不同顺产方式分娩前后的盆底功能评估
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摘要
目的不同顺产方式分娩前后的盆底功能评估。方法 2016年7月～2017年6月随机选取我院分娩孕妇300例,按随机数字表法分为三组,各100例。会阴侧切组采用会阴侧切术,会阴正中切开组采用会阴正中切开术,无创会阴保护组采用会阴正常分娩,所有产妇分娩后均随访8周。采用女性尿失禁调查问卷调查孕妇孕前及分娩后8周SUI发生情况,检测产妇孕前及分娩后8周盆底Ⅰ类、Ⅱ类肌纤维肌功能的损伤情况,采用盆底器官脱垂质量评估系统(POP-Q)评估产妇孕前及分娩后8周盆腔器官脱垂程度;分析孕妇临床资料对产后发生PFD影响。结果产后,三种顺产方式发生SUI比例无统计学意义(P> 0.05);产后,无创会阴保护组盆底肌纤维肌力异常例数低于会阴侧切组及会阴正中切开组(P <0.05);妊娠期及产后,三种顺产方式POP-Q分度比例分布无明显差异(P> 0.05);年龄、产前BMI、新生儿体重与孕妇产后发生PFD有关(P <0.05);年龄超过35岁、产前BMI值超过23kg/m~2、新生儿体重超过3.5kg是产后发生PFD危险因素(P <0.05)。结论会阴正常分娩方式对盆底Ⅰ类、Ⅱ类肌纤维肌功能的损伤更小,是阴道终止妊娠中较为合适的方式。
Objective To evaluate the pelvic floor function before and after delivery in different spontaneous delivery modes. Methods Three hundred pregnant women who delivered in the hospital from July 2016 to June 2017 were randomly selected and they were divided into three groups according to the random number table method,with100 cases in each group.Lateral episiotomy group was treated with lateral episiotomy,the midline episiotomy group was treated with midline episiotomy and non-invasive perineal protection group was treated with normal perineal delivery.All parturient women were followed up for 8 weeks after delivery.The female urinary incontinence questionnaire was used to investigate the occurrence of SUI in pregnant women before delivery and at 8 weeks after delivery.The damage of pelvic floor muscle function of type Ⅰ and type Ⅱ muscle fibers was measured before delivery and at 8 weeks after delivery.The pelvic organ prolapse quality(POP-Q)assessment system was used to evaluate the degree of pelvic organ prolapse before delivery and at 8 weeks after delivery.The effects of clinical data of pregnant women on the occurrence of postpartum PFD were analyzed. Results After delivery,there was no significant difference in the incidence of SUI among the three delivery modes(P > 0.05).After delivery,the number of people with abnormal pelvic floor muscle function of muscle fibers in non-invasive perineal protection group was higher than that in lateral episiotomy group and midline episiotomy group(P < 0.05).During pregnancy and after delivery,there was no significant difference in proportion distribution of POP-Q grading among the three spontaneous delivery modes(P > 0.05).Age,prenatal BMI and neonatal weight were associated with postpartum PFD in pregnant women(P < 0.05).Age over 35 years old,prenatal BMI value over 23 kg/m~2 and neonatal weight over 3.5 kg were risk factors for postpartum PFD(P < 0.05).Conclusion Normal perineal delivery mode has less damage to pelvic floor muscle function of type Ⅰ and type Ⅱmuscle fibers and it is a more appropriate way to terminate pregnancy in the vagina.
Objective To evaluate the pelvic floor function before and after delivery in different spontaneous delivery modes. Methods Three hundred pregnant women who delivered in the hospital from July 2016 to June 2017 were randomly selected and they were divided into three groups according to the random number table method,with100 cases in each group.Lateral episiotomy group was treated with lateral episiotomy,the midline episiotomy group was treated with midline episiotomy and non-invasive perineal protection group was treated with normal perineal delivery.All parturient women were followed up for 8 weeks after delivery.The female urinary incontinence questionnaire was used to investigate the occurrence of SUI in pregnant women before delivery and at 8 weeks after delivery.The damage of pelvic floor muscle function of type Ⅰ and type Ⅱ muscle fibers was measured before delivery and at 8 weeks after delivery.The pelvic organ prolapse quality(POP-Q)assessment system was used to evaluate the degree of pelvic organ prolapse before delivery and at 8 weeks after delivery.The effects of clinical data of pregnant women on the occurrence of postpartum PFD were analyzed. Results After delivery,there was no significant difference in the incidence of SUI among the three delivery modes(P > 0.05).After delivery,the number of people with abnormal pelvic floor muscle function of muscle fibers in non-invasive perineal protection group was higher than that in lateral episiotomy group and midline episiotomy group(P < 0.05).During pregnancy and after delivery,there was no significant difference in proportion distribution of POP-Q grading among the three spontaneous delivery modes(P > 0.05).Age,prenatal BMI and neonatal weight were associated with postpartum PFD in pregnant women(P < 0.05).Age over 35 years old,prenatal BMI value over 23 kg/m~2 and neonatal weight over 3.5 kg were risk factors for postpartum PFD(P < 0.05).Conclusion Normal perineal delivery mode has less damage to pelvic floor muscle function of type Ⅰ and type Ⅱmuscle fibers and it is a more appropriate way to terminate pregnancy in the vagina.
