影响产后盆底肌力的多因素分析

Multivariate Analysis of Factors Affecting Postnatal Pelvic Floor Muscle Strength

目的检测产妇产后42 d盆底肌力,分析影响产后盆底肌力的因素,为实施盆底康复治疗提供理论依据。方法选择2019年11月1日—2020年10月31日115名产后42 d至我院妇产科门诊复查产妇为研究对象,记录患者基本情况,并检测其盆底肌力。结果无论何种分娩方式,高龄、产次≥3次、孕期体质量增加≥15 kg及分娩巨大儿者,产后42 d盆底肌力均明显降低,差异有统计学意义(P<0.05);经阴道分娩者较剖宫产者产后42 d盆底肌力明显降低,差异有统计学意义(P<0.05)。经阴道分娩者第二产程时长≥2 h者产后42 d盆底肌力较<2 h者低,差异无统计学意义(P>0.05);会阴裂伤或侧切者产后42 d盆底肌力较会阴无裂伤者低,差异无统计学意义(P>0.05);孕前体质量指数(BMI)≥24 kg/m^(2)者产后42 d盆底肌力较孕前BMI<24 kg/m^(2)者低,差异无统计学意义(P>0.05);新生儿出生体质量越高,产妇产后42 d盆底肌力越低,尤其是Ⅱ类肌,差异有统计学意义(P<0.05)。结论产后盆底肌力受分娩方式、年龄、产次、孕期体质量增加情况及新生儿出生体质量等因素影响。为减少盆底肌损伤,孕前应适当减重,孕期注意控制体质量增长,尽量避免高BMI、高龄妊娠、巨大儿、多次分娩等高危因素。

Objective To detect the pelvic floor muscle strength of 42 days after parturient,analyze the factors influencing the pelvic floor muscle strength,and provide theoretical basis for the implementation of pelvic floor rehabilitation treatment.Methods A total of 115 postpartum women who came to our obstetrics and gynecology clinic 42 days after delivery from November 1,2019 to October 31,2020 were selected as the research objects,the basic situation was recorded,and the pelvic floor muscle strength was detected.Results Regardless of the mode of delivery,the pelvic floor muscle strength decreased significantly at 42 days postpartum in the elderly,the number of births≥3,the increase of body mass during pregnancy≥15 kg and the delivery of macrosomia,the difference was statistically significant(P<0.05);the pelvic floor muscle strength of vaginal delivery was significantly lower than that of cesarean section at 42 days postpartum,the difference was statistically significant(P<0.05).The pelvic floor muscle strength at 42 days postpartum in those with the second stage of labor longer than or equal to 2 hours was lower than that in those with less than 2 hours postpartum,and the difference was not statistically significant(P>0.05);the pelvic floor muscle strength of patients with perineal laceration or lateral incision at 42 days postpartum was lower than that of patients without perineal laceration,and the difference was not statistically significant(P>0.05);the pelvic floor muscle strength of those with pre pregnancy body mass index(BMI)≥24 kg/m^(2)at 42 days postpartum was lower than those with pre pregnancy BMI<24 kg/m^(2),and the difference was not statistically significant(P>0.05);the higher the birth weight of newborns,the lower the pelvic floor muscle strength of pregnant women at 42 days postpartum,especially classⅡmuscle,the difference was statistically significant(P<0.05).Conclusion Postpartum pelvic floor muscle strength is affected by delivery mode,age,delivery times,weight gain during pregnancy and neonatal weight;In order to reduce the injury of pelvic floor muscle,weight should be properly reduced before pregnancy,weight gain should be controlled during pregnancy,and high BMI and high risk factors such as high BMI,old pregnancy,giant children and multiple delivery should be avoided.