不同分娩方式对盆底功能的影响及电刺激治疗的疗效分析

目的探讨不同分娩方式对女性盆底功能的影响及生物反馈电刺激治疗在盆底功能恢复方面的疗效。方法选取2013年1月至2015年4月兰州大学第二医院妇产科产后6~8周进行复查的初产妇460例的临床资料,根据分娩方式不同分为剖宫产组(204例)、中转剖宫产组(24例)、会阴保护组(59例)、会阴侧切组(163例)和产钳助产组(10例),运用盆底肌电生物反馈仪对5组量化评估盆底不同肌纤维的肌力,对44例肌力较弱者进行生物反馈电刺激治疗后再次进行盆底肌力评估。结果 1剖宫产组前静息状态平均肌电值高张型构成比(71.57%)明显高于会阴侧切组(47.24%),且其高张型平均肌电值(8.54 u V)明显高于会阴保护组(6.27 u V)、会阴侧切组(6.99 u V)和产钳助产组(5.26 u V);2剖宫产组后静息状态平均肌电值高张型构成比(72.55%)明显高于其它4组,且其高张型平均肌电值(8.26 u V)明显高于会阴保护组(6.65 u V)和会阴侧切组(6.76 u V);3会阴保护组和会阴侧切组快肌最大肌电值低张型构成比(81.36%、74.23%)明显高于剖宫产组(46.57%),且会阴侧切组低张型平均肌电值(20.68 u V)低于剖宫产组(23.44 u V);4会阴保护组和会阴侧切组混合肌平均肌电值低张型构成比(91.53%、92.64%)明显高于剖宫产组(73.53%),且两组低张型平均肌电值均低于剖宫产组;5会阴侧切组慢肌平均肌电值低张型构成比(89.57%)高于剖宫产组(75.98%),且剖宫产组低张型平均肌电值高于其他4组;6产钳助产组快肌、混合肌、慢肌低张型平均肌电值明显低于其他4组;7快肌、混合肌、慢肌三者各自低张型构成比在生物反馈电刺激治疗后明显降低,三者各自整体平均肌电值在治疗后均明显升高,经比较差异均有统计学意义(P0.05)。结论不同分娩方式对女性盆底功能造成不同程度的影响,会阴保护和会阴侧切对盆底功能的损伤大于剖宫产,产钳助产对盆底组织的损伤最为严重;生物反馈电刺激治疗对女性产后盆底功能的恢复具有重要积极意义。

Efficacy analysis of different delivery modes on female pelvic floor function and therapeutic effect of the biofeedback combined with electrical stimulation on pelvic floor

Objective To analyze the effects of different delivery modes on female pelvic floor function and the significance of biofeedback combined with electrical stimulation on restoring female pelvic floor function. Methods 460 cases of primipara treated at 6 to 8 weeks after dellvery in the Department of Gynecology and Obstetrics of Lanzhou University Second Hospital from January 2013 to April 2015 were selected as study objects, and then they were divided into cesarean section group (n =204), transit cesarean delivery group (n =24), perineal protection group (n = 59), episiotomy group (n = 163) and forceps delivery group (n = 10); pelvic floor muscle strength was assessed by pelvic floor myoelectricity physiologic instrument in the five groups; 44 cases of pelvic floor dysfunction underwent the therapy of biofeedback combined with electrical stimulation and pelvic floor muscle strength assessment was performed again. Results ① The composition ratio of higher type on the former resting state in cesarean section group(71. 57 %) was statistically significantly higher than those in episiotomy group(47. 24 %)and the averaged electromyogram(AEMG) of higher type in cesarean section group(8. 54 uV)was statistically significantly higher than those in perineal protection group(6. 27 uV), episiotomy group(6. 99 uV)and forceps delivery group(5. 26 uV); ② the composition ratio of higher type on the latter resting state in cesarean section group(72. 55 %)was statistically significantly higher than those in the rest of groups and the AEMG of higher type in cesarean section group(8.26 uV)was statistically significantly higher than those in perineal protection group(6.65 uV)and episiotomy group(6.76 uV);③ the composition ratios of lower type on the fast pelvic floor muscle fiber in perineal protection group(81. 36 %)and episiotomy group (74. 23 %)were statistically significantly higher than that in cesarean section group(46. 57 %) and the AEMG of lower type in episiotomy group(20. 68 uV)was statistically lower than that in cesarean section group(23. 44 uV); ④ the composition ratios of lower type on the mixed pelvic floor muscle fiber in perineal protection group(91. 53 %)and episiotomy group(92. 64 %)were statistically significantly higher than that in cesarean section group(73. 53 %)and the AEMG of lower type in episiotomy group and cesarean section group was statistically lower than in cesarean section group; ⑤ the composition ratio of lower type on the slow pelvic floor muscle fiber in episiotomy group(89. 57 %)was significantly higher than that in cesarean section group(75. 98 %)and the AEMG of lower type in cesarean section group was statistically higher than those in the rest of the groups; ⑥ the AEMG of lower type on the fast, mixed and slow pelvic floor muscle fiber in forceps delivery group were statistically significantly lower than those in the rest of the groups; ⑦ after biofeedback combined with electrical stimulation therapy, the composition ratio of lower type on the fast, mixed and slow pelvic floormuscle fiber were statistically significantly lower and the AEMG of fast, mixed and slow pelvic floor muscle fiber were significantly better(P <0. 05). Conclusion Different delivery modes had different effects on female pelvic floor function, the damage of perineal protection group and episiotomy group were more serious than cesarean section group, the damage of forceps delivery group on female pelvic floor function was the worst; the therapy of biofeedback combined with electrical stimulation had important clinical significance on postpartum female’s health.