引文
[1]孙智晶,朱兰,郎景和,等.产后盆底康复锻炼对女性盆底功能障碍性疾病的预防作用[J].中华妇产科杂志,2015,50(6):420-427.
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[8]李春颖,朱兰,郎景和,等.尿失禁诊断问卷简体中文版的信度和效度评价[J].中华妇产科杂志,2016,51(5):357-360.
[9]张桓,朱兰,徐涛,等.简化POP-Q分度系统与标准POP-Q分度法用于盆腔器官脱垂的对比研究[J].中华妇产科杂志,2016,51(7):510-514.
[10]林丽.会阴切开术的临床应用现状与研究进展[J].上海护理,2016,16(1):64-67.
[11]吉训玲,童碧芳,吴燕,等.会阴切开术助产分娩切口感染的病原菌特点与预防[J].中华医院感染学杂志,2017,27(11):2591-2594.
[12]耿鹂姝,沈伟,陈海清.探究阴道分娩与剖宫产对产后盆底功能及产后性功能的影响[J].中国性科学,2016,25(5):123-126.
[13]孙丽洲,黄诗韵.减少会阴切开的循证医学评价[J].中国实用妇科与产科杂志,2015,31(2):127-131.
[14]张月,张洁,韩萍,等.会阴侧切对产后女性盆底功能的近期影响[J].现代妇产科进展,2015,24(6):456-458.
[15]郭仁妃,吴燕,王爱宝,等.不同分娩方式产妇产后阴道收缩力及性生活质量比较研究[J].重庆医学,2017,46(26):3696-3698.
[2]姜卫国,洪淑惠.女性盆底功能障碍性疾病的诊治进展[J].山东医药,2015,55(45):26-29.
[3]常悦,刘海峰,王建六.组织工程及再生医学在盆底功能障碍性疾病中的应用进展[J].中华妇产科杂志,2015,50(6):470-472.
[4]杨雪梅,樊萍,黄楠,等.1342例女教师盆底功能障碍性疾病的危险因素分析[J].重庆医学,2014,43(18):2348-2350.
[5]叶茜,钮琳玮,赵玲.产妇盆底功能情况调查及产科因素对盆底功能的近期影响分析研究[J].实用妇产科杂志,2016,32(11):843-846.
[6]周铮,史铁梅,刘晨,等.超声评价分娩方式对产后盆底功能的影响[J].中国介入影像与治疗学,2016,13(12):775-778.
[7]张晓红.不同分娩方式对于盆底功能影响及康复治疗[J].中国实用妇科与产科杂志,2015,31(2):169-173.
[8]李春颖,朱兰,郎景和,等.尿失禁诊断问卷简体中文版的信度和效度评价[J].中华妇产科杂志,2016,51(5):357-360.
[9]张桓,朱兰,徐涛,等.简化POP-Q分度系统与标准POP-Q分度法用于盆腔器官脱垂的对比研究[J].中华妇产科杂志,2016,51(7):510-514.
[10]林丽.会阴切开术的临床应用现状与研究进展[J].上海护理,2016,16(1):64-67.
[11]吉训玲,童碧芳,吴燕,等.会阴切开术助产分娩切口感染的病原菌特点与预防[J].中华医院感染学杂志,2017,27(11):2591-2594.
[12]耿鹂姝,沈伟,陈海清.探究阴道分娩与剖宫产对产后盆底功能及产后性功能的影响[J].中国性科学,2016,25(5):123-126.
[13]孙丽洲,黄诗韵.减少会阴切开的循证医学评价[J].中国实用妇科与产科杂志,2015,31(2):127-131.
[14]张月,张洁,韩萍,等.会阴侧切对产后女性盆底功能的近期影响[J].现代妇产科进展,2015,24(6):456-458.
[15]郭仁妃,吴燕,王爱宝,等.不同分娩方式产妇产后阴道收缩力及性生活质量比较研究[J].重庆医学,2017,46(26):3696-3698.