分娩镇痛对初产妇盆底肌功能、盆底肌状态和疼痛的研究  

Study of labor analgesia on primipara pelvic floor muscle function,pelvic floor muscle status and pain

作　　者：贾志[1] 李丽 刘海艳[1] 王黎明 刘群[1] 曹净净 朱永宁[2] Jia Zhi;Li Li;Liu Haiyan;Wang Liming;Liu Qun;Cao Jingjing;Zhu Yongning(Department of Anesthesiology,Affiliated Hospital of Jining Medical College,Jiningg272100,China;Department of Obstetrics,Affiliated Hospital of Jining Medical College,Jining 272100,China)

机构地区：[1]济宁医学院附属医院麻醉科,济宁272100 [2]济宁医学院附属医院产科,济宁272100

出　　处：《中国医师进修杂志》2024年第8期742-746,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨分娩镇痛对初产妇经阴分娩产后盆底肌肉功能的保护作用。方法回顾性选择2022年3—8月济宁医学院附属医院收治的140例经阴分娩初产妇作为研究对象,按照产妇分娩意愿分为对照组(采用常规分娩)和观察组(采用无痛分娩),每组70例。比较两组分娩过程中的疼痛程度、产后6周时盆底肌功能评分和盆底肌状态及产后3个月时女性性功能量表(FSFI)评分和产后主述症状。结果观察组胃窦排空即刻、饮用碳水化合物后(5、30、60、120 min)、宫口全开时视觉模拟量表(VAS)评分均低于对照组,差异有统计学意义(P<0.05)。产后6周时观察组盆底肌最大肌电压、盆底肌持续收缩60 s平均肌电压高于对照组[(20.97±2.64)μV比(17.31±2.48)μV、(17.33±3.01)μV比(13.42±2.77)μV],膀胱颈移动度、静息状态下肛提肌裂孔面积低于对照组[(27.15±3.55)mm比(31.05±4.75)mm、(9.97±2.12)cm2比(11.57±2.84)cm2],差异均有统计学意义(P<0.05)。产后6周时观察组静态前阶段评分、静态后阶段评分、Ⅰ型肌纤维、Ⅱ型肌纤维、总分均高于对照组[(67.21±12.54)分比(54.17±10.84)分、(69.12±14.11)分比(56.47±11.24)分、(63.54±11.45)分比(50.97±10.74)分、(57.15±8.15)分比(49.76±6.44)分、(64.25±12.14)分比(57.84±20.57)分],差异有统计学意义(P<0.05)。产后3个月时观察组FSFI各项评分均高于对照组,差异有统计学意义(P<0.05)。观察组产后主述出现漏尿、发热、褥汗比例均低于对照组[22.86%(16/70)比40.00%(28/70)、15.71%(11/70)比30.00%(21/70)、30.00%(21/70)比47.14%(33/70)],差异有统计学意义(χ^(2)=4.77、4.05、4.34,P<0.05)。结论分娩镇痛在初产妇的经阴分娩中能有效缩短产程,减轻分娩疼痛,对盆底肌肉功能有保护作用。Objective:To explore the protective effect of labor analgesia on pelvic floor muscle function of primipara after vaginal delivery.Methods:A total of 140 cases of primipara with vaginal delivery admitted to the Affiliated Hospital of Jining Medical College from March to August 2022 were selected retrospectively,and they were divided into control group(routine delivery)and observation group(painless delivery)according to the intention of delivery,each group with 70 cases.Labor pain,pelvic floor muscle function score and pelvic floor muscle status at 6 weeks postpartum,Female Sexual Function Scale(FSFI)score at 3 months postpartum and reported postpartum symptoms were compared between the two groups.Results:The scores of Visual Analogue Scale(VAS)at immediately after gastric antral empting,after drinking carbohydrates(5,30,60,120 min)and at full opening of uterine orifice in the observation group were lower than those in control group,there were statistical differences(P<0.05).At 6 weeks postpartum,the maximum muscle voltage of pelvic floor muscle and the average muscle voltage of continuous contraction of pelvic floor muscle for 60 s in the observation group were higher than those in control group:(20.97±2.64)μV vs.(17.31±2.48)μV,(17.33±3.01)μV vs.(13.42±2.77)μV;the mobility of bladder neck and the hiatus area of levator anal muscle in resting state in the observation group were lower than those in the control group:(27.15±3.55)mm vs.(31.05±4.75)mm,(9.97±2.12)cm 2 vs.(11.57±2.84)cm 2,there were statistical differences(P<0.05).At 6 weeks postpartum,the scores of static pre-stage,static post-stage,typeⅠmuscle fiber,typeⅡmuscle fiber and total scores in the observation group were higher than those in the control group:(67.21±12.54)scores vs.(54.17±10.84)scores,(69.12±14.11)scores vs.(56.47±11.24)scores,(63.54±11.45)scores vs.(50.97±10.74)scores,(57.15±8.15)scores vs.(49.76±6.44)scores,(64.25±12.14)scores vs.(57.84±20.57)scores,there were statistical differences(P<0.05).At 6 weeks postpartum,t

关 键 词：分娩 生产 镇痛 产科 骨盆底疾病 产褥期疾病 

分 类 号：R714.3[医药卫生—妇产科学]