产后盆底肌功能筛查对盆底功能障碍性疾病的诊断价值  

Diagnostic value of postpartum pelvic floor muscle function screening on pelvic floor dysfunction

作　　者：秦媚[1] 姚波[2] 游坤[3] QIN Mei;YAO Bo;YOU Kun(School of Nursing,Guangxi Medical College,Nanning 530022,Guangxi,China;Information Center,Guangxi Medical College,Nanning 530022,Guangxi,China;School of Basic Medicine,Guangxi Medical College,Nanning 530022,Guangxi,China)

机构地区：[1]广西卫生职业技术学院护理学院,广西南宁市530022 [2]广西卫生职业技术学院信息中心,广西南宁市530022 [3]广西卫生职业技术学院医学基础学院,广西南宁市530022

出　　处：《广西医学》2023年第12期1427-1431,1448,共6页Guangxi Medical Journal

基　　金：广西高校中青年教师科研基础能力提升项目(2021KY1365);广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20170767)。

摘　　要：目的分析产后盆底肌功能筛查对盆底功能障碍性疾病(PFD)的诊断价值。方法纳入845例接受产后随访和盆底肌功能筛查的产妇,根据产后是否发生PFD,将其分为PFD组(n=647)和非PFD组(n=198)。比较两组产妇的一般资料及盆底肌功能筛查结果(盆底肌力分级及盆底表面肌电图检查参数)。采用决策树模型分类回归树法分析产后发生PFD的影响因素及构建诊断模型,并通过增益图、索引图评价模型的状态。结果最终构建的决策树模型共包含4层,筛选出5个解释变量,分别为分娩方式、快肌阶段最大值、盆底肌力、慢肌阶段平均值、前静息阶段平均值,其中阴道分娩是产后发生PFD的主要危险因素(P<0.05)。此外,盆底肌力≤2级、慢肌阶段平均值≤13.85μV、前静息阶段平均值>12.6μV的阴道分娩者产后发生PFD的概率更高(均P<0.05);而对于剖宫产者,快肌阶段最大值≤37.8μV时产后发生PFD的概率更高(P<0.05)。结论结合分娩方式,盆底肌功能筛查(盆底肌力分级和盆底表面肌电图检查参数)可为产后PFD的诊断提供有力依据。临床医师应重点关注盆底肌力≤2级、慢肌阶段平均值≤13.85μV、前静息阶段平均值>12.6μV的阴道分娩者,以及快肌阶段最大值≤37.8μV的剖宫产者,尽早给予盆底肌锻炼以预防PFD的发生。Objective To analyze the diagnostic value of postpartum pelvic floor muscle function screening on pelvic floor dysfunction(PFD).Methods A total of 845 puerpera receiving postpartum follow-up and pelvic floor muscle function screening were enrolled,and they were assigned to PFD group(n=647)or non-PFD group(n=198)according to the presence of suffering from postpartum PFD.The general data and results of pelvic floor muscle function screening in terms of pelvic floor muscle strength classification and examination parameters of pelvic floor surface electromyography were compared between puerpera of the two groups.The decision tree model classification regression tree method was used to analyze the influencing factors for occurrence of postpartum PFD,and to establish the diagnostic model.The model status was evaluated through the gain chart and key plan.Results The final established decision tree model consisted of four layers,and five explanatory variables were screened out,which were delivery method,the maximum value of fast muscle stage,pelvic floor muscle strength,average value of slow muscle stage,and average value of pre-resting stage,therein vaginal delivery was the main risk factor for the occurrence of postpartum PFD(P<0.05).In addition,puerpera in vaginal delivery with pelvic floor muscle strength≤grade 2,average value of slow muscle stage≤13.85μV,average value of pre-resting stage>12.6μV were at a higher probability of the occurrence of postpartum PFD(all P<0.05),whereas puerpera in Cesarean section with the maximum value of fast muscle stage≤37.8μV were at a higher probability of suffering from postpartum PFD(P<0.05).Conclusion combining with the delivery methods,pelvic floor muscle function screening(pelvic floor muscle strength classification and examination parameters of pelvic floor surface electromyography)can provide a strong basis for the diagnosis of postpartum PFD.Clinicians should place emphasis on vaginal delivery puerpera with pelvic floor muscle strength≤grade 2,average value of slow

关 键 词：盆底功能障碍性疾病 盆底肌功能筛查 盆底肌力 表面肌电图检查 诊断价值 决策树模型 

分 类 号：R71[医药卫生—妇产科学]