盆底肌锻炼对不同绝经状态下中老年女性轻度盆腔器官脱垂盆底功能的影响  

Effect of Pelvic Floor Muscle Training on Pelvic Floor Function in Middle-Aged and Elderly Women with Mild Pelvic Organ Prolapse under Different Menopausal States

作　　者：樊卫敏 梅小会[1] 陈记娜 孙克 张丽文[1] 陈亚萍[1] 陈汝君 FAN Weimin;MEI Xiaohui;CHEN Ji'na(Department of Gynecology,Shanghai Fifth People's Hospital,Fudan University,Shanghai 200240,China;Department of Gynecology,The First Affiliated Hospital of Soochow Unirersity,Suzhou Jiangshu 215006,China)

机构地区：[1]复旦大学附属上海市第五人民医院妇科,上海200240 [2]苏州大学附属第一医院妇科,江苏苏州215006

出　　处：《实用妇产科杂志》2022年第1期58-63,共6页Journal of Practical Obstetrics and Gynecology

基　　金：上海市闵行区卫生健康委员会课题(编号:2019MW05)。

摘　　要：目的:评价对于处在不同绝经状态下轻度盆腔器官脱垂(POP)的女性,进行盆底肌锻炼干预对其盆底功能的影响。方法:纳入2020年1月至2021年1月在复旦大学附属上海市第五人民医院盆底中心就诊的中老年轻度(Ⅰ~Ⅱ期)POP患者(年龄45~65岁)共计165例为研究对象,采用生殖衰老分期系统(STRAW+10)将其分为绝经前期组(45例)、绝经早期组(62例)、绝经晚期组(58例)。指导患者进行盆底肌锻炼(PFMT),分别干预12周,通过POP-Q分期、PERFECT法盆底评估、盆底肌电评估(Glazer法)、盆底B超及POP量表(PFDI-20、PFIQ-7)及其分量表评估,比较PFMT干预前、后的治疗情况。结果:(1)3组总体客观治愈率为58.33%(7/12),总体主观治愈率为94.55%(156/165)。(2)POP-Q分期:与干预前比较,3组的POP-Q分期差异无统计学意义(P>0.05),绝经早期组中Aa点位置有所上升(P<0.05),绝经晚期组中Ba点位置有所上升(P<0.05)。(3)PERFECT盆底评估:PFMT干预后3组患者的肌力、耐力、重复收缩力、快速收缩力均较干预前有所提升(P<0.05)。(4)Glazer法:3组干预后患者的盆底肌电前静息、后静息值均较干预前降低(P<0.05),绝经早期组和绝经晚期组中,干预后患者的盆底肌电Ⅱ类肌、Ⅰ类肌及耐力值均较干预前升高(P<0.05)。(5)盆底超声检查:3组的静息状态下肛提肌裂孔面积(rLHA)和Valsalva状态下肛提肌裂孔面积(vLHA)均较干预前减少(P<0.05);绝经晚期组各项超声指标均较干预前减小(P<0.05);(6)量表评估:3组PFDI-20总分及其分量表评分均较干预前下降(P<0.05),绝经前期组和绝经晚期组PFIQ-7总分下降(P<0.05)。结论:PFMT没有改善轻度POP患者的POP-Q分期情况,但有助于绝经早期、绝经晚期患者阴道壁Aa、Ba指示点解剖位置的上升;PFMT能总体有效缓解不同绝经状态下轻度POP女性盆底相关症状,及盆底支持结构的稳定性、盆底肌力,提高其生活质量。Objective: To evaluate the effects of pelvic floor muscle training on pelvic floor function in women with mild pelvic organ prolapse( POP) in different menopausal states. Methods: A total of 165 middle-aged and elderly female patients( 45-65 years old) with mild( stage Ⅰ-Ⅱ) pelvic organ prolapse who were treated in the pelvic floor center of Shanghai Fifth People’s Hospital Affiliated to Fudan University from January 2020 to January2021 were included. The patients were divided into three groups using STRAW + 10,including premenopausal group( n = 45),early menopausal group( n = 62) and late menopausal group( n = 58). The subjects were instructed to perform pelvic floor muscle training( PFMT) for 12 weeks. The treatment before and after PFMT intervention was compared through POP-Q staging,PERFECT pelvic floor assessment,pelvic floor electromyography assess-ment,pelvic floor ultrasound examination and POP-related scales( PFDI-20,PFIQ-7). Results:(1)The overall objective cure rate was 58. 33%( 7/12),and the overall subjective cure rate was 94. 55%( 156/165).(2)Compared with that before intervention,there was no significant difference in POP-Q staging among the three groups( P >0. 05). Point Aa in the early menopausal group was significantly elevated( P < 0. 05),while point Ba in the late menopausal group was significantly elevated( P < 0. 05).(3) PERFECT pelvic floor evaluation showed that after PFMT intervention,the muscle strength,endurance,repetitive contraction strength and rapid contraction strength of the 3 groups were improved compared with those before intervention( P < 0. 05).(4)The results of Glazer method showed that in 3 groups,the pre-EMG and post-EMG values of pelvic floor patients after PFMT intervention were lower than those before intervention( P < 0. 05). In the early menopausal group and the late menopausal group,there were statistically significant differences in the type Ⅱ pelvic floor muscle potential,type I pelvic floor muscle potential and endurance values after PFMT intervention compa

关 键 词：盆底肌锻炼 盆底功能障碍性疾病 生殖衰老分期 不同绝经状态 

分 类 号：R711.2[医药卫生—妇产科学]