会阴侧切对初产妇产后早期盆底康复疗效的影响

Influence of episiotomy on the early rehabilitation of pelvic floor after delivery in primiparas

目的探讨会阴侧切对初产妇产后早期盆底康复疗效的影响。方法经阴道分娩并于产后6~8周经盆底肌力筛查确诊盆底肌肌力≤Ⅲ级的初产妇145例,其中单纯性会阴侧切100例为侧切组,会阴部无裂伤或会阴裂伤≤Ⅱ度45例为非侧切组,2组均采用盆底康复技术进行治疗,比较2组治疗前、后盆底肌肌力、疲劳度和阴道动态压力,分析会阴侧切对盆底肌治疗效果的影响。结果治疗前,2组盆底肌Ⅰ、Ⅱ类肌纤维肌力比较差异无统计学意义(P>0.05),侧切组盆底肌Ⅰ类肌纤维疲劳度[(2.340±0.572)%]、Ⅱ类肌纤维疲劳度[(3.420±0.718)%]、阴道动态压力[(8.850±1.405)kPa]与非侧切组[(2.310±0.514)%、(3.290±0.757)%、(9.309±1.319)kPa]比较差异均无统计学意义(P>0.05);治疗后,侧切组盆底肌Ⅰ、Ⅱ类肌纤维肌力明显低于非侧切组(P<0.05),Ⅰ类肌纤维疲劳度[(1.850±0.359)%]、Ⅱ类肌纤维疲劳度[(2.020±0.630)%]、阴道动态压力值[(10.423±1.699)kPa]与非侧切组[(1.690±0.557)%、(1.980±0.398)%、(11.038±1.478)kPa]比较差异无统计学意义(P>0.05);2组治疗后盆底肌Ⅰ、Ⅱ类肌纤维肌力、阴道动态压力均明显高于治疗前,Ⅰ、Ⅱ类肌纤维疲劳度均明显低于治疗前(P<0.05)。结论产后早期采用盆底康复技术治疗对盆底肌功能恢复效果良好;会阴侧切可明显影响女性盆底功能。

Objective To analyze the influence of episiotomy on early rehabilitation of pelvic floor after delivery in primiparas.Methods A total of 145 primiparas with pelvic floor muscle strength≤ Ⅲ grade confirmed in pelvic floor muscle strength screening in 6to 8 weeks after vaginal delivery were divided into episiotomy group(n=100)and non-episiotomy group(n=45)with no perineal laceration or perineal laceration ≤ Ⅱ degree.The pelvic floor muscle strength,fatigue and vaginal dynamic pressure were compared before and after treatment between two groups to analyze the influence of episiotomy on the pelvic floor muscle.Results There were no significant differences in typeⅠ and typeⅡ muscle fiber strengths between two groups before treatment(P>0.05).There were no significant differences in typeⅠ muscle fiber fatigue of pelvic floor muscle((2.340±0.572)%),typeⅡ muscle fiber fatigue((3.420±0.718)%)and vaginal dynamic pressure((8.850±1.405)kPa)between episiotomy group and non-episiotomy group((2.310±0.514)%,(3.290±0.757)%,(9.309±1.319)kPa)(P>0.05).After treatment,type Ⅰ and type Ⅱ muscle fiber strengths were significantly lower in episiotomy group than those in non-episiotomy group(P<0.05).Type Ⅰ muscle fiber fatigue of pelvic floor muscle((1.850±0.359)%),typeⅡ muscle fiber fatigue((2.020±0.630)%)and vaginal dynamic pressure((10.423±1.699)kPa)in episiotomy group showed no significant differences in comparison with those in non-episiotomy group((1.690±0.557)%,(1.980±0.398)%,(11.038±1.478)kPa)(P>0.05).TypeⅠand typeⅡ muscle fiber strengths,vaginal dynamic pressure,and fatigue of vaginal delivery after treatment were significantly higher than those before treatment in both groups(P<0.05).Conclusion Early use of pelvic floor rehabilitation technique can improve the pelvic floor muscle function after delivery.Episiotomy could significantly influence the function of pelvic floor.