值和快速收缩值均高于无痛分娩组(P<0.05)。(2)无痛分娩组盆腔脱垂程度较自然分娩组减轻,差异有统计学意义(P<0.05);剖宫产组盆腔脱垂程度较无痛分娩组减轻,差异有统计学意义(P<0.05)。(3)无痛分娩组盆底肌力强于自然分娩组,差异有统计学意义(P<0.01);剖宫产组盆底肌力强于无痛分娩组,差异有统计学意义(P<0.01)。(4)无痛分娩组与自然分娩组尿失禁发生率无明显差异,均高于剖宫产组,但差异无统计学意义(P<0.05)。结论:自控镇痛无痛分娩在减轻分娩疼痛的同时,还可以减轻对盆底组织的损伤,增加孕妇选择无痛分娩的依从性,提高阴道分娩率,降低因社会因素而增加的剖宫产率,可能降低将来发生PFD的几率。

Objectives： To investigate the effect of patient- controlled epidural analgesia （PCIA） painless delivery on the early postpartum pelvic floor function. Methods ： 290 postpartum women in our hospital from January 2014 to December 2015 were selected as research objects, including 103 women adopted PCIA （painless delivery group） , 93 ones adopted traditional vaginal delivery （vaginal delivery group） and 94 ones using selective cesarean section delivery （ cesarean section group）. Basic information of the three groups was recorded. The time of first and second stage of labor, intrapartum hemorrhage, neonatal weight, Apgar score were recorded in the first two groups. Pelvic floor function was evaluated at postpartum 6 - 8 weeks. Pelvic organ prolapse（ POP - Q） method were used to assess the early postpartum period pelvic floor dysfunction （PFD）. 1 hour pad test were used to assess incidences of stress urinary incontinence （SUI） and the pelvic floor muscle pressure were observed by the Glazer pelvic floor mus- cle sEMG protocol. Results： ① The mean and maximum sEMG values of painless delivery group in flick contractions （1s）, tonic contractions （10s） and endurante contractions （60s） were significantly higher than those of vaginal deliveryroup （ P 〈 0. 05 ）. ② Pelvic floor muscle strength of painless delivery group was also significantly high- er than that of vaginal delivery group （ P 〈 0. 01 ）. ③Pelvic prolapse extent of painless delivery group was less than that of the vaginal delivery group, with statistically significant difference （ P 〈 0. 05 ）. ④The stress urinary inconti- nence rates in painless delivery group and vaginal delivery group were 7.8% and 9.7% respectively, without statis- tically significant difference （P 〉 0. 05 ）. Conclusion： Besides reducing labor pain, PCIA painless delivery can also mitigate damage to the pelvic floor tissue, which increases vaginal delivery rate and reduces the increased rate of cesarean section due to social factors, hereby reducing future occurrence of the PFD and improving the quality of life.