不同分娩方式产后盆底功能结局的分析对比研究

Outcome indicators of postpartum pelvic floor function in parturients using different modes of delivery：A comparative analysis

摘要:

目的：比较不同分娩方式产后盆底功能的结局指标。方法：采用单中心对照研究，将我院2016年4至10月产后3~6个月复查的足月产妇按纳入及排除标准，分为剖宫产组、阴道分娩组。收集患者基本情况，通过盆底功能结局评估指标对2组产妇盆底肌力、表面肌电值及盆底功能障碍性疾病（pelvic floor dysfunction，PFD）分布进行对比分析。结果：142例阴道分娩及146例剖宫产分娩产妇在尿失禁、子宫脱垂及腹直肌分离发生率上有统计学差异（P=0.00），阴道分娩组子宫脱垂及尿失禁发生率高于剖宫产组，而腹直肌分离发生率低于剖宫产组。2组浅深肌群的Ⅰ、Ⅱ类肌纤维肌力、快肌肌纤维上升时间及恢复时间、慢肌肌纤维平均肌电值比较差异无统计学意义（P>0.05）；而2组静息阶段平均值、快肌（Ⅱ类肌）肌纤维最大值、慢肌（Ⅰ类肌）肌纤维变异性、治疗前肌电评分、腹肌参与度比较差异有统计学意义（P<0.05），阴道分娩产妇快肌肌电最大值及腹直肌分离发生率均小于剖宫产产妇。结论：阴道分娩与剖宫产均对盆底肌力、表面肌电值造成损伤，可能导致盆底功能障碍性疾病的发生。

Abstract:

Objective：To investigate the outcome indicators of postpartum pelvic floor function in parturients using different modes of delivery through a comparative analysis. Methods：A single-center control study was performed. From April to October，2016，full-term parturients who underwent reexamination at 3-6 months after delivery were enrolled according to inclusion and exclusion criteria and divided into cesarean section group and vaginal delivery group. Their general information was collected，and outcome indicators of pelvic floor function were used to compare pelvic floor muscle strength，surface electromyography values，and distribution of pelvic floor dysfunction（PFD） between the two groups. Results：There were significant differences in the incidence rates of urinary inconti－nence，uterine prolapse，and diastasis recti abdominis between the vaginal delivery group with 142 parturients and the cesarean section group with 146 parturients（P=0.00），and compared with the cesarean section group，the vaginal delivery group had significantly high－er incidence rates of uterine prolapse and urinary incontinence and a significantly lower incidence rate of diastasis recti abdominis. There were no significant differences between the two groups in type Ⅰ/Ⅱ muscle fiber strength of the superficial and deep muscle groups，rise time and recovery time of fast muscle fibers，and average electromyography values of slow muscle fibers（P >0.05），while there were significant differences between the two groups in average value of resting stage，maximum value of fast（type Ⅱ） muscle fibers，variability of slow（typeⅠ） muscle fibers，total electromyography score before treatment，and abdominal muscle involvement（P<0.05）. The vaginal delivery group had significantly lower maximum electromyography value of fast muscle fibers and incidence rate of diastasis recti abdominis than the cesarean section group. Conclusion：Both vaginal delivery and cesarean section can injure pelvic floor muscle strength and superficial electromyography value and may lead to the development of PFD.