育龄期妇女腹直肌间距的临床观察

Clinical observation of child-bearing age women inter-recti distance change

目的观察育龄期妇女腹直肌间距随时间变化的规律。方法本研究为横断面研究,研究对象为2017年8月至2018年3月到中山大学附属第六医院超声科体检或产检的201名育龄期妇女。其中,未育组(N_(1))30名,妊娠组(N_(2))141名,产后组(N_3)30名。使用超声测量育龄期妇女的脐水平腹直肌间距离(IRD_(1))、脐与耻骨联合上缘连线中点腹直肌间距离(IRD_(2))、脐水平左右两侧腹直肌宽度(WRA_(L)、WRA_R),横断面观察并分析各组的腹直肌形态学变化特点。结果 N_(1)组的IRD_(1)、IRD_(2)、(WRA_(L)+WRA_(R))/2平均值分别为(16.57±4.62)mm、0 mm、(72.03±11.38)mm。N_(2)组的IRD_(1)从妊早期开始随妊娠周数的增加而增加,孕21周后增加更为显著,直至分娩前(孕37~40周)达到高峰,平均值(92.41±23.40)mm;IRD_(2)、WRA_(L)和WRA_(R)在妊早期变化不明显,在孕21周后(WRAL+WRAR)/2开始显著增加,分娩前达到高峰,平均值(113.27±18.5)mm。各数据变化存在较大的个体差异。N3组的WRA_(L)、WRA_(R)在产后1个月恢复正常;IRD_(1)于产后3 d即可恢复41%,67.1%的妇女产后1个月可恢复至未育水平,产后超过1年者中约有26.6%的妇女IRD_(1)仍>27 mm。IRD_(1)(Y)与孕周(X_(1))和IRD_(2)(X_(2))有相关性,模拟曲线方程(逐步法)Y=2.801X_(1)+1.111X_(2)-26.049,X_(1)>21。结论女性在妊娠期及产后前腹壁的结构发生一系列形态学改变,此变化有一定的规律性,但个体差异较大。

Objective To observe the changes of inter-recti distance(IRD)in women of childbearing age over time.Methods The study is a cross-sectional study.The subjects of the study were 201 women of childbearing age who went to the Ultrasound Department of the Sixth Affiliated Hospital of Sun Yat-sen University from August 2017 to March 2018.Among them,30 were in the non-fertile group(N_(1)),141 were in the pregnancy group(N_(2)),and 30 were in the postpartum group(N_(3)).Using ultrasound to measure the IRD at the umbilical level(IRD_(1)),the IRD at the midpoint of the connection between the umbilical cord and the upper edge of the pubic symphysis(IRD_(2)),and the width of the rectus abdominis at the left and right sides of the umbilical level(WRAL,WRAR).We observed and analyzed the characteristics of the morphological changes of the rectus abdominis in each group.Results Non-fertility group(N_(1)):The mean IRD1 is(16.57±4.62)mm and IRD_(2) is 0 mm and(WRAL+WRA_(R))/2 is(72.03±11.38)mm.Pregnancy group(N_(2)):The IRD1 of increased with the weeks of gestation from the early stage of pregnancy,and increased more significantly after 21 weeks of gestation,until it reached a peak before delivery(37to 40 weeks of gestation)with an average value of(92.41±23.40)mm at that time.IRD_(2),WRAL and WRAR did not change significantly in the early stage of pregnancy.After 21 weeks of gestation,(WRA_(L)+WRA_(R))/2 began to increase significantly,and reached a peak before delivery with an average of(113.27±18.5)mm.There are large individual differences in the data changes.Postpartum group(N_(3)):WRAL and WRAR returned to normal in one month after delivery.IRD1 recovered 41%in 3 days after delivery and 67.1%of women recovered to the level of non-fertility in one month after delivery.Approximately 26.6%of postpartum women have IRD1>27 mm for more than one year after delivery.IRD1(Y)is correlated with gestational week(X_(1))and IRD_(2)(X_(2)).The simulation curve equation(stepwise method)Y=2.801X_(1)+1.111X_(2)-26.049,X_(1)>21.Conclusion A series of morphological changes occur in the structure of the abdominal wall in women during pregnancy and after delivery. This change has certain regularity, but there are large individual differences.