分娩方式对初产妇产后盆底功能状态的影响  

Effect of delivery mode on postpartum pelvic floor function in primiparous women

作　　者：谭秋晓 叶俊彤 何云霞 贺娟 李娟华 李田[1] Tan Qiuxiao;Ye Juntong;He Yunxia;He Juan;Li Juanhua;Li Tian(Department of Gynecology,the Seventh Affiliated Hospital of Sun Yat-sen University,Shenzhen 518107,China)

机构地区：[1]中山大学附属第七医院妇科,深圳518107

出　　处：《新医学》2023年第12期889-894,共6页Journal of New Medicine

基　　金：广东省自然科学基金(2018A030313735)。

摘　　要：目的 评估以不同方式分娩的初产妇在产后2年内的盆底功能状态。方法 纳入妇科门诊盆底中心就诊的初产妇,根据分娩方式分为阴道分娩组和剖宫产组,收集2组初产妇的一般资料,完善盆腔脏器脱垂评分(POP-Q)、盆底肌力和肌电分析,评估患者慢性盆腔痛、排尿排便情况,同时完善盆腔脏器脱垂/尿失禁性功能问卷(PISQ-12)、尿失禁生活质量问卷(I-QOL)、盆底功能障碍问卷(PFDI-20)和抑郁自评量表(SDS),比较阴道分娩组和剖宫产分娩的初产妇在盆底解剖结构改变以及临床症状表现的差异。结果 本研究共纳入521例初产妇,其中阴道分娩402例,剖宫产119例。阴道分娩组初产妇在阴道前壁POP-Q、子宫POP-Q、Ⅰ类肌力、Ⅱ类肌力以及前静息、Ⅰ类肌电、Ⅱ类肌电、后静息水平均低于剖宫产组初产妇(P均<0.05)。与剖宫产组初产妇比较,阴道分娩组初产妇的SUI者比例较高、I-QOL评分较低(P均<0.05)。2组慢性盆腔痛、排便障碍、性功能障碍、抑郁状态等比较差异均无统计学意义(P均> 0.05)。结论 阴道分娩可能是引起初产妇产后POP以及SUI发病率升高的危险因素。临床上应重视对初产妇进行早期产后盆底康复性锻炼或治疗干预,尤其需要关注其排尿功能的变化。Objective To evaluate the pelvic floor functional status of primiparous women undergoing different delivery modes within 2 years postpartum.Methods Primiparous women admitted to the Pelvic Floor Center of Department of Gynecology were enrolled in this study.All participants were divided into the vaginal delivery and cesarean section groups according to the delivery mode.General clinical data were collected.Pelvic Organ Prolapse Quantification(POP-Q),pelvic floor muscle strength and electromyographic analysis were performed.Chronic pelvic pain,urinary and bowel function were evaluated.The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12(PISQ-12),Incontinence Quality of Life Questionnaire(I-QOL),Pelvic Floor Distress Inventory-20(PFDI-20),and Self-Rating Depression Scale(SDS)were performed.The differences in pelvic floor anatomy and clinical symptoms in primiparous women were assessed between the vaginal delivery and cesarean section groups.Results A total of 521 primiparous women completed the survey,including 402 cases undergoing vaginal delivery and 119 receiving cesarean section.Primiparous women who underwent vaginal delivery had lower levels of anterior vaginal wall POP-Q,uterine/cervix POP-Q,ClassⅠmuscle strength,ClassⅡmuscle strength,pre-rest,ClassⅠelectromyography,ClassⅡelectromyography,and post-rest compared with those who underwent cesarean section(all P<0.05).Moreover,primiparous women who had vaginal delivery were more prone to experiencing stress urinary incontinence(SUI)and lower I-QOL score compared with those receiving cesarean section(both P<0.05).In terms of clinical manifestations such as chronic pelvic pain,bowel disorders,sexual dysfunction,and depressive status,there were no significant differences observed between two groups(all P>0.05).Conclusions Vaginal delivery may be a risk factor for the increased incidence of postpartum pelvic organ prolapse(POP)and SUI in primiparous women.In clinical practice,early postpartum pelvic floor rehabilitation exercises or interv

关 键 词：分娩方式 盆腔脏器脱垂 盆腔脏器脱垂评分 盆底肌力分析 盆底肌电分析 压力性尿失禁 

分 类 号：R714.3[医药卫生—妇产科学]