椎管内阻滞用于分娩镇痛对产后早期盆底功能的影响  

Clinical study of the effect of intrathecal labor analgesia on early stage postpartum pelvic floor muscle function

作　　者：幸吉娟[1] 刘秀芬[2] 黄鹂[2] 杨梅[3] 高珊[3] 劳诚毅[1] 朱云峰[1] 黄琼燕[1] 

机构地区：[1]广西省南宁市妇幼保健院麻醉科,530011 [2]北京大学第一医院麻醉科 [3]广西省南宁市妇幼保健院妇保科,530011

出　　处：《临床麻醉学杂志》2015年第3期267-269,共3页Journal of Clinical Anesthesiology

基　　金：南宁市科技攻关与新产品试验(20133189)

摘　　要：目的探讨椎管内阻滞用于分娩镇痛对初产妇早期盆底功能和盆底功能障碍性疾病（PFD）发生的影响。方法随机选择我院阴道分娩并于分娩后6-8周复查的初产妇292例,根据分娩方式均分为椎管内阻滞分娩镇痛组（A组）和非镇痛组（B组）,检测盆底肌力、疲劳度和动态压力以评估产后早期盆底功能;采用一般问卷调查和盆底器官脱垂（POP-Q）法了解产后早期PFD发生情况,记录两组产妇早期盆底功能受损及压力性尿失禁（SUI）、盆腔器官脱垂（POP）的发生率。结果产后6-8周盆底功能受损发生率A组为87例（59.6%）,B组为94例（64.4%）,两组盆底功能受损发生率差异无统计学意义;产后6-8周POP的发生率A组为55例（37.7%）,B组为61例（41.8%）;SUI的发生率A组6例（4.1%）,B组为5例（3.4%）;两组POP、SUI发生率差异无统计学意义。结论阴道分娩可使产后早期发生盆底功能损伤,椎管内分娩镇痛不增加产后早期盆底损伤的风险并有改善女性盆底功能受损的可能。Objective To investigate the effects of intrathecal labor analgesia on early stage postpartum pelvic floor muscle function and pelvic floor dysfunctional disease（PFD）.Methods Two hundred and ninty-two primipara interviewed 6-8weeks after first term vaginal delivery were randomly divided into two groups：labor analgesia group（group A）using combined spinal-epidural analgesia and control group（group B）without labor analgesia.The pelvic floor muscle strength,muscle fatigue and dynamic pressure detection were evaluated.The general questionnaire and pelvic organ prolapse（POP-Q）method were used to assess the early postpartum period PFD.Incidences of pelvic floor muscle function damage and stress urinary incontinence（SUI）,pelvic organ prolapse（POP）were compared between the two groups.Results The pelvic floor muscle damage rate was 87（59.6%）in group A and 94（64.4%）in group B at 6to 8weeks after labor.There was no difference between the two groups.The incidence of POP was 55（37.7%）in group A and 61（41.8%）in group B.The incidence of SUI was 6（4.1%）in group A and 5（3.4%）in group B.There was no difference in POP and SUI between the two groups.Conclusion Vaginal delivery will cause early postpartum pelvic floor function injury,while intrathecal labor analgesia will not increase the risk of early pelvic disorders and might have some potential protective effects.

关 键 词：椎管内阻滞 分娩镇痛 盆底功能 

分 类 号：R714.3[医药卫生—妇产科学]