摘要
目的探讨不同分娩方式与产后早期盆底肌肉肌电值、肌力变化的关系。方法选择2014年1月至2015年1月妊娠36~38周于中国医科大学附属盛京医院门诊产检、于盆底治疗中心行产前产后盆底功能检测、并符合纳入标准与排除标准的329例产妇为研究对象,按照分娩方式不同将所有产妇分为选择性剖宫产组162例与阴道分娩组167例,其中阴道分娩组分为会阴侧切组84例与非侧切组83例。分别对产妇分娩前、产后6周、产后3个月、产后5个月的盆底肌肉肌电值、Ⅰ类肌肌力与Ⅱ类肌肌力进行测定。结果剖宫产组与阴道分娩组产后6周及3、5个月比较,除产后6周两组肌电位活力值间差异无统计学意义(P>0.05)外,其余各时间点各组肌电值相比较,剖宫产组均明显高于阴道分娩组,差异均有统计学意义(P<0.05)。阴道分娩组中,会阴侧切组与非侧切组产后6周及3、5个月比较,两组间各项肌电值差异均无统计学意义(P>0.05)。而在产后6周及3、5个月3次复查中,剖宫产组Ⅰ类肌肌力分别下降32.26%、35.48%、27.42%,Ⅱ类肌肌力分别下降61.29%、54.84%、46.77%;阴道分娩组Ⅰ类肌肌力分别下降41.79%、52.24%、46.27%;Ⅱ类肌肌力分别下降71.64%、70.15%、62.69%。会阴侧切组Ⅰ类肌肌力分别下降41.17%、52.94%、44.12%;Ⅱ类肌肌力分别下降79.41%、76.47%、52.94%;非侧切组Ⅰ类肌肌力分别下降42.42%、51.52%、39.39%,Ⅱ类肌肌力分别下降63.64%、63.64%、51.52%。无论剖宫产组与阴道分娩组,还是会阴侧切组与非侧切组,盆底Ⅰ类、Ⅱ类肌肌力下降发生率在组间比较差异均无统计学意义(P>0.05)。结论剖宫产对早期肌电值的影响较阴道分娩小,对盆底肌力的影响与阴道分娩相比差异不大;会阴侧切无法减轻对产后盆底肌肉功能的影响;盆底肌肉肌电值与肌力在评价产后早期盆底功能时可能不具有同步性。
Objective To explore the correlation between different delivery modes and the changes of postpartum pelvic floor electromyography as well as muscle strength.Methods A total of 329 cases meeting the inclusion and exclusion criteria were included as the research objects in the study who received antenatal examination during 36-38 weeks of gestation in Shengjing Hospital of China Medical University and were tested pelvic floor function in the treatment center from January,2014 to January,2015.They were divided into elective cesarean section group（162 cases）and vaginal delivery group（167 cases）according to the different modes of delivery,and the latter was divided into episiotomy group（84 cases）and non-episiotomy group（83 cases）.All objects were instructed to measure the pelvic floor electromyography and class Ⅰ,Ⅱ type muscle strength for 4 times：at the period of antepartum,6 weeks,3 months and 5 months postpartum respectively.Results By comparing elective caesarean section group with the vaginal delivery group,episiotomy group with non-episiotomy group,the antepartal pelvic floor electromyography,muscle strength and some general situation had no statistically significant differences（P〉0.05）.For elective caesarean section group and the vaginal delivery group,ex-,significant differences（P〈0.05）at other time points,and the results of pelvic floor electromyography in cesarean section group were significantly higher than those in vaginal delivery group.For episiotomy group and non-episiotomy group,the differences of all at the period of 6 weeks,3 months and 5 months postpartum had no statistical significance（P〉0.05）.At the period of 6 weeks,3 months and 5 months postpartum,in elective caesarean group,type Ⅰ muscle strength decreased 32.26%,35.48% and 27.42%,and type Ⅱ muscle strength decreased 61.29%,54.84% and46.77%.In vaginal delivery group,type Ⅰ muscle strength decreased 41.79%,52.24% and 46.27%,and type Ⅱ muscle strength decreased 71.64%,70.15% and 62.69%.In episiotomy group,type Ⅰ muscle strength decreased 41.17%,52.94% and 44.12%,and type Ⅱ muscle strength decreased 79.41%,76.47% and 52.94%.In non-episiotomy group,type Ⅰ muscle strength decreased 42.42%,51.52 and 39.39%,and type Ⅱ muscle strength decreased 63.64%,63.64%and 51.52%.Therefore,whether in the cesarean section group and vaginal delivery group,or episiotomy group and nonepisiotomy group,the incidences of pelvic floor class Ⅰ,Ⅱ type muscle strength decline was not significantly different（P〉0.05）.Conclusion The impact of elective cesarean section on the early postpartum pelvic floor electromyography is less than the vaginal delivery.However,there is no difference in pelvic floor muscle strength between these two groups.Episiotomy cannot reduce the effect of postpartum pelvic floor function.Pelvic floor electromyography and muscle strength may not be synchronized for the evaluation of early postpartum pelvic floor function.
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2017年第12期1288-1292,共5页
Chinese Journal of Practical Gynecology and Obstetrics
基金
国家科技部十二五"重大新药创制"科技重大专项课题(2012ZX09401004)
关键词
盆底功能障碍性疾病
阴道分娩
选择性剖宫产
会阴侧切术
盆底电生理指标
pelvic floor dysfunction
vaginal delivery
elective caesarean section
episiotomy
pelvic floor electrical physiological indexes
