阴道助产对产后盆底功能的影响
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摘要
目的:探讨阴道助产对产后盆底功能的影响。方法:选择2015年5月至2017年8月在成都市第五人民医院分娩的初产妇88例,根据分娩方式不同分为两组,经阴道分娩组44例,阴道助产组44例,均于产后6周～10周接受盆底超声检查和盆底肌电生物反馈仪检查评估盆底功能。比较两组最大Valsalva动作状态和静息状态下膀胱尿道后角(posterior urethravesical angel,PUA)、尿道倾斜角(urethral tilt angel,UTA)、宫颈外口的位置(cervical mouth position,CMP)、膀胱颈的位置(bladder neck position,BNP)、膀胱颈移动度(Bladder neck descent,BND)、尿道旋转角(urethral rotation angel,URA)、宫颈外口移动度(cervix down distance,CDD)以及盆底不同肌纤维的肌力。结果:静息状态下经阴道分娩组UTA、BNP均高于阴道助产组,CMP低于阴道助产组,差异具有统计学意义(P <0. 05);最大Valsalva状态下经阴道分娩组UTA、BNP均低于阴道助产组,CMP高于阴道助产组,差异具有统计学意义(P <0. 05);不同状态下两组PUA值比较,差异无统计学意义(P> 0. 05);阴道助产组BND、URA、CDD值分别为(16. 35±8. 22) mm、(42. 78±32. 48) mm、(13. 94±9. 68) mm,经阴道分娩组BND、URA、CDD值分别为(15. 01±9. 00) mm、(32. 10±28. 34) mm、(12. 14±10. 21) mm,差异具有统计学意义(P <0. 05);阴道分娩组前静息平均肌电值、快肌最大肌电值、混合肌平均肌电值、慢肌平均肌电值、后静息平均肌电值均高于阴道助产组,差异具有统计学意义(P <0. 05)。结论:与经阴道分娩相比,阴道助产术对产后早期盆底肌力的损伤以及对盆底结构与功能的影响较大。
Objective:To investigate the impact of assisted vaginal delivery on postpartum pelvic floor function. Methods: 88 primiparas in our hospital from May 2015 to August 2017 were selected and divided into vaginal delivery group and assisted vaginal delivery group by delivery modes,each of 44 cases. All the 88 primiparas were given pelvic floor ultrasound and pelvic muscle electricity biofeedback instrument examination at 6 to 10 weeks after delivery. The posterior urethravesical angel( PUA),urethral tilt angel( UTA),cervical mouth position( CMP),bladder neck position( BNP),bladder neck descent( BND),urethral rotation angel( URA),cervix down distance(CDD) and pelvic floor muscle force of different muscle fibers at maximum Valsalva action state and rest state were compared between the two groups. Results: At rest state,the UTA and BNP in vaginal delivery group were higher than those in assisted vaginal delivery group,and CMP was lower than that in assisted vaginal delivery group,all with statistically significant differences(P < 0. 05). At maximum Valsalva state,the UTA and BNP in vaginal delivery group were lower than those in assisted vaginal delivery group,and CMP was higher than that in assisted vaginal delivery group,with statistically significant difference(P < 0. 05). There was no statistically significant difference in PUA value at different state between the two groups(P > 0. 05); The BND,URA,CDD value in assisted vaginal delivery group were(16. 35 ± 8. 22)mm,(42. 78 ± 32. 48)mm,(13. 94 ± 9. 68) mm respectively and those in the vaginal delivery group were(15. 01 ± 9. 00)mm,(32. 10 ± 28. 34) mm and(12. 14 ± 10. 21) mm accordingly,with statistically significant differences(P < 0. 05). The anterior resting averaged electromyogram,maximum fast muscle electromyogram,mixed muscle averaged electromyogram,slow muscle averaged electromyogram,posterior resting averaged electromyogram in vaginal delivery group were higher than those in assisted vaginal delivery group,with statistically significant differences(P < 0. 05). Conclusions: Compared with vaginal delivery,assisted vaginal delivery has greater impact on postpartum injury of pelvic floor muscle force and pelvic structure and function.
