2种不同分娩方式对初产妇近期盆底组织功能的影响研究

目的探讨2种不同分娩方式对产后早期盆底功能的影响。方法随机选择58例产妇,按不同分娩方式分为选择性剖宫产组（26例）和经阴道顺产组（32例）。分别于产后6～8周行问卷调查,采用女性尿失禁症状、子宫脱垂发生情况调查问卷,同时行POP-Q评分、尿垫试验、超声检测残余尿以及会阴超声检查,比较2组产妇压力性尿失禁（SUI）、盆腔器官脱垂（POP）的发生率及膀胱颈移动度情况,并采用盆底肌力检测法进行评价盆底肌力。结果产后6～8周时,SUI发生率选择性剖宫产组为3.85%（1/26）,顺产组18.75%（6/32）,差异无统计学意义（P〉0.05）。POP发生率选择性剖宫产组为19.23%（5/26）,较顺产组的46.88%（15/32）低,差异有统计学意义（P〈0.05）。经会阴超声结果显示,选择性剖宫产组膀胱颈角度（80.32±8.06）°与顺产组（94.11±12.73）°比较,及膀胱颈旋转角度（16.72±7.19）°与（26.63±10.05）°比较,差异有统计学意义（P〈0.05）。盆底肌力检测法结果显示选择性剖宫产组分别为≤3分19.2%（5/26）,≥4分80.8%（21/26）;阴道分娩组≤3分50%（16/32）,≥4分50%（16/32）。2组之间比较有统计学意义（P〈0.05）。结论选择性剖宫产可降低产后早期POP的发生率,并可减少发生SUI的风险。

The Effects of Two Different Delivery Methods onthe Pelvic Floor Muscle Strength of the Primipara in the Early Post Partum

Objective To explore the effect of different delivery methods on the pelvic floor muscle strength in the early post partum.Methods The 58 pregnant women were randomly selected and were allocated into two groups,elective caesarean section group and vaginal delivery group. In 6～8 weeks after childbirth, they were respectively given POP-Q scoring, protective pad experimenting, ultrasonic testing of residual urine and perineum ultrasound examination.An analysis on their occurrence of SUI and POP and bladder neck mobility was carried out.Pelvic floor muscle strength testing method was used to evaluate pelvic floor muscle strength according to the comparative study carried out at 0～51.Results Followed up in 6～8 weeks after childbirth, the proportion of occurrence of stress urinary incontinence was respectively 3.85%（1/26）in elective caesarean section group, and18.75%（6/32）in vaginal delivery group.There was no significant difference between two groups（P〉0105）.The proportion of occurrence of pelvic organ prolapse was respectively 19.23%（5/26）in elective caesarean section group, lower than that 46.88% （15/32）in vaginal delivery group,the differences having statistical significance（P〈0.05）.The perineum ultrasound examination in 6～8 weeks after childbirth showed that there was significant difference between two groups when comparing the bladder neck angle（80.32±8.06）°vs（94.11±12.73）°and the bladder neck rotation angle（16.72±7.19）°vs（26.63±10.05）°（P〈0.05）. The scores of floor muscle strength testing ≤3in selective cesarean section group was 19.2% （5/26）,≥4was 80.8%（21/26）;the scores of floor muscle strength testing≤3 in vaginal delivery group was 50%（16/32）,≥4was 50% （16/32） .There was significant difference between two groups（P〈0.05）.Conclusion Two delivery methods both impact on early post partum pelvic floor muscle strength, cesarean section may reduce the impact of pelvic floor muscle strength at a certain extent compared with vaginal delivery, but selective cesarean section is not the best solution to terminate pregnancy; all the women after pregnancy and delivery should do the pelvic floor function recovery training as soon as possible, in order to reduce the female pelvic floor dysfunction disease （PFD）incidence,or delay its onset age.