产后早期静力性收缩训练联合神经肌肉电刺激治疗产后腹直肌分离的疗效研究  

Clinical effects of early postpartum static contraction training combined with neuromuscular electrical stimulation in the treatment of postpartum diastasis recti abdominis

作　　者：谢丹丹 巩尊科 樊莉琳[2] 张彩侠[2] Xie Dandan;Gong Zunke;Fan Lilin;Zhang Caixia(The Second Clinical Medical College of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China;Department of Postpartum Health Care,Huai'an Maternal and Child Health Care Hospital,Huai'an 223001,Jiangsu Province,China)

机构地区：[1]徐州医科大学第二临床医学院,徐州221000 [2]淮安市妇幼保健院产后保健科,淮安223001

出　　处：《中华妇幼临床医学杂志（电子版）》2022年第3期357-365,共9页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：江苏省妇幼健康科研项目(F201707)。

摘　　要：目的探讨产后早期(产后4~6周)静力性收缩训练(SCT)联合神经肌肉电刺激(NES),对产后腹直肌分离(DRA)产妇的疗效。方法选择2018年1月至2021年10月,江苏淮安市妇幼保健院收治的90例产后DRA产妇为研究对象。采用随机数字表法,将其随机分为研究组(n=45)与对照组(n=45)。于产后早期,对研究组产妇DRA采取SCT联合NES治疗;而对照组产妇仅采取NES治疗。2组产妇治疗第2、4、6周时的腹围、双侧腹直肌间距(IRD),盆底Ⅰ、Ⅱ类肌纤维肌电压值,产妇腰、背部疼痛的视觉模拟评分量表(VAS)评分比较,采用重复测量资料方差分析,治疗不同时间点上述指标两两比较,采用最小显著性差异(LSD)-t检验。本研究遵循的程序获得江苏淮安市妇幼保健院医学伦理委员审核批准(审批文号:201806),征得受试者知情同意,并与其签署临床研究知情同意书。结果①2组产妇本次分娩孕龄、剖宫产术分娩比例、孕期体重增加值、第一与第二产程持续时间、新生儿出生体重≥4000 g占比,产次、剖宫产次数≥2次占比,以及治疗前人体质量指数(BMI)≥24 kg/m^(2)占比、腹围、双侧IRD等临床资料比较,差异均无统计学意义(P>0.05)。②对2组DRA产妇治疗第2、4、6周时,腹围和双侧IRD,经重复测量资料方差分析结果显示,不同治疗措施与时间因素交互效应,均无统计学意义(F_(治疗×时间)=4.214、2.193,P_(治疗×时间)=0.062、0.241)。进一步对DRA治疗措施的主效应分析结果显示,不同治疗措施对产后DRA产妇治疗不同时间点的腹围、双侧IRD的主效应,均有统计学意义(F_(治疗)=6.874、8.291,P_(治疗)=0.032、0.012),研究组产妇治疗不同时间点的腹围、双侧IRD总体较对照组分别偏小4.1 cm(95%CI:1.2~5.3 cm,P<0.05)与偏短0.17 cm(95%CI:0.06~0.31 cm,P<0.05)。对时间因素的主效应分析结果显示,时间因素对产后DRA产妇治疗不同时间点的腹围、双侧IRD的主效应均有统计Objective To explore therapeutic effects of early postpartum(4-6 weeks postpartum)static contraction training(SCT)combined with neuromuscular electrical stimulation(NES)in the treatment of parturients with postpartum diastasis recti abdominis(DRA).Methods A total of 90 cases of postpartum DRA parturients who were admitted to Huai'an Maternal and Child Health Care Hospital from January 2018 to October 2021 were selected into this study.They were randomly divided into study group(n=45)and control group(n=45)by random number table method.At 4-6 weeks of early postpartum,parturients in study group were treated with SCT combined with NES,while parturients in control group were only treated with NES.Abdominal circumference,bilateral inter-recti distance(IRD),voltage values of type Ⅰ and Ⅱ muscle fiber of pelvic floor and visual analogue scale(VAS)scores of waist and back pain in two groups at the 2nd,4th and 6th week of treatment were compared by variance of repeated measurement data method.Least significant difference(LSD)-t test was used for pairwise comparison of the above indicators at different time points.This study was approved by the ethics committee of Huai'an Maternal and Child Health Care Hospital(Approval No.201806),and informed consent for clinical research was signed with all subjects.Results①There were no significant differences between two groups in general clinical data,such as gestational age of delivery,proportion of cesarean section,weight gain during pregnancy,duration of the first and second stage of labor,proportion of neonatal birth weight≥4000 g,parity,proportion of cesarean section more than twice,and proportion of body mass index(BMI)≥24 kg/m^(2),abdominal circumference and bilateral IRD before treatment(P>0.05).②Analysis of variance of repeated measurement data of abdominal circumference and bilateral IRD of two groups at the 4th and 6th weeks of treatment showed that there were no statistical difference in interaction effects between different treatment measures and time factors

关 键 词：腹直肌 腹直肌分离 静力性收缩训练 电刺激疗法 神经肌肉电刺激 腹围 产后期 女(雌)性 

分 类 号：R714.6[医药卫生—妇产科学]