产后腹直肌分离的评估与治疗研究进展

腹直肌分离是产后较常出现的并发症,但目前国内产科及康复科从业人员尚未关注到孕妇产后腹直肌分离的诊治,对于其发病率、危险因素、诊断评估及治疗等仍缺少相关数据研究。本文围绕腹直肌分离的评估与治疗,搜索国内外相关文献,总结归纳各种评估及治疗方法,旨在为康复工作提供理论依据,更好地解决产后腹直肌分离的问题,减少孕妇产后痛苦。     

电针配合推拿手法治疗产后腹直肌分离症的疗效观察

目的:观察电针配合推拿手法治疗产后腹直肌分离症的临床效果。方法:选取2012年12月~2017年12月于我院就诊的产后腹直肌分离症患者100例为研究对象,采用随机数字表法将其分为对照组和观察组,各50例。对照组患者进行常规治疗,观察组在常规治疗基础上给予电针配合推拿手法治疗。观察两组患者腹围及腹直肌恢复情况。结果:治疗后,观察组患者腹直肌分离恢复情况优于对照组,腹围低于对照组,P0.05。结论:针对产后腹直肌分离症患者给予电针配合推拿手法治疗,可有效增加患者腹部肌肉弹性和紧张度,促进腹直肌恢复,提高产妇产后生活质量。     

腹部仿生物理疗法在产后腹直肌分离中的效果观察

目的:观察腹部仿生物理疗法在产后腹直肌分离患者中的临床疗效。方法:选取2015年4月~2017年5月我院收治的产后腹直肌分离患者98例,随机分为治疗组和常规组各49例。治疗组予以腹部仿生物理疗治疗,常规组予以自主训练治疗,比较两组患者的临床疗效、腰背部疼痛评分以及腹直肌分离距离。结果:治疗前,两组患者腰背部疼痛评分、腹直肌分离距离比较无显著性差异(P0.05);治疗后,治疗组患者腰背部疼痛评分、腹直肌分离距离显著低于常规组(P0.05);治疗组临床疗效显著高于常规组(P0.05)。结论:仿生物理疗治疗产后腹直肌分离的效果显著,值得临床推广应用。     

基于机器学习算法建立产后腹直肌分离疗效预测模型的研究

<正>腹直肌分离(diastasis rectus abdominis,DRA)是产后最常见疾病之一，其发病率在产后6周可达60%^[1]，二胎及以上产妇产后腹直肌分离的发病率较一胎更高^[2]。腹直肌分离若不及时治疗，不仅可导致产后体态不良，亦可导致腰骶骨盆区长期慢性疼痛，甚至脐疝等更为严重后果^[3—5]。随着国家政策的引导及妇女对产后生活质量的要求，产后腹直肌分离的有效治疗将成为产后康复的重要任务。     

核心训练联合筋膜手法治疗产后腹直肌分离的疗效观察

目的:探讨核心训练联合筋膜手法对产后腹直肌分离患者的临床疗效。方法:选取产后42d进行门诊复查存在腹直肌分离的产妇40例作为研究对象,随机分成观察组和对照组各20例,对照组进行核心训练,观察组在对照组的基础上增加筋膜手法治疗,2天1次,每周3次,每次30～50min,共4周。结果:治疗前,2组产妇腹直肌分离间距、简体中文版Oswestry功能障碍指数问卷表(ODI)评分比较,差异无统计学意义。治疗4周后,2组产妇腹直肌分离间距均较治疗前减小(均P<0.05),且观察组腹直肌分离间距小于对照组(P<0.05);2组产妇ODI评分均较治疗前降低(均P<0.05),但2组间比较无统计学差异。结论:核心训练联合筋膜手法治疗能有效改善产后腹直肌分离。     

