产后盆底肌训练对改善盆底功能的效果分析

Effect of postpartum pelvic floor muscle training on improving pelvic floor function

目的·评价产后1年内盆底肌训练(Kegel训练)对产妇盆底功能康复的作用。方法·选取2020年1-4月在上海交通大学医学院附属国际和平妇幼保健院产后6周检查有不同程度尿失禁和/或盆腔器官脱垂的阴道分娩初产妇,分为锻炼组(147例)和对照组(194例)。锻炼组于产后6周开始进行Kegel训练,对照组进行一般的产后健康教育。在产后6周及产后1年,对2组产妇进行一般情况问卷及国际尿失禁咨询委员会尿失禁问卷表简表(International Consultation Incontinence Questionnaire-UI Short Form,ICIQ-SF)调查,并进行盆底肌力测定和分级(盆底肌力分级>Ⅲ级表明肌力正常);根据盆腔器官脱垂分度法(pelvic organ prolapsed quantitation,POP-Q)定量评估脱垂程度。比较2组产妇的盆底肌力分级、尿失禁评分以及盆底器官脱垂情况,评价盆底肌训练的效果。结果·随访至产后1年,锻炼组和对照组失访数分别为20例和28例。锻炼组产后1年盆底肌力正常的比例显著高于产后6周(56.0%vs 34.7%,P=0.000),尿失禁发生率显著低于产后6周(25.2%vs 36.7%,P=0.040)。对照组产后1年盆底肌力正常的比例显著高于产后6周(43.4%vs 32.5%,P=0.033),尿失禁发生率显著低于产后6周(17.5%vs 28.9%,P=0.011)。产后1年,锻炼组盆底肌力正常的比例高于对照组(56.0%vs43.4%,P=0.033),盆底肌力好转率高于对照组(50.4%vs 35.5%,P=0.011)。盆腔器官脱垂程度改善率和尿失禁好转率在锻炼组和对照组之间分别比较,差异均无统计学意义(P>0.05)。结论·产后进行盆底肌训练可提高盆底肌力,但对改善产妇盆底功能障碍的效果并不明显;产后1年产妇尿失禁和盆底肌力均有改善,表明盆底肌有自行恢复的机制,但可能需要较长的时间。

Objective·To evaluate the effect of pelvic floor muscle training(Kegel training)on the rehabilitation of pelvic floor function within 1 year after delivery.Methods·From January to April 2020,primiparas with different degrees of urinary incontinence or pelvic organ prolapse were selected and divided into exercise group(147 cases)and control group(194 cases).The exercise group received Kegel training at 6 weeks of the postpartum period,while the control group received general postpartum health education only.At 6 weeks and 1 year after delivery,these postpartum women in the two groups were investigated with the general information questionnaire and International Consultation Incontinence Questionnaire-UI Short Form(ICIQ-SF).The pelvic floor muscle strength was measured(the pelvic floor muscle strength grade>Ⅲindicates normal muscle strength).The pelvic organ prolapsed quantitation(POP-Q)score was assigned accordingly.The urinary incontinence score,pelvic floor muscle strength and pelvic floor organ prolapse were compared between the two groups,and the effect of pelvic floor muscle training was evaluated.Results·In the exercise group,20 postpartum women lost contact during follow up sections,and 28 women in the control group were unable to be contacted within 1 year.In the exercise group,the proportion of women with normal pelvic floor muscle strength at 1 year postpartum was significantly higher than that at 6 weeks postpartum(56.0%vs 34.7%,P=0.000),and the incidence of incontinence at 1 year postpartum was significantly lower than that at 6 weeks postpartum(25.2%vs 36.7%,P=0.040).In the control group,the proportion of women with normal pelvic floor muscle strength at 1 year postpartum was significantly higher than that at 6 weeks postpartum(43.4%vs 32.5%,P=0.033),and the incidence of incontinence at 1 year postpartum was significantly lower than that at 6 weeks postpartum(17.5%vs 28.9%,P=0.011).At 1 year postpartum,the proportion of women with normal pelvic floor muscle strength in the exercise group was higher than that in the control group(56.0%vs 43.4%,P=0.033).The improvement rate of muscle strength in the exercise group was higher than that in control group(50.4%vs 35.5%,P=0.011).There was no significant difference in the improvement rate of pelvic organ prolapse and frequency of urinary incontinence between the exercise group and the control group(P>0.05).Conclusion·Postpartum pelvic floor muscle training can improve pelvic floor muscle strength,but has no significant effect on improving pelvic floor dysfunction in the current samples.The urinary incontinence condition and pelvic floor muscle strength of women improve 1 year after delivery,indicating that there is a mechanism for self recovery of pelvic floor muscle,but it may take a long time.