盆底康复治疗时机对初产妇产后盆底功能障碍性疾病的影响

Effect of timing of pelvic floor rehabilitation therapy on pelvic floor dysfunction in postpartum women with single delivery

目的探讨盆底康复治疗时机对初产妇产后盆底功能障碍性疾病的影响。方法选取2018年1月—2019年8月在医院完成规律产检且正常分娩的初产妇458例的资料进行回顾性分析。依据在产后开始进行盆底康复治疗的时间差异,分为三组,早期治疗组(A组,n=367),中期治疗组(B组,n=68),晚期治疗组(C组,n=23)。A组在产后42 d至3个月内开始治疗,B组在产后3~6个月内开始治疗,C组在产后6个月以上开始治疗。对比三组治疗前后的电测肌电值、Ⅰ类和Ⅱ类肌力、压力性尿失禁(SUI)发生情况、子宫脱垂情况。结果治疗后,A组和B组的电测肌电值、Ⅰ类和Ⅱ类肌力明显升高(P<0.05),C组的电测肌电值、Ⅰ类和Ⅱ类肌力未出现明显变化。治疗后,A组和B组的SUI发生率明显降低(P<0.05),C组的SUI发生率未出现明显变化。治疗后A组和B组的SUI发生率低于C组(P<0.05)。三组治疗1个疗程前后的子宫脱垂发生情况数据差异具有统计学意义(P<0.05),仅有A组在经过治疗后,子宫脱垂情况出现明显好转(P<0.05),B组和C组在治疗前后的子宫脱垂情况未出现明显变化。结论对于单胎顺产的初产妇,在产后42 d开始进行盆底康复治疗可获得良好的效果,随着治疗时机的延后,产妇可获得的疗效也会降低。对于错过最佳治疗时间点的产妇,如何改善疗效,尚需要进一步的研究。

Objective To explore the effect of pelvic floor rehabilitation treatment timing on pelvic floor dysfunction of postpartum women with single delivery. Methods The data of 458 primiparas who completed regular delivery in the hospital from January 2018 to August 2019 and delivered normally were selected for retrospective analysis. The patients were divided into 3 groups based on the difference in time to start pelvic floor rehabilitation treatment after delivery. Early treatment group(A group, n=367), middle treatment group(B group, n=68), late treatment group(C group, n=23). Group A started treatment within 42 days to 3 months postpartum, group B started treatment within 3 months to 6 months postpartum, and group C started treatment more than 6 months postpartum. Compare the electromyographic value, the muscle strength of class Ⅰ and Ⅱ, the occurrence of stress urinary incontinence(SUI) and the occurrence of uterine prolapse before and after treatment. Result After treatment, the electromyographic values and the muscle strengths of class Ⅰ and class Ⅱ in group A and group B increased significantly(P<0.05). There were no significant changes in the electromyographic values and muscle strength of class Ⅰ and Ⅱ in group C. After treatment, the incidence of SUI in groups A and B was significantly reduced(P<0.05). The incidence of SUI in group C did not change significantly. After treatment, the incidence of SUI in groups A and B was lower than that in group C(P<0.05). The difference in the occurrence of uterine prolapse between the three groups before and after a course of treatment was statistically significant(P<0.05). Only in group A, after treatment, the uterine prolapse was significantly improved(P<0.05). Uterine prolapse in groups B and C before and after treatment did not change significantly. Conclusion For primiparous women who have a single birth, the pelvic floor rehabilitation treatment can be obtained at 42 days after delivery to obtain good results. With the wrong treatment timing, the curative effect that the maternal can obtain will also decrease. For the parturient who missed the optimal treatment time point, how to improve the curative effect still needs further research.