椎管内阻滞镇痛阴道分娩与剖宫产术对初产妇盆底功能的影响对比

Effects of intravaginal delivery and cesarean section using spinal-epidural anesthesia on pelvic floor function in primiparae:a comparative study

目的比较椎管内阻滞镇痛阴道分娩与剖宫产术对初产妇盆底功能的影响。方法 292例初产妇,其中146例采用椎管内阻滞镇痛阴道分娩(阴道分娩组),146例采用椎管内阻滞麻醉行剖宫产术分娩(剖宫产组)。产后3个月,采用PHENIX肌肉刺激治疗仪检测两组产妇盆底肌肌力、疲劳度和阴道压力,观察两组产妇盆腔器官脱垂(POP)、压力性尿失禁(SUI)及阴道松弛、腰背酸痛、盆腔疼痛发生率。结果产后3个月,两组产妇盆底肌肉Ⅰ类、Ⅱ类肌纤维肌力差异无统计学意义(P> 0. 05),两组盆底肌肉疲劳度、盆底肌肌力、阴道压力异常率及POP、SUI、阴道松弛、腰背酸痛、盆腔疼痛发生率差异均无统计学意义(均P> 0. 05)。结论椎管内阻滞镇痛阴道分娩及剖宫产术均可导致不同程度的盆底功能损伤,剖宫产术并不具有保护盆底功能的作用。

Objective To compare the effects of intravaginal delivery versus cesarean section using spinal-epidural anesthesia on the pelvic floor function in primiparae.Methods Totally 292 primiparae included 146 cases who underwent intravaginal delivery using spinal-epidural anesthesia(vaginal delivery group),and146cases underwent cesarean section using spinal-epidural anesthesia(cesarean section group).Three months after delivery,PHENIX Neuromuscular Stimulation Therapy System was applied to determining the pelvic floor muscle strength and fatigue level as well as vaginal pressure of the primiparae in the two groups,and the incidence rates of pelvic organ prolapse(POP),stress urinary incontinence(SUI),vaginal relaxation,low back pain and pelvic pain were observed in both groups.Results Three months after delivery,there were no statistically significant differences in the pelvic floor muscle strength of typeⅠorⅡmuscle fiber between the two groups(P>0.05),and there were no statistically significant differences in the fatigue level of pelvic floor muscle,pelvic floor muscle strength,rate of abnormal vaginal pressure,or incidence rate of POP,SUI,vaginal relaxation,low back pain or pelvic pain between the two groups(all P>0.05).Conclusion Both intravaginal delivery and cesarean section using spinal-epidural anesthesia might cause pelvic floor dysfunction,and cesarean section has no effects on pelvic floor function protection.