神经肌肉电刺激配合康复按摩治疗产后腹直肌分离与盆底肌修复的效果观察

目的观察神经肌肉电刺激配合康复按摩治疗产后腹直肌分离与盆底肌修复的临床效果。方法对2018年10月至2019年9月本院产后康复中心腹直肌分离且伴有不同程度盆底肌力降低的78例患者进行随机分组治疗,研究组39例采用神经肌肉电刺激配合康复按摩治疗,对照组39例采用单纯神经肌肉电刺激治疗,治疗疗程为3周,观察比较两组腹直肌分离距离及盆底肌肌力水平的差异。结果治疗后两组腹直肌分离距离均较治疗前显著降低(P<0.05),治疗后研究组腹直肌分离距离小于对照组(P<0.05)。治疗后两组Ⅰ类及Ⅱ类盆底肌纤维电压均较治疗前显著升高(P<0.05),治疗后研究组Ⅰ类及Ⅱ类盆底肌纤维电压高于对照组(P<0.05)。结论神经肌肉电刺激配合康复按摩对产后腹直肌分离与盆底肌修复治疗效果良好,显著促进腹直肌愈合并提升盆底肌力水平,有较高的临床应用价值。     

盆底神经肌肉电刺激和悬吊训练治疗产后腹直肌分离的效果

目的 观察盆底神经肌肉电刺激(NMES)结合悬吊训练(SET)对产后腹直肌分离的临床疗效。方法 2019年9月至12月,产后腹直肌分离> 2 cm、盆底肌肌力Ⅲ级以上患者90例,随机分为三组,分别接受单纯盆底NMES (A组)、NMES结合SET (B组)和单纯SET (C组)治疗,共4周。治疗前、治疗2周、治疗4周、治疗结束后4周,测量腹直肌分离距离。结果 治疗后,各组腹直肌分离距离均明显缩小(F > 8.327, P < 0.01);治疗后各时间点,B组腹直肌分离距离最小( F > 8.327, P < 0.01);多重比较,A组与C组无显著性差异( P > 0.05)。 结论 盆底NMES和SET均可有效改善产后腹直肌分离,两种方法结合疗效更佳。     

核心肌力稳定导向的呼吸训练对产后腹直肌分离患者的研究进展

腹直肌分离常导致产妇盆底脏腑生理功能障碍,诱发盆腔脏器脱垂,严重者可形成腹壁疝。产后及时改善腹直肌分离间距,不仅能改善产妇体态,更能预防继发疾病。呼吸训练是产后腹直肌分离的重要康复措施。本文就核心肌力稳定导向的呼吸训练在产后腹直肌分离患者中指导实践的训练目标、强度、持续时间、运动频率、运动时机、安全性及干预效果进行综述,旨在为我国康复人员提供一种可选择的针对性疗法,同时为临床开展产后腹直肌分离患者的呼吸训练提供参考。     

产后腹直肌分离患者强化核心肌群的呼吸康复训练研究进展

腹直肌分离是产后的常见问题,可导致产妇体态改变、盆底肌功能障碍及盆腔脏器脱垂等,对产后妇女的生活质量有一定影响.本文聚焦产后腹直肌分离患者的呼吸训练,围绕腹直肌分离的发生机制、强化核心肌群呼吸康复训练的具体实施方法等进行综述,旨在为临床开展相关康复训练提供参考.     

489例产后腹直肌分离产妇患病现状及影响因素分析

目的 了解产后6~8周产妇腹直肌分离的患病现状,分析其影响因素。方法 采用便利抽样法,选取2020年7月—2021年1月于山东省某三级甲等医院产后康复门诊就诊的产妇489例作为研究对象,采用问卷调查法收集产妇的一般资料,采用Glazer评估法测量产妇的盆底肌电值,采用指测法测量产妇腹直肌分离的程度,采用二元Logistic回归分析产后腹直肌分离发生的主要影响因素。结果 本组产妇产后腹直肌分离的患病率为61.6%（301/489）,其中轻度占比74.8%（225/301）,中度占比21.5%（65/301）,重度占比3.7%（11/301）。产妇年龄较大、经产分娩、混合喂养及新生儿体质量较高是产后腹直肌分离的独立危险因素（P<0.05）。结论 产后腹直肌分离的患病率较高,应重点关注年龄较大、经产分娩、混合喂养及新生儿体质量较高的产妇腹直肌分离的情况。医护人员也应对腹直肌分离引起重视,在围产期采取针对性的预防及干预措施,减轻产后腹直肌分离的发生及发展。     

