目的 探讨孕期盆底肌锻炼联合产后盆底功能康复治疗对产后女性盆底功能障碍的防治效果。方法 选取2019年1月—2020年6月在我院产科门诊定期产检,B超确认为单胎足月顺产,剔除妊娠合并症及并发症,符合入组标准病例共316例,随机分成观察组和对照组,观察组131例,对照组185例,观察组在孕12周开始宣教孕期定期行盆底肌Kegel运动,并在产后42天开始行盆底康复治疗仪治疗6周,统计临床疗效,2组均在产后42天、3个月、6个月统计2组盆底功能检测、盆底器官脱垂(pelvic organ prolapse,POP)和压力性尿失禁(stress urinary incorrtinence,SUI)发生情况。结果 观察组和对照组一般资料,2组在年龄、分娩孕周、新生儿平均体重无统计学差异(P＞0.05),2组盆底功能进行检测比较,产后42天观察组阴道收缩持续时间、Ⅱ类肌纤维强度(85.24±22.19 cmH₂O)高于对照组(74.14±19.94 cmH₂O),差异具有统计学意义(P＜0.05),产后3月观察组I类肌纤维强度、阴道收缩持续时间、Ⅱ类肌纤维强度(76.41±16.42 cmH₂O;4.35±1.78 s;94.15±18.25 cmH₂O)高于对照组(62.45±17.55 cmH₂O;3.89±1.52 s;88.55±18.36 cmH₂O),差异具有统计学意义(P＜0.05),产后6月观察组I类肌纤维强度、阴道收缩持续时间、Ⅱ类肌纤维强度(79.56±15.78 cmH₂O;5.46±2.01 s;99.78±23.47 cmH₂O)明显高于对照组(67.63±14.45 cmH₂O;4.13±1.45 s;90.16±18.75 cmH₂O),差异具有统计学意义(P＜0.05)。对比2组POP和SUI发生率情况,产后42天观察组SUI发生率(28.24%)低于对照组(35.14%),差异具有统计学意义(P＜0.05);产后3月观察组POP和SUI发生率(18.32%;13.74%)低于对照组(22.70%;17.83%),差异具有统计学意义(P＜0.05),产后6月观察组POP和SUI发生率(0.00%;0.07%)明显低于对照组(8.10%;11.89%),差异具有统计学意义(P＜0.05)。 结论 孕期行盆底肌锻炼联合产后盆底功能康复治疗能明显改善产后盆底功能状态,显著降低产后盆底功能障碍性疾病的发生率。

Objective To explore the prevention and treatment effect of pelvic floor muscle exercise during pregnancy combined with postpartum pelvic floor function rehabilitation therapy on postpartum pelvic floor dysfunction in women. Methods From January 2019 to June 2020, women in our hospital's obstetrics outpatient department for regular obstetric checkups were selected, which ultrasound confirmed it was a singleton full-term delivery. The cases of stillbirth, fetal malformation and placenta previa were excluded. A total of 316 cases met the inclusion criteria and were randomly divided into the observation group and the control group, with 131 cases in the observation group and 185 cases in the control group. Observation group started regular pelvic floor muscle Kegel exercises from 12 weeks of gestation,and accepted pelvic floor rehabilitation therapeutic treatment from 42 days to six weeks postpartum. We summerized the pelvic floor function tests results, pelvic organ prolapse (POP) and stress urinary incontinence (SUI) situation of both groups in 42 days, 3 months and 6 months postpartum. Results The general information of the observation group and the control group showed that there were no statistical differences in age, gestational age of delivery and average weight of newborn (P>0.05). The pelvic floor function 42 days after delivery of the two groups was tested and compared, duration of vaginal contraction and class Ⅱ muscle fiber strength of the observation group [(85.24±22.19) cmH₂O] was significantly higher than that of the control group [(74.14±19.94) cmH₂O], and the difference was statistically significant (P＜0.05). Class I muscle fiber strength, duration of vaginal contraction and class Ⅱ muscle fiber strength were observed at 3 months postpartum, those of observation group[(76.41±16.42) cmH₂O; (4.35±1.78) s; (94.15±18.25) cmH₂O] were significantly higher than that in the control group [(62.45± 17.55) cmH₂O; (3.89±1.52) s; (88.55±18.36) cmH₂O], and the difference were statistically significant (P<0.05). At 6 months postpartum, class I muscle fiber strength, vaginal contraction duration and class Ⅱ muscle fiber strength in observation group [(79.56±15.78) cmH₂O; (5.46±2.01) s; (99.78±23.47) cmH₂O] were significantly higher than that of the control group [(67.63±14.45) cmH₂O; (4.13± 1.45) s; (90.16±18.75) cmH₂O], and the difference were statistically significant (P<0.05). Comparison of the incidence of POP and SUI between the two groups showed that the incidence of SUI in the observation group at 42 days postpartum (28.24%) was significantly lower than that in the control group (35.14%), the difference was statistically significant (P＜0.05). The incidences of POP and SUI in the observation group at 3 months postpartum (18.32%; 13.74%) were significantly lower than that of the control group (22.70%; 17.83%), the difference were statistically significant (P＜0.05). The incidences of POP and SUI in the observation group at 6 months postpartum (0.00%; 0.07%) were significantly lower than that of the control group (8.10%; 11.89%), the difference were statistically significant (P＜0.05). Conclusion Pelvic floor muscle exercise during pregnancy combined with postpartum pelvic floor function rehabilitation therapy can significantly improve postpartum pelvic floor function and significantly reduce the incidence of postpartum pelvic floor dysfunction diseases.