Objective:To investigate the impact of assisted vaginal delivery on postpartum pelvic floor function. Methods: 88 primiparas in our hospital from May 2015 to August 2017 were selected and divided into vaginal delivery group and assisted vaginal delivery group by delivery modes,each of 44 cases. All the 88 primiparas were given pelvic floor ultrasound and pelvic muscle electricity biofeedback instrument examination at 6 to 10 weeks after delivery. The posterior urethravesical angel( PUA),urethral tilt angel( UTA),cervical mouth position( CMP),bladder neck position( BNP),bladder neck descent( BND),urethral rotation angel( URA),cervix down distance(CDD) and pelvic floor muscle force of different muscle fibers at maximum Valsalva action state and rest state were compared between the two groups. Results: At rest state,the UTA and BNP in vaginal delivery group were higher than those in assisted vaginal delivery group,and CMP was lower than that in assisted vaginal delivery group,all with statistically significant differences(P < 0. 05). At maximum Valsalva state,the UTA and BNP in vaginal delivery group were lower than those in assisted vaginal delivery group,and CMP was higher than that in assisted vaginal delivery group,with statistically significant difference(P < 0. 05). There was no statistically significant difference in PUA value at different state between the two groups(P > 0. 05); The BND,URA,CDD value in assisted vaginal delivery group were(16. 35 ± 8. 22)mm,(42. 78 ± 32. 48)mm,(13. 94 ± 9. 68) mm respectively and those in the vaginal delivery group were(15. 01 ± 9. 00)mm,(32. 10 ± 28. 34) mm and(12. 14 ± 10. 21) mm accordingly,with statistically significant differences(P < 0. 05). The anterior resting averaged electromyogram,maximum fast muscle electromyogram,mixed muscle averaged electromyogram,slow muscle averaged electromyogram,posterior resting averaged electromyogram in vaginal delivery group were higher than those in assisted vaginal delivery group,with statistically significant differences(P < 0. 05). Conclusions: Compared with vaginal delivery,assisted vaginal delivery has greater impact on postpartum injury of pelvic floor muscle force and pelvic structure and function.
引文
[1]史永梅,冯保雯,张建红,等.不同分娩方式对产妇产后早期盆底肌力的影响.中国妇幼保健,2017,32(4):704-706.
[2]裘轶超,张珂,邱丽倩.分娩方式对再生育与初产产后盆底肌的影响观察.现代妇产科进展,2017,26(6):445-447.
[2]蒋莹,刘静华,杨硕,等.经会阴超声观察不同分娩方式对盆底结构的影响.临床超声医学杂志,2014,16(8):538-540.
[3]刘菲菲,白云,高岩冰,等.经会阴超声评估不同分娩方式对女性前盆腔的短期影响.中华超声影像学杂志,2016,25(6):516-519.
[4]刘鹏,孙红霞.不同分娩方式对盆底功能的影响及产后电刺激对盆底肌康复治疗效果对比研究.临床和实验医学杂志,2017,16(5):507-510.
[5]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.中国性科学,2016,25(5):123-126.
[6]李玉芹,吴娟,颜群.选择性剖宫产和阴道分娩方式对产妇盆底功能障碍的影响.局解手术学杂志,2016,25(9):662-665.
[7]周杰,李维玲,李牧.不同分娩方式对产妇早期盆底功能障碍的影响.实用临床医药杂志,2016,20(23):78-81.
[8]毛丽洁,孙继芬,岳青芬.不同分娩方式对产后盆底肌力的影响.中国妇幼健康研究,2016,27(10):1243-1245.
[9]陈美芳,赵仁峰,林海燕.不同分娩方式对盆底功能的影响及产后盆底康复治疗的效果研究.广西医学,2014,36(11):1670-1672.
[10]黄泽萍,徐净,毛永江,等.经会阴实时三维超声评估不同分娩方式对产后女性前腔室结构的影响.中华腔镜泌尿外科杂志(电子版),2014,8(5):13-16.
[11]何浪驰,叶明,黄柳.不同分娩方式产后盆底肌力的测定及意义.广东医学,2016,37(9):1347-1349.
[12]闫志强,于春玲,莫培晖,等.分娩对产后早期盆底功能及盆底功能障碍性疾病发生的影响.蚌埠医学院学报,2016,41(2):205-207.
[13]王淑静,邓晓岚,陈德新,等.不同分娩方式对女性盆底功能影响的研究进展.中华临床医师杂志(电子版),2015,9(20):3768-3773.