What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis

BackgroundDiastasis recti abdominis (DRA) affects a significant number of women in the postpartum period.ObjectiveTo systematically review whether abdominal and pelvic floor muscle (PFM) exercise programs are effective in the treatment of DRA postpartum.MethodsElectronic search was conducted from inception to March 2020. Randomized controlled trials (RCT) or pilot RCTs that compared abdominal training, PFM training, or a combination of both in at least one arm of the trial were included. The primary outcome was presence of DRA (numbers/percentage) or inter-recti distance (IRD) change. GRADE was used to rate the overall quality of evidence. Pooled effect sizes were expressed as mean difference (MD) with 95% confidence intervals (CI).ResultsSeven RCTs totaling 381 women were included. Two studies comparing transversus abdominis (TrA) training with minimal intervention provided data to be included in a meta-analysis. The results provided very low level quality evidence that TrA training reduced IRD (MD = -0.63 cm, 95% confidence interval: -1.25, -0.01, I² = 0%). Two studies included curl-up exercises as part of their intervention. Level of evidence based on single trials of high risk of bias show very low evidence that curl-up training is more effective than minimal intervention for treating DRA. Similarly, analyses based on single trials provided low to very low quality evidence that PFM training is not more effective than minimal intervention for treating DRA.ConclusionThere is currently very low-quality scientific evidence to recommend specific exercise programs in the treatment of DRA postpartum.     

不同分娩方式对产后早期腹直肌分离的影响

目的 探讨不同分娩方式对产妇产后6~8周腹直肌分离（DRA）的影响。方法 收集1354例单胎产妇的临床资料。根据分娩次数和方式对产妇分组随访,初产妇775例［顺产组（A1组）546例,剖宫产组（B1组）229例］,第2次分娩产妇579例［第2次顺产组（A2组）357例,第2次剖宫产组（B2组）222例］。所有产妇在产后...     

Effect of pelvic floor and transversus abdominis muscle contraction on inter-rectus distance in postpartum women: a cross-sectional experimental study

ObjectivesTo investigate the effect of acute isometric contraction of the pelvic floor muscles (PFM) and transversus abdominis muscle (TrAM) on inter-rectus distance (IRD) from resting values in postpartum women with diastasis rectus abdominis (DRA).DesignCross sectional experimental study.SettingPhysiotherapy clinic.ParticipantsThirty eight postpartum women presenting with DRA of at least two finger widths.MethodsTwo dimensional ultrasound images of IRD were recorded using a linear probe (5 to 10 MHz) at rest, during PFM contraction, during TrAM contraction, and during combined PFM and TrAM contraction. IRD data were normally distributed.Main outcome measureChange in IRD.ResultsThere was a significant increase in IRD during PFM and TrAM contraction compared with IRD at rest. At 2 cm above the umbilicus, mean PFM was 26.9 [standard deviation (SD) 8.8] mm vs rest 25.7 (SD 8.5) mm {mean difference 1.2 [95% confidence interval (CI) 0.7 to 1.7] mm}; and mean TrAM was 28.4 (SD 9.0) mm vs rest 25.7 (SD 8.5) mm [mean difference 2.8 (95% CI 1.9 to 3.6) mm]. Similarly, 2 cm below the umbilicus, mean PFM was 22 (SD 8.3) mm vs rest 21 (SD 7.9) mm [mean difference 0.9 (95% CI 0.4 to 1.6) mm]; and mean TrAM was 23.3 (SD 8.7) mm vs rest 21 (SD 7.9) mm [mean difference 2.3 (95% CI 1.5 to 3.1) mm]. Combined TrAM and PFM contraction measured 2 cm above the umbilicus caused the greatest increase in IRD: mean PFM + TrAM 29.6 (SD 9.4) mm vs rest 25.7 (SD 8.5) mm [mean difference 3.9 (95% CI 2.8 to 5.0) mm].ConclusionBoth PFM and TrAM contraction, and combined PFM and TrAM contraction increased IRD in postpartum women with DRA.     

