不同助产方式对阴道分娩产妇产后疼痛 盆底肌力及压力性尿失禁的影响

Effects of different delivery methods on postpartum pain,pelvic floor muscle strength,and stress urinary incontinence

目的分析不同助产方式对阴道分娩产妇产后疼痛、盆底肌力及压力性尿失禁的影响。方法选取2019年1-6月在温州医科大学附属第二医院经阴道分娩的896例孕妇,按助产方式分为自然组(自然分娩)、产钳组(产钳助产)及侧切组(会阴侧切)。分娩后6周,检测产妇盆底肌力和超声参数,统计并发症发生情况,比较各组盆底肌力、超声参数及并发症发生情况。结果自然组前静息平均肌电值、后静息平均肌电值、快肌最大肌电值、混合肌平均肌电值及慢肌平均肌电值分别为(6.79±2.71)μV、(6.65±3.02)μV、(40.47±11.84)μV、(24.29±7.57)μV及(20.41±6.58)μV;侧切组前静息平均肌电值、后静息平均肌电值、快肌最大肌电值、混合肌平均肌电值及慢肌平均肌电值分别为(5.41±1.83)μV、(5.29±1.69)μV、(32.05±10.52)μV、(20.35±5.97)μV及(16.39±6.03)μV;产钳组前静息平均肌电值、后静息平均肌电值、快肌最大肌电值、混合肌平均肌电值及慢肌平均肌电值分别为(4.53±1.76)μV、(4.51±1.72)μV、(27.55±7.29)μV、(16.38±6.11)μV及(13.79±5.34)μV。侧切组和产钳组前静息平均肌电值、后静息平均肌电值、快肌最大肌电值、混合肌平均肌电值及慢肌平均肌电值均低于自然组(均P<0.05)。产钳组前静息平均肌电值、后静息平均肌电值、快肌最大肌电值、混合肌平均肌电值及慢肌平均肌电值均低于侧切组(均P<0.05)。产钳组静息状态、瓦氏动作及缩肛动作时盆膈裂孔面积(LH-S)和前后径(LH-D)均大于自然组和侧切组,侧切组静息状态LH-S及瓦氏动作、缩肛动作时LH-D和LH-S均大于自然组,差异均有统计学意义(均P<0.05)。产钳组和侧切组压力性尿失禁、子宫脱垂及阴道壁膨出发生率均高于自然组,差异均有统计学意义(均P<0.05)。结论产钳助产和会阴侧切对盆底肌力的影响均大于自然分娩,其中产钳助产尤为严重,导致压力性尿失禁等产后并发症发生率增高,但对产后疼痛发生率无明显影响。

Objective To analyze the effects of different delivery methods on postpartum pain,pelvic floor muscle strength,and stress urinary incontinence.Methods From January to June in 2019,896 pregnant women of vaginal delivery in the Second Affiliated Hospital of Wenzhou Medical University were selected and divided into natural group(natural delivery),forceps group(forceps delivery),and lateral episiotomy group(lateral episiotomy)according to delivery mode.At 6 weeks after delivery,pelvic floor muscle strength and ultrasound parameters were detected.The incidence rates of complications were calculated,the levels of pelvic floor muscle strength,ultrasound parameters,and complications were compared among the three groups.Results In natural group,pre-resting average electromyography,post-resting average electromyography,maximum electromyography of fast muscle,average electromyography of mixed muscle,and average electromyography of slow muscle were(6.79±2.71)μV,(6.65±3.02)μV,(40.47±11.84)μV,(24.29±7.57)μV,and(20.41±6.58)μV,respectively;in lateral episiotomy group,the above-mentioned parameters were(5.41±1.83)μV,(5.29±1.69)μV,(32.05±10.52)μV,(20.35±5.97)μV,and(16.39±6.03)μV,respectively;in forceps group,the above-mentioned parameters were(4.53±1.76)μV,(4.51±1.72)μV,(27.55±7.29)μV,(16.38±6.11)μV,and(13.79±5.34)μV,respectively.The levels of pre-resting average electromyography,post-resting average electromyography,maximum electromyography of fast muscle,average electromyography of mixed muscle,and average electromyography of slow muscle in lateral episiotomy group and forceps group were statistically significantly lower than those in natural group(P<0.05).The levels of pre-resting average electromyography,post-resting average electromyography,maximum electromyography of fast muscle,average electromyography of mixed muscle,and average electromyography of slow muscle in forceps group were statistically significantly lower than those in lateral episiotomy group(P<0.05).The area of hiatus of pelvic diaphragm(LH-S)and anteroposterior diameter of pelvic diaphragm(LH-D)in resting state,valsalva maneuver,and Shrinkage anal action in forceps group were higher than those in natural group and lateral episiotomy group;LH-S in resting state,LH-D and LH-S in valsalva maneuver and Shrinkage anal action in lateral episiotomy group were higher than those in natural group(P<0.05).The incidence rates of stress urinary incontinence,prolapse of uterus,and vaginal wall protruding in forceps group and lateral episiotomy group were statistically significantly higher than those in natural group(P<0.05).Conclusion The influence of forceps delivery and lateral episiotomy on pelvic floor muscle strength is greater than that of natural delivery,especially forceps delivery,which leads to higher incidence rates of postpartum complications such as stress urinary incontinence,but it has no significant impact on the incidence rate of postpartum pain.