超声检查在产后女性腹直肌分离及康复治疗效果评估中的应用分析

Exploration on the application of ultrasound in the assessment of postpartum DRA and on the analysis of the effect of rehabilitation and treatment

目的:探讨超声检查在产后女性腹直肌分离(DRA)及康复治疗效果评估中的应用。方法:选取医院接收的92名初产妇纳入观察组,依据DRA评估情况分为DRA组(49例)和非DRA组(43组),同期选取46名未妊娠女性纳入对照组,对比腹直肌间距;其中DRA组予以盆底神经肌肉电刺激配合康复按摩,观察总有效率及治疗前后的腹直肌间距变化。结果:观察组妊娠晚期脐上方、脐水平及脐下方腹直肌间距均高于对照组,差异有统计学意义(t=23.211,t=18.514,t=14.307;P<0.05);观察组产后42 d脐上方、脐水平及脐下方腹直肌间距均高于对照组,差异有统计学意义(t=6.205,t=5.207,t=7.874;P<0.05),DRA组脐上方、脐水平、脐下方腹直肌间距均高于非DRA组,差异有统计学意义(t=6.981,t=6.173,t=6.460;P<0.05)。脐上方、脐水平、脐下方等部分腹直肌间距诊断产后腹直肌分离的受试者工作特征(ROC)曲线下面积(AUC)分别为0.789、0.771和0.822;灵敏度分别为100.00%、98.00%和93.90%;特异度分别为55.80%、53.50%和55.80%。DRA组初产妇盆底神经肌肉电刺激配合康复按摩治疗后总有效率为87.76%,且干预后脐上方、脐水平及脐下方的腹直肌间距低于干预前。脐上方、脐水平、脐下方等部分腹直肌间距预测疗效的AUC分别为0.942、0.971和0.919;灵敏度分别为82.10%、92.90%和92.90%;特异度分别为90.50%、90.50%和81.00%。结论:超声检查用于产后女性腹直肌分离及康复治疗效果的评估具有较高临床价值,能为DRA诊断及临床治疗提供指导。

Objective:To explore the application of ultrasound in the assessment of postpartum diastasis recti abdominis(DRA)and the effect of rehabilitation treatment.Methods:92 primiparas were selected and were divided into observation group,and they were divided further into DRA group(49 cases)and non-DRA group(43 cases)according to DRA assessment condition.At the same time,46 women without pregnancy were divided into control group,and the separation distance of rectus abdominis were compared.DRA group underwent pelvic floor neuromuscular electrical stimulation combined with rehabilitation massage.The total effective rate and the change of separation distance of rectus abdominis before and after treatment were observed.Results:The separation distances between rectus abdominis(above the umbilicus,parallel with umbilicus and under the umbilicus)of observation group were significantly higher than those of control group(t=23.211,t=18.514,t=14.307,P<0.05),respectively.And the separation distances between rectus abdominis(above the umbilicus,parallel with umbilicus and under the umbilicus)at the postpartum 42th d of observation group were significantly higher than those of control group(t=6.205,t=5.207,t=7.874,P<0.05),respectively.The separation distances between rectus abdominis(above the umbilicus,parallel with umbilicus and under the umbilicus)of DRA group were significantly higher than those of non-DRA group(t=6.981,t=6.173,t=6.460,P<0.05),respectively.The area under curves(AUCs)of receiver operating characteristics(ROC)of above the umbilicus,parallel with umbilicus and under the umbilicus were 0.789,0.771 and 0.822 in diagnosing the separation of postpartum rectus abdominis,and the sensitivities of them were 100.00%,98.00%and 93.90%,and the specificities of them were 55.80%,53.50%and 55.80%,respectively.The total effective rate of primiparas in DRA group was 87.76%after they underwent pelvic floor neuromuscular electrical stimulation combined with rehabilitation massage treatment,and the separation distances between rectus abdominis above the umbilicus,parallel with umbilicus and under the umbilicus after the intervention were significantly lower than those before the intervention.The AUCs of separation distances between rectus abdominis of above umbilicus,parallel with umbilicus and under umbilicus were respectively 0.942,0.971 and 0.919,and the sensitivities of them were 82.10%,92.90%and 92.90%,and the specificities of them were 90.50,90.50%and 81.00%,respectively.Conclusion:Ultrasound is of high clinical value in assessing DRA of postpartum women,and it can provide guidance for the diagnosis and clinical treatment of DRA.