基于信息化管理平台的延续护理对产妇盆底功能康复的影响

目的 探讨基于信息化管理平台的延续护理对产妇盆底功能康复的影响.方法 将134例自然分娩的产妇按照意愿分为观察组(n=67名)和对照组(n=67名),两组住院期间按常规进行产后护理,并由责任护士指导产妇行盆底功能训练.出院后对照组由专人负责进行电话随访,每2周1次,连续3个月;观察组出院后开展基于信息化管理平台的延续护理.干预前和干预后3个月评价产妇盆底肌力、盆底肌电位及盆底功能障碍得分情况.结果 干预后,两组Ⅰ、Ⅱ类盆底肌纤维力和肌电位显著改善,且观察组显著优于对照组(均P＜0.01);两组盆底功能障碍评分显著降低,观察组显著低于对照组(均P＜0.01).结论 对产妇实施基于信息化管理平台的延续护理,可以提升产妇盆底肌力和肌电位,有效改善其盆底功能.     

生物反馈盆底肌肉锻炼在产妇产后盆底功能康复治疗中的应用

目的探讨生物反馈盆底肌肉锻炼在产妇产后盆底功能康复治疗中的应用效果。方法选取2017-02—2018-02间郑州大学第一附属医院收治的100例分娩产妇,根据产后盆底功能康复治疗方法的差异分为2组,每组50例。对照组产妇给予常规盆底肌肉锻炼,观察组产妇在对照组基础上应用生物反馈仪进行康复治疗。结果盆底功能康复治疗2个月,产后102 d时,观察组产妇盆底肌力分级明显高于对照组,盆底肌最大肌电压及盆底肌持续收缩60 s的肌电压均明显高于对照组,产妇的尿道膀胱后角和尿道膀胱连接部的移动度小于对照组,膀胱颈到耻骨联合下缘距离高于对照组。以上指标的差异均有统计学意义(P0.05)。结论对产妇使用生物反馈治疗仪康复治疗,有助于促进产妇产后盆底功能恢复,预防盆底功能障碍性疾病的发生,可显著改善产妇产后的生活质量。     

信息动机行为模型用于子宫切除术患者盆底肌功能锻炼

目的探讨信息-动机-行为模型(IMB)在子宫切除术后患者盆底肌功能锻炼的效果。方法将子宫切除术后患者120例,依据住院时间分为干预组(2016年7~12月)和对照组(2016年1~6月)各60例。对照组按照常规实施盆底功能锻炼;干预组实施基于IMB的盆底肌功能锻炼。结果干预3个月后,干预组患者功能锻炼依从性显著高于对照组,压力性尿失禁发生率显著低于对照组(均P0.01)。结论基于信息-动机-行为模型的功能锻炼能有效提高子宫切除术患者盆底肌功能锻炼依从性,有助于盆底功能的恢复。     

经会阴盆底超声结合MRI评估不同分娩方式对女性盆底功能的研究

目的研究经会阴盆底超声结合MRI评估不同分娩方式对盆底功能的影响。方法选取本院妇产科2020年1月至2021年3月的80例分娩产妇,按照不同分娩方式分成顺产组与剖宫产组,每组40例,两组均行经会阴盆底超声结合MRI检查进行女性盆底功能评估,对比其差异。结果剖宫产组产后1周的肛提肌损伤率低于顺产组,P0.05;剖宫产组静息时、Valsalva状态时的膀胱后角度均小于顺产组,P0.05;剖宫产组产妇产后6周的盆底肌的持续收缩力、最大收缩力均大于顺产组,P0.05。结论不同分娩方式对盆底功能的影响存在明显差异,经会阴盆底超声结合MRI检查有助于准确评估产后女性盆底功能,值得应用。     

全程护理干预对产后抑郁的影响

目的 探讨护理干预对产后抑郁的影响.方法 将180例产妇随机分为干预组和对照组各90例.对照组进行常规护理;干预组在此基础上进行全程护理干预,包括对患者及其家属产前进行健康教育指导,针对健康问题进行评估,制订措施,有针对性给予行为干预和心理疏导;产后进行家居护理,帮助产妇照顾婴儿,提供相关信息等.两组干预后分别采用爱丁堡产后抑郁量表(EPDS)进行调查.结果 干预后产妇EPDS评分显著低于对照组(P＜0.01),抑郁发生率显著低于对照组(P＜0.05).结论 全程护理干预能有效降低产后抑郁的发生.     

