不同盆底肌功能康复训练方法对产后盆底肌功能降低初产妇的恢复作用  

Clinical effects of different methods of pelvic floor muscle rehabilitation for primiparae with postpartum pelvic floor muscle function hypotonia

作　　者：程芳[1] 杨云洁[1] 罗亚[2] 马乐[2] Cheng Fang;Yang Yunjie;Luo Ya;Ma Le(Department of Postpartum Health Care, Huai′an Women and Children Health Hospital of Jiangsu Province, Huai′an 223000, Jiangsu Province, China;Department of Urology Surgery, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100000, China)

机构地区：[1]江苏省淮安市妇幼保健院产后保健科,223000 [2]首都医科大学附属北京妇产医院泌尿外科,100000

出　　处：《中华妇幼临床医学杂志（电子版）》2019年第3期334-342,共9页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

摘　　要：目的探讨盆底肌功能康复训练方法,如Kegel训练和阴道康复器辅助训练,对于改善初产妇产后盆底肌功能的效果,评估阴道康复器辅助训练,对于初产妇产后盆底肌功能的恢复作用。方法选取2016年1月至6月,在江苏省淮安市妇幼保健院足月经阴道分娩,并于产后第42天返回医院接受盆底肌功能评估的60例盆底肌肌力下降初产妇为研究对象。按照随机数字表法,将其分为研究组( n =30)与对照组( n =30)。对研究组受试者采用阴道康复器辅助训练至产后第18周,再改为Kegel训练至产后1年。对对照组受试者采用Kegel训练至产后1年。2组受试者在产后第6、10、18周及1年时,盆底Ⅰ、Ⅱ类肌纤维不同级别肌力发生率比较,采用Cochran-Mantel-Haenszel检验。受试者产后盆底Ⅰ、Ⅱ类肌纤维肌力影响因素分析,分别以其产后盆底Ⅰ、Ⅱ类肌纤维肌力为因变量,治疗措施、时间、治疗措施与时间交互效应为自变量,进行非线性混合效应模型(NLMIXED)分析。本研究遵循的程序符合江苏省淮安市妇幼保健院人体试验委员会制定的标准,并经过该伦理委员会批准(批准文号:2014016),并与所有受试者签订临床研究知情同意书。结果①2组受试者年龄、孕次、人体质量指数(BMI)、新生儿出生体重及治疗前盆底Ⅰ、Ⅱ类纤维的肌力分级构成比等一般临床资料比较,差异均无统计学意义( P >0.05)。②控制治疗措施因素后,受试者产后盆底Ⅰ、Ⅱ类肌纤维肌力变化,均具有显著时间趋势,即随着训练时间延长,产后盆底肌功能不断恢复,并且差异均有统计学意义(χ^ 2 =133.204、116.344, P <0.001);控制时间因素后,研究组治疗措施对受试者产后盆底Ⅰ类肌纤维肌力的恢复情况,显著优于对照组,差异亦有统计学意义(χ^2 =22.239, P <0.001),但是2组治疗措施对受试者产后盆底Ⅱ类肌纤维肌力的恢复情况比较,差异无统计学意义( P >0.0Objective To observe the efficacy of different pelvic floor muscle function rehabilitation training methods, such as measures of Kegel training and vaginal rehabilitation device auxiliary training, for improving pelvic floor muscle function of postpartum primiparae, and to assess the effect of vaginal rehabilitation device auxiliary training can improve the pelvic floor muscle function. Methods A total of 60 cases of primiparae with pelvic floor muscle function hypotonia after delivery who underwent term vaginal delivery in Huai′an Women and Children Health Hospital of Jiangsu Province and returned to evaluate the pelvic floor muscle function 42 d after delivery from January to June 2016 were selected as research subjects. They were randomly divided into the study group ( n =30) and control group ( n =30) by random digits table method. In study group, postpartum primiparae were trained by measure of vaginal rehabilitation device auxiliary training until the 18 weeks after delivery, and then were trained by Kegel training until 1 year after delivery. Postpartum primiparae in control group were treated by measure of Kegel training until 1 year after delivery. At the 6 weeks, 10 weeks, 18 weeks and 1 year after delivery, the rates of different grades of type Ⅰ and Ⅱ muscle fiber strength of postpartum pelvic floor between two groups were compared by Cochran-Mantel-Haenszel test. The influencing factors of muscle strength of type Ⅰ and Ⅱ muscle fibers of pelvic floor in postpartum primiparae were analyzed by nonlinear mixed effect model (NLMIXED). This study was approved by the Ethics Committee of Human Beings in Huai′an Women and Children Health Hospital of Jiangsu Province (Approval No. 2014016). Informed consent for clinical research was signed with each postpartum primipare. Results ①There were no statistically significant differences between two groups in terms of age, gravidity, body mass index (BMI), birth weight of newborns and constituent ratios of different grades of muscle strength of type �

关 键 词：盆腔脏器脱垂 肌张力过低 康复 盆底肌功能 产后 Kegel训练 阴道康复器辅助训练 治疗结果 初产妇 

分 类 号：R714.6[医药卫生—妇产科学]