不同分娩方式对产妇盆底功能障碍性疾病的影响和康复训练的临床研究

Clinical study of different delivery methods on efficacy and rehabilitation training of puerperae with pelvic floor dysfunction

目的探究不同分娩方式对产妇盆底功能障碍性疾病(PFD)的影响和康复训练的效果。方法回顾性分析河北省衡水市第二人民医院妇产科成功分娩的221例产妇资料,根据分娩方式不同分为自然分娩组(n=116)和剖宫产组(n=105),比较两组盆腔结构、盆底肌功能及康复训练效果。结果自然分娩组膀胱颈移动距离、尿道转角、静息状态及Valsalva状态膀胱尿道后夹角均显著大于剖宫产组(P<0.05);自然分娩组Ⅰ、Ⅱ类肌纤维异常率,Ⅰ类盆底肌疲劳度异常率、阴道压力异常率、阴道壁脱垂率、子宫脱垂发生率均显著高于剖宫产组(P<0.05);入选患者经康复训练后,两组盆底肌力、肌电压阴道压力及子宫脱垂现象均显著改善(P<0.05),其中剖宫产组Ⅰ、Ⅱ类盆底肌纤维改善率及肌电压改善程度显著优于自然分娩组(P<0.05)。结论自然分娩引起的盆腔结构异常和盆底肌功能损伤均较剖宫产严重,且自然分娩组产后康复训练效果更好。

Objective To explore the effects of different delivery methods on efficacy and rehabilitation training of puerperae with pelvic floor dysfunction(PFD).Methods A retrospective analysis was performed on the data of 221puerperae who gave birth successfully in the Department of Obstetrics and Gynecology of the Second People’s Hospital of Hengshui.All the puerperae were divided into natural delivery group(n=116)and cesarean section group(n=105).The pelvic structure,pelvic floor muscle function and rehabilitation training effect were compared between the two groups Results The bladder neck movement distance,urethral rotating angle and posterior angles of bladder and urethra in the resting state and Valsalva state were significantly longer or larger in natural delivery group than those in cesarean section group(P<0.05).The abnormal rates of type I and type II muscle fibers,abnormal rate of type I pelvic floor muscle fatigue,abnormal vaginal pressure rate,vaginal wall prolapse rate and incidence rate of uterine prolapse in natural delivery group were significantly higher compared with those in cesarean section group(P<0.05).After rehabilitation training for the selected patients,the pelvic floor muscle strength,muscle voltage,vaginal pressure,and uterine prolapse were significantly improved in both two groups(P<0.05),and the improvement rates of type I and type II pelvic floor muscle fibers and improvement degree of muscle voltage in cesarean section were significantly better than those in natural delivery group(P<0.05).Conclusion The abnormal pelvic structure and pelvic floor muscle function damage caused by natural childbirth are more serious than cesarean section,and the rehabilitation training effect of natural delivery group is better.