盆底肌电生理参数对自然分娩初产妇产后盆腔器官脱垂的预测价值

Prediction Value of Pelvic Organ Prolapse After Spontaneous Delivery of Primipara by Electrophysiological Parameters of Pelvic Floor Muscles

目的探讨盆底肌电生理参数对自然分娩初产妇产后出现盆腔器官脱垂的预测价值。方法回顾性研究,收集2020年5月至2022年7月在开封市妇幼保健院自然分娩的84例初产妇的临床资料,且均完成6个月随访,依据产后6个月内是否出现盆腔器官脱垂分为脱垂组(44例)和未脱垂组(40例)。收集两组患者一般资料及产后42 d时盆底肌电生理参数(最大肌电位、Ⅰ型肌纤维耐力及肌肉疲劳度、Ⅱ型肌纤维耐力及肌肉疲劳度),采用点二列相关性分析盆底肌电生理参数与自然分娩初产妇产后盆腔器官脱垂发生的相关性,并绘制受试者工作特征(ROC)曲线评估盆底肌电生理参数单独及联合预测自然分娩初产妇产后出现盆腔器官脱垂的价值。结果两组Ⅱ型肌纤维耐力及肌肉疲劳度对比,差异无统计学意义(P>0.05);脱垂组最大肌电位、Ⅰ型肌纤维耐力、Ⅰ型肌肌肉疲劳度均小于未脱垂组(P<0.05);点二列相关性分析显示,最大肌电位、Ⅰ型肌纤维耐力、Ⅰ型肌肌肉疲劳度与自然分娩初产妇产后盆腔器官脱垂的发生均呈负相关(r<0,P<0.05);绘制ROC曲线,结果显示,最大肌电位、Ⅰ型肌纤维耐力及肌肉疲劳度自然分娩初产妇产后盆腔器官脱垂发生的曲线下面积(AUC)均>0.5,具有预测价值,且联合预测价值更高。结论盆底肌电生理参数中最大肌电位、Ⅰ型肌纤维耐力及肌肉疲劳度可预测自然分娩初产妇产后盆腔器官脱垂发生情况,且三者联合预测价值更高。

Objective To explore the predictive value of the electrophysiological parameters of pelvic floor muscles on the occurrence of pelvic organ prolapse after spontaneous delivery of primipara.Methods A retrospective study was conducted to collect the clinical data of 84 primipara who delivered naturally in Kaifeng Maternal and Child Health Care Hospital from May 2020 to July 2022,and all of them were followed up for 6 months.According to whether there was pelvic organ prolapse within 6 months after delivery,patients divided into prolapse group(44 cases)and non-propagation group(40 cases).The general data of the two groups of patients and the electrophysiological parameters of pelvic floor muscles(maximum muscle potential,typeⅠmuscle fiber endurance and muscle fatigue,typeⅡmuscle fiber endurance and muscle fatigue)at 42 days postpartum were collected.The correlation between the electrophysiological parameters of pelvic floor muscles and the occurrence of pelvic organ prolapse after spontaneous delivery of primipara was analyzed by using point-binary correlation,and the value of the electrophysiological parameters of pelvic floor muscles alone and jointly predicting the occurrence of pelvic organ prolapse after spontaneous delivery of primipara was evaluated by receiver operating characteristic(ROC)curve of subjects.Results There was no statistical difference in typeⅡmuscle fiber endurance and muscle fatigue between the two groups(P>0.05).The maximum muscle potential,typeⅠmuscle fiber endurance and typeⅠmuscle fatigue in the prolapse group were lower than those in the non-propagation group(P<0.05).Point two column correlation analysis showed that the maximum muscle potential,typeⅠmuscle fiber endurance,typeⅠmuscle fatigue were negatively correlated with the occurrence of pelvic organ prolapse after spontaneous delivery(r<0,P<0.05).The ROC curve was drawn,and the results showed that the area under the curve(AUC)of the maximum muscle potential,typeⅠmuscle fiber endurance and muscle fatigue in the occurrence of pelvic organ prolapse after spontaneous delivery of primipara women were more than 0.5,which had predictive value,and the combined predictive value was higher.Conclusion The maximum muscle potential,typeⅠmuscle fiber endurance and muscle fatigue among the electrophysiological parameters of pelvic floor muscle can predict the occurrence of pelvic organ prolapse after spontaneous delivery of primipara,and the combined prediction value of the three parameters is higher.