超声评估新生儿体质量对产后女性肛提肌裂孔形态及功能的影响

The effect of neonatal body mass on the hiatus shape and function of levator ani muscle of postpartum women as ultrasound assessment

目的:探讨超声评估新生儿体质量对产后女性肛提肌裂孔形态及功能的影响。方法:选取在医院分娩的134例西南地区产后初产妇,按照新生儿出生时的体质量将产妇分为正常组(93例)和巨大组(41例),采用超声评估产妇肛提肌裂孔的形态和损伤情况,比较两组产妇肛提肌裂孔各径线超声检测结果、不同状态肛提肌裂孔面积以及肛提肌肌力情况。结果:正常组产妇肛提肌裂孔的周长(LHC)、直径(LHD)、横径(LHW)、前后径(LHAP)以及尿道中点至肛提肌的距离(LUG)明显低于巨大组产妇,差异有统计学意义(t=-5.718,t=-5.919,t=-9.940,t=-12.621,t=-4.124;P<0.05)。正常组产妇的静息状态、缩肛状态以及Valsalva动作产后3d、42d和90d时的肛提肌裂孔面积明显低于巨大组产妇,差异均有统计学意义(t_(静息状态)=-8.058,t=-9.794,t=-11.478;t_(缩肛状态)=-9.644,t=-10.058,t=-10.794;t_(Valsalva动作)=-14.375,t=-13.462,t=-13.056;P<0.05)。重复测量显示,两组产妇的静息状态、缩肛状态及Valsalva动作产后3个时间点(3d、42 d及90d)的肛提肌裂孔面积比较,差异均有统计学意义(F=11.944,F=25.733,F=23.613;P<0.05)。两组肛提肌肌力0级、2级、3级、4级及5级比较差异均无统计学意义,正常组产妇肛提肌肌力1级发生率为21.51%(20/93),明显低于巨大组产妇[39.02%(16/41)],差异均有统计学意义(x^(2)=4.445,P<0.05)。结论:经会阴二维及三维超声、断层超声可有效评估西南地区新生儿体质量对初产妇肛提肌的影响,分娩巨大儿易导致产后女性肛提肌损伤以及功能改变。

Objective:To explore the effect of neonatal body mass on the hiatus shape and function of levator ani muscle of postpartum women as ultrasound assessment.Methods:A total of 134 postpartum primipara who delivered in hospital were selected and they were divided into the normal group(93 cases)and the macrosomia group(41 cases)according to body mass of neonates at birth.The hiatus shape and injury of levator ani muscle of delivery women were assessed by ultrasound,and the results of ultrasonic examination of each diameter line of the hiatus of levator ani muscle of delivery women,the area of the hiatus of levator ani muscle in different states and the muscle strength of levator ani muscle were compared between the two groups.Results:The levator hiatus circumference(LHC),diameter of levator hiatus(LHD),width of levator hiatus(LHW),antero-posterior of levator hiatus(LHAP)and the levator-urethra gap(LUG)in the normal group were significantly lower than those in the macrosomia group(t=-5.718,t=-5.919,t=-9.940,t=-12.621,t=-4.124,P<0.05),respectively.The area of the hiatus of levator ani muscle of delivery women in resting state,contraction state and valsalva action at the postpartum 3rd d,42th d and 90th d in the normal group were significantly lower than those in the macrosomia group(t_(resting state)=-8.058,t=-9.794,t=-11.478,t_(contraction state)=-9.644,t=-10.058,t=-10.794,t_(valsalva action)=-14.375,t=-13.462,t=-13.056,P<0.05),respectively.The results of repeated measurement showed that there were significant differences in the areas of the hiatus of levator ani muscle at resting state,contraction state and Valsalva action at the postpartum 3rd d,42th d and 90th d between two groups(F=11.944,F=25.733,F=23.613,P<0.05),respectively.There were not significant at the grade 0,grade 2,grade 3,grade 4,and grade 5 of the strength of levator ani muscle between the two groups(P>0.05),respectively.The incidence of the grade 1 of levator ani muscle strength in the normal group was 21.51%,which was significantly lower than 39.02%in the macrosomia group(x^(2)=4.445,P<0.05).Conclusion:Trans-perineal two-dimensional and three-dimensional ultrasound and tomographic ultrasound can effectively assess the influence of newborn body mass on levator ani muscle of primiparous women in southwest region of China,and the delivery of macrosomia can easily cause the injury and functional change of levator ani muscle of postpartum women.