盆底康复训练对不同分娩方式产后盆底功能障碍的防治作用

目的：通过比较康复治疗前后的产后妇女控尿能力、盆底肌肉收缩力强度的变化，探讨产后盆底康复训练对盆底功能障碍性疾病（PFD）的防治作用。方法选取本院2013年1月至2013年12月收治的200例产妇，按照数字随机的方法将患者分为4组，每组50例，A组为剖宫产联合为期3个月的盆底康复训练治疗；B组为剖宫产联合产后常规性护理；C组经阴道分娩联合为期3个月的盆底康复训练治疗；D组为经阴道分娩联合产后常规性护理，观察各组经过康复训练治疗后的产妇尿失禁（SUI）及盆腔脏器脱垂（POP）发生率、盆底肌力强度的变化情况。结果选择性剖宫产组（A组＋B组）和经阴道顺产组（C组＋D组）治疗前相比，SUI、SUI合并POP（S＋P）发生率差异无统计学意义（P＜0.01）；治疗后，选择性剖宫产A组与B组相比，SUI、SUI合并POP（S＋P）发生率差异有统计学意义（P＜0.01）；经阴道顺产C组与D组相比，SUI、SUI合并POP（S＋P）发生率差异有统计学意义（P＜0.01）；治疗后选择性剖宫产A组与经阴道顺产C组相比，SUI、SUI合并POP（S＋P）发生率差异有统计学意义（P＞0.05）。治疗后选择性剖宫产A组的手测盆底肌力评分高于B组，Ⅰ、Ⅱ类肌纤维疲劳度低于B组，肌纤维肌电压高于B组，差异有统计学意义（P＜0.01）。治疗后经阴道顺产C组的手测盆底肌力评分高于D组，Ⅰ、Ⅱ类肌纤维疲劳度低于D组，肌纤维肌电压高于D组，差异有统计学意义（P＜0.01）。经过康复治疗，选择性剖宫产A组与经阴道顺产C组相比较，手测盆底肌力评分，Ⅰ、Ⅱ类肌纤维疲劳度以及肌纤维肌电压，差异均无统计学意义（P＞0.05）。结论经阴道顺产确实会增加各种PFD症状的发生率，但经过盆底康复训练后，各种PFD症状改善明显，盆底康复训练治疗对产后盆底功能障碍具有防治作用，经过康复治疗后，经阴道顺产PFD的发生率与选择性剖宫产PFD的发生率无明显差别。

Effect of rehabilitation training in prevention and treatment of postpartum pelvic floor dysfunction in different delivery modes

Objective To explore the application effect of postpartum pelvic floor rehabilitation training in the prevention and treat-ment of pelvic floor dysfunction,by means of assessment of urinary continence and pelvic floor muscle strength in puerpera before and after treatment.Methods 200 cases of puerpera in our hospital from Jan 2013 to Dec 2013 were enrolled in the study,and their urinary conti-nence,pelvic floor muscle strength,incidence of pelvic organ prolapse were assessed within 6 -8 weeks after childbirth.All participants were equally divided into 4 groups through random number generation:group A of 50 cesarean section cases and group C of 50 vaginal deliv-ery cases treated with pelvic floor rehabilitation training for 3 months;group B of 50 cesarean section cases and group D of 50 vaginal delivery cases treated with routine postpartum nursing.Again the rate of stress urinary incontinence (SUI rate),pelvic organ prolapsed (POP rate) and muscle strength changes in each group were recorded and compared with pre-therapy results.Results Compared with cesarean section groups (group A +B),the SUI,SUI and POP (S+P)incidence rate in vaginal delivery groups (group C+D)had significant difference before treatment (P<0.01).After treatment,the SUI,SUI and POP (S +P)incidence rate between group A and B were of significant difference (P<0.01),and so is it with group C and D (P<0.01).There was no significant difference between the SUI,SUI and POP (S+P)incidence rate in group A and C after treatment (P>0.05 ).The post-therapy results of hand-measured pelvic muscle strength in group A were higher than that of group B,with lower type I or II muscle fiber fatigue degree and higher muscle voltage in group A,and all the differences in muscle strength between group A and B were statistically significant (P<0.01 ).The post-therapy results of hand-measured pelvic muscle strength in group C were higher than that of group D,with lower type I or II muscle fiber fatigue degree and higher muscle volt-age in group C,and all the differences in muscle strength between group C and D were statistically significant (P<0.01).After pelvic floor rehabilitation training,all results of hand-measured pelvic muscle strength,type I or II muscle fiber fatigue degree and muscle voltage be-tween group A and C had no significant difference (P>0.05 ).Conclusion Vaginal delivery will indeed bring about the variable symptoms of pelvic floor dysfunction,but all the dysfunction symptoms could be improved significantly through pelvic floor rehabilitation training.The pelvic floor rehabilitation treatment has protective and therapeutic effect on postpartum pelvic floor dysfunction,since the occurrence of it has no significant difference between puerpera with vaginal delivery and caesarean section after rehabilitation treatment.