目的 探讨选择性会阴侧切术对会阴体及产后盆底功能的影响。方法 选取2018年1月—2019年12月在广州市红十字会医院顺产的初产妇作为研究对象,研究组为选择性会阴侧切组、对照组为常规治疗,统计两组的会阴裂伤情况,盆底Ⅰ类肌、Ⅱ类肌肌力分级,POPQ评分的分级,肛提肌裂孔扩张情况。结果 会阴裂伤率:研究组2.5%,对照组为56.22%,连续性校正χ²为53.14,连续性校正P＜0.05。盆底Ⅰ类、Ⅱ类肌力＜3级发生率:研究组分别为30%、23%,对照组分别为 49%、38%,χ²分别为9.03、5.96,P＜0.05。POPQ 0级率:研究组26.25%,对照组12.5%,χ²为4.84,P＜0.05。肛提肌裂孔无扩张率:研究组16.25%,对照组为5%,χ²为5.33,P＜0.05。结论 在本研究中,与对照组相比,研究组会阴裂伤率、盆底肌力<3级发生率更低;盆腔器官无脱垂率、肛提肌裂孔无扩张率更高。选择性会阴侧切术对会阴体及盆底功能具有保护作用。

Objective To investigate the effect of selective lateral episiotomy on perineal body and pelvic floor function. Methods The primiparas who delivered naturally in Guangzhou Red Cross Hospital from January 2018 to December 2019 were selected as the research subjects. The research group were given selective lateral episiotomy, while the control group were given conventional treatment. The incidence of perineal laceration, pelvic floor muscle strength lower than grade 3, the POPQ score and levator ani hiatus dilatation were analyzed. Chi-square test was used to analyze the incidence of the two groups. Results The incidence of perineal laceration in the research group was 2.5% vs 56.22% in the control group(χ²=53.14, P<0.05). The incidence of pelvic floor muscle(group I) strength lower than grade 3 in the research group was 30% vs 49% in the control group(χ²=9.03, P<0.05). The incidence of pelvic floor muscle(group II) strength lower than grade 3 in the research group was 23% vs 38% in the control group(χ²=5.96, P<0.05). The rate of the incidence of POPQ 0 in the research group was 26.25% vs 12.5% in the control group (χ²=4.84,P＜0.05). The incidence of levator ani hiatus dilatation in the research group was 16.25%, while 5% in the control group (χ²=5.33, P<0.05). Conclusion Compared with conventional treatment group, selective lateral episiotomy group has a lower incidence of perineal laceration and pelvic floor muscle strength lower than grade 3. Selective lateral episiotomy group has a higher incidence of POPQ 0 and no levator ani hiatus dilatation. Selective lateral episiotomy can protect the perineal body and pelvic floor function.

目的 探讨自由体位分娩方式和传统体位分娩方式对产后盆底功能的影响。方法 2015年3月—2016年3月在广州市妇女儿童医疗中心定期产检并分娩单胎初产阴道分娩610例产妇,按分娩方式分为自由体位分娩298例为实验组,传统体位分娩312例为对照组,对两组产妇会阴损伤,产后6～8周筛查盆底肌力,探讨不同体位分娩方式对产后盆底肌力的影响。结果 实验组阴道静息压,阴道收缩压、Ⅰ类肌纤维强度、 Ⅱ类肌纤维强度、阴道收缩持续时间均较对照组有增加,差异性均有统计学意义(P<0.05)。结论 自由体位分娩方式不降低产后盆底肌力,对产后盆底有保护作用。

Objective To analyze the effects of liberal intrapartum postures on the pelvic floor function of postpartum. Methods 610 pregnant women (vaginal delivery,single birth,and head position) were classified and analyzed in Guangzhou Women and Children Medical Center from March 2015 to March 2016. All the pregnant women were mature without pregnancy complications; 298 pregnant women who adopted free posture delivery were selected as observation group,312 pregnant women who adopted traditional posture delivery were selected as control group. We counted the number of perineal injury incidence of the two group,and the pelvic floor strength of the two groups was measured after fetal birth after 6 to 8 weeks. Results We compared the vaginal resting pressure(VRP),vaginal squeezing pressure(VSP),classⅠfiber strength, class Ⅱ fiber strength and the time of vaginal contraction between the two groups. Pelvic floor muscle strength was significantly stronger in the observation group than that in the control group (P<0. 05). Conclusion There is a closely association between the different intrapartum postures and the pelvic floor function of postpartum. Adopting free posture delivery has no adverse impact on pelvic floor function of postpartum, which can protect the function of female pelvic floor.