[14]杨秀华,郭峰.不同分娩方式产后盆底功能障碍分析及盆底肌力与产科分娩因素的相关性分析.新医学,2015,46(3):172-176.
[15]李林,邓彦东,陈然,等.分娩方式对阴道静息压力、盆底肌肉力量和耐力的影响.中国现代医学杂志,2016,26(9):67-71.
[16]周亚萍.不同分娩方式对产妇产后近期性功能及盆底结构功能的影响比较.中国现代医学杂志,2014,24(31):88-91.
[17]陈仙琴,刘梅青.不同分娩方式对产后盆底肌力近期影响的比较.中国基层医药,2014,21(22):3477-3478.
[18]李淑萍,李婕娜,王英红.盆底超声检查和盆底肌力评估分析不同分娩方式对女性盆底功能的影响.中国妇幼保健,2014,29(21):3520-3522.
[19]Handa VL,Blomquist JL,Mc Dermott KC,et al.Pelvic floor disorders after vaginal birth:effect of episiotomy,perineal laceration,and operative birth.Obstet Gynecol,2012,119(2):233-239.
[2]裘轶超,张珂,邱丽倩.分娩方式对再生育与初产产后盆底肌的影响观察.现代妇产科进展,2017,26(6):445-447.
[2]蒋莹,刘静华,杨硕,等.经会阴超声观察不同分娩方式对盆底结构的影响.临床超声医学杂志,2014,16(8):538-540.
[3]刘菲菲,白云,高岩冰,等.经会阴超声评估不同分娩方式对女性前盆腔的短期影响.中华超声影像学杂志,2016,25(6):516-519.
[4]刘鹏,孙红霞.不同分娩方式对盆底功能的影响及产后电刺激对盆底肌康复治疗效果对比研究.临床和实验医学杂志,2017,16(5):507-510.
[5]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.中国性科学,2016,25(5):123-126.
[6]李玉芹,吴娟,颜群.选择性剖宫产和阴道分娩方式对产妇盆底功能障碍的影响.局解手术学杂志,2016,25(9):662-665.
[7]周杰,李维玲,李牧.不同分娩方式对产妇早期盆底功能障碍的影响.实用临床医药杂志,2016,20(23):78-81.
[8]毛丽洁,孙继芬,岳青芬.不同分娩方式对产后盆底肌力的影响.中国妇幼健康研究,2016,27(10):1243-1245.
[9]陈美芳,赵仁峰,林海燕.不同分娩方式对盆底功能的影响及产后盆底康复治疗的效果研究.广西医学,2014,36(11):1670-1672.
[10]黄泽萍,徐净,毛永江,等.经会阴实时三维超声评估不同分娩方式对产后女性前腔室结构的影响.中华腔镜泌尿外科杂志(电子版),2014,8(5):13-16.
[11]何浪驰,叶明,黄柳.不同分娩方式产后盆底肌力的测定及意义.广东医学,2016,37(9):1347-1349.
[12]闫志强,于春玲,莫培晖,等.分娩对产后早期盆底功能及盆底功能障碍性疾病发生的影响.蚌埠医学院学报,2016,41(2):205-207.
[13]王淑静,邓晓岚,陈德新,等.不同分娩方式对女性盆底功能影响的研究进展.中华临床医师杂志(电子版),2015,9(20):3768-3773.
[14]杨秀华,郭峰.不同分娩方式产后盆底功能障碍分析及盆底肌力与产科分娩因素的相关性分析.新医学,2015,46(3):172-176.
[15]李林,邓彦东,陈然,等.分娩方式对阴道静息压力、盆底肌肉力量和耐力的影响.中国现代医学杂志,2016,26(9):67-71.
[16]周亚萍.不同分娩方式对产妇产后近期性功能及盆底结构功能的影响比较.中国现代医学杂志,2014,24(31):88-91.
[17]陈仙琴,刘梅青.不同分娩方式对产后盆底肌力近期影响的比较.中国基层医药,2014,21(22):3477-3478.
[18]李淑萍,李婕娜,王英红.盆底超声检查和盆底肌力评估分析不同分娩方式对女性盆底功能的影响.中国妇幼保健,2014,29(21):3520-3522.
[19]Handa VL,Blomquist JL,Mc Dermott KC,et al.Pelvic floor disorders after vaginal birth:effect of episiotomy,perineal laceration,and operative birth.Obstet Gynecol,2012,119(2):233-239.