盆底康复临床指导对剖宫产后康复效果及并发症的影响

目的探讨盆底康复临床指导对剖宫产后康复效果及并发症的影响。方法选取2016年1月至2017年12月本院接收的80例行剖宫产后患者进行研究。按照随机数表法,将其分为两组。对照组采取常规临床指导措施,观察组采取专业盆底康复临床指导。比较分析两组患者的盆底肌力恢复情况以及并发症发生情况,对患者治疗前后心理状况进行评估。结果观察组产后3个月盆底肌力的恢复情况显著好于对照组,观察组并发症发生率(7.50%)显著低于对照组(60.00%),治疗后,两组患者的SAS、SDS均比治疗前降低,且观察组评分明显比对照组低,差异具有统计学意义(P0.05)。结论盆底康复临床指导应用于剖宫产后患者,不仅可以提高康复效果,改善患者的不良心理状况,也能够降低并发症发生率,临床应用价值较高。     

针刺联合生物反馈治疗女性产后盆底失弛缓综合征

为探讨针刺联合生物反馈治疗女性产后盆底失弛缓综合征的疗效,选取产后42d的产妇进行盆底肌电图及肛管压力测定,评估其盆底功能,将临床便秘症状明显的40例产后盆底失弛缓综合征患者作为观察对象,随机分为治疗组和对照组各20例。对照组患者自己进行提肛锻炼,治疗组在对照组基础上应用针刺联合生物反馈治疗。比较两组在治疗前、后盆底肌力测定数据及临床症状的改善情况。结果显示,两组患者治疗后盆底肌力情况改善不明显;但肛门压力及临床症状得到明显改善,治疗组优于对照组,差异均有统计学意义（P〈0．05）。结果表明,针刺联合生物反馈治疗可有效改善女性产后盆底肛门压力及临床症状,从而提高患者的生活质量。     

盆底肌功能锻炼对会阴切口及盆底肌张力的影响

目的探讨盆底肌功能锻炼对会阴切口的愈合及盆底肌张力恢复的影响。方法将67例经阴道分娩产妇随机分为观察组(37例)和对照组(30例)。观察组采用一对一盆底肌功能锻炼指导,对照组采用常规会阴护理。结果观察组产后第3天会阴切口肿胀及产后第5天疼痛情况显著优于对照组(P<0.01,P<0.05),观察组产后第42天盆底肌张力恢复率显著高于对照组(P<0.05)。结论孕产妇坚持盆底肌功能锻炼,可促进会阴切口的愈合,促进盆底肌张力的恢复。     

盆底康复治疗在不同分娩方式女性中的治疗效果分析

目的研究不同分娩方式对女性盆底功能的影响及盆底康复治疗效果。方法选取2017年6月至2018年6月于南华大学附属第二医院初次妊娠分娩的女性94例为研究对象,其中自然分娩产妇47例(自然分娩组),剖宫产产妇47例(剖宫产组)。两组产妇均在产后6～8周接受早期盆底康复治疗。观察比较两组产妇治疗前后盆底肌群肌力及肌电位。结果两组产妇的年龄及新生儿体重比较均无统计学差异(P0.05)。两组患者盆底康复治疗后均获得不同程度盆底肌力及肌电位的改善,有效率85.11%～95.75%。治疗前剖宫产组Ⅰ类肌群肌力显著高于自然分娩组(P0.05),而Ⅱ类肌群肌力与自然分娩组无统计学差异(P0.05);治疗前剖宫产组肌电位显著高于自然分娩组(P0.05)。治疗后剖宫产组Ⅰ、Ⅱ类肌群肌力及肌电位均显著高于自然分娩组(P0.05)。结论早期盆底康复治疗能有效增强盆底肌群肌力及神经功能,能够促进盆底功能的恢复。自然分娩对盆底肌肉损伤更大。     

延续护理对产妇产褥期心境及自我护理能力的影响

目的探讨延续护理对产妇产褥期心境及自我护理能力的影响。方法将425例健康产妇随机分为观察组(212例)和对照组(213例),观察组实施产后延续护理,采用产后电话随访和上门访视相结合的方式,指导产妇产后自我护理和护理婴儿及协助解决产褥期并发症,并提供心理疏导服务等方法;对照组采用一般随访。结果出院后第30天,观察组负性心境得分显著低于对照组,正性心境得分显著高于对照组;观察组自我护理能力及护理水平较对照组显著升高;观察组大部分产褥期并发症发生率较对照组显著下降(P0.05,P0.01)。结论产后延续护理有利于产妇产褥期心境的改善,有效提升产妇的自我护理能力及护理水平,减少产褥期并发症,提高母婴健康水平。     

