妊娠期自主盆底肌锻炼对保护盆底肌肌群功能的效果评价

Evaluation of The Effect of Autonomous Pelvic Floor Muscle Exercise on Protecting Pelvic Floor Muscle Function During Pregnancy

目的 探讨妊娠期自主凯格尔运动对初产妇产后早期盆底结构及功能的影响。方法 前瞻性研究。募集拟于北京大学深圳医院产检及分娩的初产妇中收集基线资料,对符合入排标准的研究对象通过宣教后配对分组为运动组(妊娠期凯格尔运动组)、对照组。对照组孕妇按照一般诊疗常规进行,无特殊干预措施;运动组孕妇从妊娠期28周起至分娩前在专科医师指导下进行盆底肌肉锻炼,余均同对照组。建立运动组微信群组并实时监督指导运动组进行规范化盆底肌锻炼。(1)比较两组产妇的年龄、孕前孕后BMI、分娩方式概率差异;(2)比较两组产妇产前及产后6周时盆底肌障碍早期症状发生率;(3)比较两组产妇孕前及产后6周时逼尿肌厚度、会阴体长度和厚度、肛提肌裂口面积差异;比较Valsalva状态下两组产妇产后6周时盆底超声测量指标的差异;(4)比较两组产妇产后6周时电生理差异。结果 (1)两组产妇年龄、产前产后BMI、孕期、新生儿体重、顺产率的差异均无统计学意义(P值均大于0.05)。(2)61例产妇中存在性欲降低共14例(22.9%),两组比较有统计学意义(P<0.05)。(3)产前基线期两组逼尿肌厚度、会阴体长度、会阴体厚度、肛提肌裂口面积差异均无统计学意义(P>0.05);产后6周时测量两组产妇逼尿肌厚度、会阴体长度差异存在统计学意义(P<0.05)。产后6周时在Valsalva状态下测量两组产妇膀胱移动度、尿道旋转角差异存在统计学意义(P<0.05);膀胱后角差异无统计学意义(P>0.05),但对照组膀胱移动度、尿道旋转角、膀胱后角平均值均大于实验组。(4)两组产妇电生理参数比较,对照组盆底肌Ⅱ类肌纤维最大肌力平均值小于实验组,且差异存在统计学意义(P<0.05);测量I类、Ⅱ类肌纤维肌力时腹肌参与度平均值对照组均大于实验组,且差异存在统计学意义(P<0.05)。结论 妊娠期经专科医师指导后自主盆底肌锻炼降低妊娠期及分娩时对盆底肌肌纤维损伤程度可能;在掌握盆底肌康复动作要领后,对Ⅱ类肌纤维保护效果更明显。

Objective To explore the effect of autonomous Kegel exercise during pregnancy on the pelvic floor structure of primipara in early postpartum period.Methods Prospective study.Baseline data were collected from the primiparas who planned to attend labor examination and delivery in Shenzhen Hospital of Peking University.The subjects meeting the admission criteria were paired divided into exercise group(Kegel exercise group during pregnancy)and control group after education.The control group was treated according to the general diagnosis and treatment routine without special intervention measures.Pregnant women in the exercise group did pelvic floor muscle exercise under the guidance of professionals from 28 weeks of gestation to delivery,and the rest were the same as the control group.Establish a wechat group to supervise and guide the exercise group to standardize the pelvic floor muscle exercise.(1)Compared the age of the two groups of women,BMI before and after pregnancy,and the probability of delivery mode;(2)The incidence of early symptoms of pelvic floor muscle disorder during prenatal and postpartum period of 6 weeks was compared between the two groups;(3)The thickness of detrusor muscle,length and thickness of perineal body,and tear area of levator ANI muscle were compared between the two groups before pregnancy and 6 weeks after delivery.To compare the difference of ultrasonic measurements of pelvic floor between the two groups at 6 weeks postpartum under Valsalva condition.(4)Compare the electrophysiological differences between the two groups at 6 weeks postpartum.Results(1)There were no significant differences in maternal age,prenatal and postpartum BMI,pregnancy,newborn weight and vaginal delivery rate between the two groups(all P values were greater than 0.05).(2)There were 14 cases(22.9%)of 61 women with decreased libido,and there was statistical significance between the two groups(P<0.05).(3)There were no significant differences in detrusor muscle thickness,perineal body length,perineal body thickness and levator ANI tear area between the two groups in the baseline prenatal period(P>0.05).There were significant differences in detrusor muscle thickness and perineal body length between the two groups at 6 weeks postpartum(P<0.05).There were statistically significant differences in bladder mobility and urethra rotation Angle between the two groups at 6 weeks postpartum under Valsalva condition(P<0.05).There was no significant difference in posterior bladder Angle(P>0.05),but the mean value of bladder mobility,urethra rotation Angle and posterior bladder Angle in the control group were greater than those in the experimental group.(4)Compared with the electrophysiological parameters of the two groups,the average maximum muscle strength of classⅡmuscle fibers of the pelvic floor muscle in the control group was lower than that in the experimental group,and the difference was statistically significant(P<0.05);When measuring the muscle strength of ClassⅠand ClassⅡmuscle fibers,the average abdominal muscle participation of the control group was greater than that of the experimental group,and the difference was statistically significant(P<0.05).Conclusion It is possible to reduce the damage of pelvic floor muscle fibers during pregnancy and delivery by independent pelvic floor muscle exercise under the guidance of a specialist.It can better grasp the essentials of pelvic floor muscle rehabilitation action,and the protective effect of ClassⅡmuscle fibers is more obvious.