阴道助产对产后盆底功能的影响

Impact of assisted vaginal delivery on postpartum pelvic floor function

目的:探讨阴道助产对产后盆底功能的影响。方法:选择2015年5月至2017年8月在成都市第五人民医院分娩的初产妇88例,根据分娩方式不同分为两组,经阴道分娩组44例,阴道助产组44例,均于产后6周～10周接受盆底超声检查和盆底肌电生物反馈仪检查评估盆底功能。比较两组最大Valsalva动作状态和静息状态下膀胱尿道后角(posterior urethravesical angel,PUA)、尿道倾斜角(urethral tilt angel,UTA)、宫颈外口的位置(cervical mouth position,CMP)、膀胱颈的位置(bladder neck position,BNP)、膀胱颈移动度(Bladder neck descent,BND)、尿道旋转角(urethral rotation angel,URA)、宫颈外口移动度(cervix down distance,CDD)以及盆底不同肌纤维的肌力。结果:静息状态下经阴道分娩组UTA、BNP均高于阴道助产组,CMP低于阴道助产组,差异具有统计学意义(P <0. 05);最大Valsalva状态下经阴道分娩组UTA、BNP均低于阴道助产组,CMP高于阴道助产组,差异具有统计学意义(P <0. 05);不同状态下两组PUA值比较,差异无统计学意义(P> 0. 05);阴道助产组BND、URA、CDD值分别为(16. 35±8. 22) mm、(42. 78±32. 48) mm、(13. 94±9. 68) mm,经阴道分娩组BND、URA、CDD值分别为(15. 01±9. 00) mm、(32. 10±28. 34) mm、(12. 14±10. 21) mm,差异具有统计学意义(P <0. 05);阴道分娩组前静息平均肌电值、快肌最大肌电值、混合肌平均肌电值、慢肌平均肌电值、后静息平均肌电值均高于阴道助产组,差异具有统计学意义(P <0. 05)。结论:与经阴道分娩相比,阴道助产术对产后早期盆底肌力的损伤以及对盆底结构与功能的影响较大。

Objective:To investigate the impact of assisted vaginal delivery on postpartum pelvic floor function.Methods:88 primiparas in our hospital from May 2015 to August 2017 were selected and divided into vaginal delivery group and assisted vaginal delivery group by delivery modes,each of 44 cases.All the 88 primiparas were given pelvic floor ultrasound and pelvic muscle electricity biofeedback instrument examination at 6 to 10 weeks after delivery.The posterior urethravesical angel(PUA),urethral tilt angel(UTA),cervical mouth position(CMP),bladder neck position(BNP),bladder neck descent(BND),urethral rotation angel(URA),cervix down distance(CDD)and pelvic floor muscle force of different muscle fibers at maximum Valsalva action state and rest state were compared between the two groups.Results:At rest state,the UTA and BNP in vaginal delivery group were higher than those in assisted vaginal delivery group,and CMP was lower than that in assisted vaginal delivery group,all with statistically significant differences(P<0.05).At maximum Valsalva state,the UTA and BNP in vaginal delivery group were lower than those in assisted vaginal delivery group,and CMP was higher than that in assisted vaginal delivery group,with statistically significant difference(P<0.05).There was no statistically significant difference in PUA value at different state between the two groups(P>0.05);The BND,URA,CDD value in assisted vaginal delivery group were(16.35±8.22)mm,(42.78±32.48)mm,(13.94±9.68)mm respectively and those in the vaginal deliverygroupwere(15.01±9.00)mm,(32.10±28.34)mmand(12.14±10.21)mmaccordingly,withstatistically significant differences(P<0.05).The anterior resting averaged electromyogram,maximum fast muscle electromyogram,mixed muscle averaged electromyogram,slow muscle averaged electromyogram,posterior resting averaged electromyogram in vaginal delivery group were higher than those in assisted vaginal delivery group,with statistically significant differences(P<0.05).Conclusions:Compared with vaginal delivery,assisted vaginal delivery has greater impact on postpartum injury of pelvic floor muscle force and pelvic structure and function.