护理干预在社区产后访视的应用价值及其发展策略

[目的]探讨护理干预在社区产后访视中的作用.[方法]对2007年10月-2009年2月在接受我院社区健康服务中心产后访视的326例产妇进行护理干预下的产后访视,比较干预前后产妇相关知识和技能掌握情况.[结果]通过产后护理干预,产妇产后自我护理、新生儿的护理知识和技能明显提高,干预前后各项观察指标比较差异均有统计学意义(P＜0.01).[结论]产后护理干预解决了产妇出院后护理支持不足的问题,为产妇提供连续性的健康服务,提高了社会效益,同时也提高了护士的价值和业务素质.     

护理干预对初产妇产后抑郁症的影响

目的探讨护理干预对预防初产妇产后抑郁的效果。方法将2008年8月至2009年8月产前检查及正常足月分娩的初产妇350例,随机分成干预组200例和对照组150例,对照组接受常规护理,干预组在常规护理的基础上,接受系统的护理干预。观察两组孕妇产后6周产后抑郁量表(EPDS)评分和产后抑郁症的发生率。结果干预组与对照组在孕28周基础EPDS评分比较差异无统计学意义(P>0.05),产后6周两组比较差异有统计学意义(P<0.05);产后6周干预组产后抑郁症的发生率为6.50%(13/200),对照组产后抑郁症的发生率为14.67%(22/150),两组差异有统计学意义(P<0.05)。结论对初产妇进行孕产期的护理干预,能有效地减轻其抑郁情绪,降低产后抑郁症的发生。     

Nurse Practitioner Intervention to improve Postpartum Appointment Keeping in an Outpatient Family Planning Clinic

A nurse practitioner (NP) program to improve postpartum appointment keeping in an outpatient family planning clinic is described and evaluated. The subjects (N = 59) were non-high-risk obstetric patients prescheduled to be seen at 6 weeks postpartum by the NP. Two groups were identified by convenience sampling: Group A (n = 25), the nonintervention group, and Group B (n = 34), the intervention group. Two types of intervention were used: a postpartum telephone call after discharge (n = 11), or a predischarge postpartum visit (n = 23). Results suggest that those in the intervention group were more likely to keep their appointments (p less than .02); only the postpartum visit increased the probability of appointment keeping (p less than .05).     

超声在诊断透析相关淀粉样变性中的研究进展

透析相关淀粉样变性（DRA）是长期透析患者的严重并发症之一。DRA常引起骨关节系统的渐进性损害,严重影响患者的后续治疗及生活质量。当前,诊断DRA主要依靠患者的临床症状及体征,但对于病变部位的观察以及严重度的评估,仍然缺乏客观方法。影像学方法有助于DRA的筛查,其中超声成像技术对于大部分肌骨系统的显示非常敏感,且对于局部病变的评估具有一定优势。本文对超声成像技术在DRA诊断中的研究进展进行综述。     

探讨前瞻性护理管理预防产后并发症的效果

目的:观察前瞻性护理管理预防产后并发症的效果。方法:随机选取本院2018年1月至2019年1月收治的100例分娩孕妇为本次研究对象,按照孕产妇分娩后护理管理中是否行产后并发症预防前瞻性护理将所有孕产妇分为对照组(50例未行前瞻性护理)与研究组(50例行前瞻性护理),比较两组孕产妇护理管理效果。结果:研究组孕产妇产后并发症发生率(6.00%)明显低于对照组(20.00%)(P<0.05)。研究组孕产妇护理干预后焦虑自评量表(SAS)以及抑郁自评量表(SDS)得分均低于对照组(P<0.05)。研究组孕产妇对产后护理管理满意度(96.00%)明显高于对照组(P<0.05)。结论:孕产妇分娩后给予产后并发症预防前瞻性护理干预效果明显优于常规护理干预效果。