分娩方式和盆底肌锻炼对初产妇产后早期盆底功能障碍的影响

The effect of delivery methods and pelvic floor muscle exercise on early pelvic floor dysfunction after delivery

目的探讨不同分娩方式和盆底肌锻炼对初产妇产后早期盆底功能障碍的影响。方法选取2019年4月—2019年7月在台州市中心医院产检和分娩的788例孕妇为研究对象,按照分娩方式分为阴道分娩组(487例)和剖宫产组(301例),对两组孕妇均进行盆底功能障碍性疾病(PFD)预防干预训练,按照是否进行盆底刺激修复分为干预组和非干预组,比较产妇产后6周、12周时盆底肌力情况、产后生活质量及产后12周PFD发生情况。结果干预前,剖宫产组产妇盆底肌力略优于阴道分娩组,差异有统计学意义(χ^(2)=7.712,P<0.05),剖宫产组产妇盆底肌力达到5级的比例为38.21%;干预后,剖宫产组组间比较,进行盆底刺激修复干预的产妇盆底肌力[(3.72±0.72)kPa、(3.79±0.62)kPa]优于非干预组[(3.29±0.59)kPa、(3.22±0.71)kPa],差异均有统计学意义(t=2.451、4.263,均P<0.05);阴道分娩组组间比较,进行盆底刺激修复干预的产妇盆底肌力[(3.48±0.41)kPa、(3.79±0.72)kPa]优于非干预组[(2.73±0.37)kPa、(3.21±0.61)kPa],差异均有统计学意义(t=3.280、3.172,均P<0.05);干预前剖宫产组和阴道分娩组产妇产后生活质量比较,差异均无统计学意义(均P>0.05);经6周干预后,进行盆底刺激修复干预的产妇产后生活质量[剖宫产组(14.18±3.22)分、阴道分娩组(13.09±4.12)分]均优于非干预组[剖宫产组(25.02±3.61)分、阴道分娩组(23.28±3.21)分],差异均有统计学意义(t=35.613、30.782,均P<0.05);进行盆底刺激修复干预的产妇PFD发生情况均明显少于非干预组,差异均有统计学意义(均P<0.05)。结论不同分娩方式对初产妇产后早期PFD的发生具有不同影响,采用剖宫产的产妇在盆底肌力方面略优于阴道分娩产妇;采用盆底肌锻炼有助于产妇产后盆底肌力的恢复,配合盆底刺激修复能够更有效地改善盆底肌力,减少盆底功能障碍。

Objective To observe and investigate the effects of different delivery methods and pelvic floor muscle exercises on early pelvic floor dysfunction in postpartum women.Methods From April 2019 to July 2019,788 pregnant women in the obstetrics and gynecology obstetrics and delivery of Taizhou Central Hospital were selected and di-vided into vaginal delivery group(487 cases)and cesarean section group(301 cases)according to the mode of delivery.Conduct pelvic floor dysfunction(PFD)preventive intervention training,and divide them into intervention group and non-intervention group according to whether pelvic floor dysfunction(PFD)is repaired,and compare the maternal pelvic floor muscle strength and quality of life at 6,12 weeks postpartum and PDF at 12 weeks postpartum.Results The pelvic floor muscle strength of cesarean section was slightly better than that of vaginal delivery group,the difference was statistically signiticant(χ^(2)=7.712,P<0.05).The proportion of pelvic floor muscle strength of cesarean section reaching grade 5 was 38.21%.Compared with the cesarean section group,the pelvic floor muscle strength of the women undergoing pelvic floor stimulation repair[(3.72±0.72)kPa,(3.79±0.62)kPa]was better than that of the non-intervention group[(3.29±0.59)kPa,(3.22±0.71)kPa],and the diffierences were statistically significant(t=2.451,4.263,all P<0.05);the vaginal delivery group was compared between the groups,and the pelvic floor of the maternal women undergoing pelvic floor stimulation repair floor muscle strength[(3.48±0.41)kPa,(3.79±0.72)kPa]was better than non-intervention group[(2.73±0.37)kPa,(3.21±0.61)kPa],the differences were statistically significant(t=3.280,3.172,all P<0.05).There were no significant differences in quality of life between the cesarean section group and the vaginal delivery group before intervention(all P>0.05).After 6 weeks of intervention,the situation of women undergoing pelvic floor stimulation repair[(14.18±3.22)points,(13.09±4.12)points]was better than that of non-intervention group[(25.02±3.61)points,(23.28±3.21)points],the differences were statistically significant(t=35.613,30.782,all P<0.05).The incidence of pelvic floor dysfunction in women undergoing pelvic floor stimulation repair was significantly less than that in the non-intervention group(all P<0.05).Conclusion Different delivery methods have different effects on the occurrence of early pelvic floor dysfunction in primiparous women.Women who use cesarean section are slightly better than women who have vaginal delivery in terms of pelvic floor muscle strength;using pelvic floor muscle exercises can help women Postpartum pelvic floor muscle strength recovery,in which pelvic floor stimulation and repair can effectively improve pelvic floor muscle strength and reduce pelvic floor dysfunction.