不同盆底肌训练开始时间对高龄初产妇产后盆底功能的影响

Effects of different starting times of pelvic floor muscle training on the postpartum pelvic floor function in elderly primiparas

目的评价不同盆底肌训练开始时间对高龄初产妇产后盆底功能的影响,旨在为寻找最佳训练时机提供参考。方法选取2020年8月至2021年1月行常规孕期检查的高龄初产妇180例,按照随机数字表法分为产前组、产后组和对照组,每组60例。对照组给予常规围生期健康教育,产前组和产后组在常规健康教育基础上,分别于妊娠28周和产后7 d开始进行盆底肌训练,总锻炼时间≥3个月。比较3组围生期盆底肌力和产后压力性尿失禁发生率。结果产后49 d,产前组Ⅰ、Ⅱ类肌纤维肌力评分为(2.38±0.98)分、(3.09±0.82)分,高于对照组的(1.93±0.79)分、(2.64±0.97)分;产后3个月、6个月,产前组Ⅰ和Ⅱ类肌纤维肌力评分为(3.36±1.38)分、(3.43±1.04)分和(3.52±0.91)分、(3.64±1.10)分,产后组为(2.77±0.99)分、(3.19±0.76)分和(3.08±0.81)分、(3.47±1.17)分,均高于对照组的(2.22±0.79)分、(2.64±1.16)分和(2.64±1.07)分、(2.91±0.82)分,且产后3个月产前组上述肌力评分又高于产后组,差异有统计学意义(P<0.05)。产后49 d,产前组压力性尿失禁发生率为7.1%,低于产后组的24.5%和对照组的27.3%;产后3个月,产前组和产后组压力性尿失禁发生率为5.4%和7.6%,均低于对照组的21.8%,差异有统计学意义(P<0.05)。结论妊娠28周开始进行盆底肌训练可有效提高高龄初产妇盆底肌力,降低产后尿失禁发生风险。

Objective To investigate the effects of different starting times of pelvic floor muscle training on the postpartum pelvic floor function in elderly primiparas,so as to provide reference for selecting the optimum training opportunity of pelvic floor muscle training.Methods A total of 180 elderly primiparas who recieved routine pregnancy examination in our hospital from August 2020 to January 2021 were enrolled in the study,who were randomly divided into prenatal group,postpartum group and control group,with 60 cases in each group.The patientsin control group recieved perinatal health education,based on this,the patients in prenatal group and postpartum group,on the basis of control group,were treated by pelvic floor muscle training at 28 weeks of gestation and at 7 days after childbirth,respectively,with the total exercise time being more than 3 months.The perinatal pelvic floor muscle strength and the incidence of postpartum stress urinary incontinence were observed and compared among the three groups.Results At 49 days after child birth,the scores of classⅠandⅡmuscle fibers muscle strength in prenatal group were higher than those in control group,which at 3m and 6m after childbirth in prenatal group and postpartum group were higher than those in control group,moreover,which at 3m after childbirth in prenatal group were significantly higher than those in postpartum group(P<0.05).At 49 days after childbirth,the incidence of stress urinary incontinence in prenatal group was 7.1%,which was significantly lower than that(24.5%)in postpartum group and that(27.3%)in control group(P<0.05),At 3m after childbirth the incidence rates of stress urinary incontinence in prenatal group and postpartum group were 5.4%and 7.6%,respectively,which were significantly lower than that(21.8%)in control group(P<0.05).Conclusion To perform pelvic floor muscle training at 28 weeks of pregnancy can effectively promote pelvic floor muscle strength and decrease the risk of postpartum urinary incontinence in elderly primiparas.