Pelvic muscle activity in nulliparous volunteers

The aim of this study was to describe normal characteristics of spontaneous and voluntary pelvic muscle function in nulliparous healthy continent women and to assess the reaction of the pelvic floor to stress and fatigue. Ten nulliparous volunteers were recruited. Pelvic muscle strength was evaluated by palpation and perineal ultrasound. Kinesiological EMG and perineal ultrasound were performed to test for possible fatigue and to assess bladder neck mobility during coughing with a pre-contraction of the pelvic floor muscles. Bladder neck mobility did not increase after attempts to fatigue the pelvic floor muscles. Bladder neck descent was significantly less when the women were instructed to contract the pelvic floor muscles before coughing. The contraction of the pelvic floor muscles stabilizes the vesical neck in nulliparous women.     

Effects of imbalanced muscle loading on hip joint development and maturation

The mechanical loading environment influences the development and maturation of joints. In this study, the influence of imbalanced muscular loading on joint development was studied using localized chemical denervation of hip stabilizing muscle groups in neonatal mice. It was hypothesized that imbalanced muscle loading, targeting either gluteal muscles or quadriceps muscles, would lead to bilateral hip joint asymmetry, as measured by acetabular coverage, femoral head volume and bone morphometry, and femoral‐acetabular shape. The contralateral hip joints as well as age‐matched, uninjected mice were used as controls. Altered bone development was analyzed using micro‐computed tomography, histology, and image registration techniques at postnatal days (P) 28, 56, and 120. This study found that unilateral muscle unloading led to reduced acetabular coverage of the femoral head, lower total volume, lower bone volume ratio, and lower mineral density, at all three time points. Histologically, the femoral head was smaller in unloaded hips, with thinner triradiate cartilage at P28 and thinner cortical bone at P120 compared to contralateral hips. Morphological shape changes were evident in unloaded hips at P56. Unloaded hips had lower trabecular thickness and increased trabecular spacing of the femoral head compared to contralateral hips. The present study suggests that decreased muscle loading of the hip leads to altered bone and joint shape and growth during postnatal maturation. Statement of Clinical Significance: Adaptations from altered muscle loading during postnatal growth investigated in this study have implications on developmental hip disorders that result from asymmetric loading, such as patients with limb‐length inequality or dysplasia. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1128–1136, 2017.

     

Transabdominal ultrasound measurement of pelvic floor muscle activity when activated directly or via a transversus abdominis muscle contraction

AIMS: The purpose of the present study was to compare the effectiveness of instruction to contract the pelvic floor muscles (PFM), the transversus abdominis (TrA), and the TrA + PFM visualized as displacement of the pelvic floor by ultrasound. MATERIALS AND METHODS: Twenty female physical therapists, mean age 41.1 years (range 26-56) participated in the study. A 3.5 MHz 35 mm curved linear array ultrasound transducer (Dornier Medtech) was placed in the mid-sagittal plane immediately suprapubically, angled at 15-30 degrees from the vertical depending on subcutaneous fat and anatomical variations, to image the pelvic floor. Six trials of three maneuvers in random order were performed: contraction of PFM, TrA, and TrA + PFM. RESULTS: In spite of correct contractions assessed by palpation and clinical observation, one subject demonstrated a downward movement of the pelvic floor during PFM contraction on ultrasound. Six subjects (30%) showed a downward movement during a TrA- contraction, and two during the combined TrA + PFM contraction. Instruction to contract PFM produced significantly greater mean displacement: 11.2 mm (95% CI 7.2-15.3) than TrA 4.3 mm (95% CI -0.2-8.8), P < 0.01, and combination: 8.5 mm (95% CI 5.2-12), P = 0.04. Hence, instruction of PFM contraction produced a 61.6% greater displacement of the pelvic floor in the correct direction than a TrA contraction. CONCLUSIONS: It is concluded that ultrasound is a more valid method than palpation and clinical observation to assess PFM function, and that instruction to contract the PFM produces a significantly more effective pelvic floor muscle contraction than instruction to perform a TrA contraction.     

盆底功能障碍性疾病患者盆底肌训练依从性评估的研究进展

介绍了依从性概念、盆底肌训练依从性判断标准，以及对国内外盆底功能障碍性疾病患者盆底肌训练依从性的评估方法，包括主观评估方法、客观评估方法，并对主观评估工具和客观评估工具进行比较分析，以期为医护人员选择合适的评估方法和干预依从性不佳行为提供参考。