产后妇女盆底肌力与分娩方式、季节的关系

刘浏，张妤，卫兵，王文艳

(安徽医科大学第二附属医院，合肥230601)

摘要：目的了解产后妇女盆底肌力与分娩方式、季节的关系。方法选择2013年12月～2014年11月安徽医科大学第二附属医院收治的足月妊娠分娩、产后6周复查产妇902例作为研究对象，其中剖宫产410例(剖宫产组)、经阴分娩492例(顺产组)。所有产妇在产后接受盆底肌力检查(受检时间为产后35～118 d，于春、夏、秋、冬季接受盆底肌力检查者分别为191、231、233、247例)，采用Glazer评估法评估其盆底肌表面肌电压。结果盆底肌肉的5次快速收缩最大肌电压(Dmax)剖宫产组为(37.01±15.65)μV、顺产组为(31.98±12.56)μV，两组相比，t=-5.359，P<0.01。盆底肌持续收缩60 s的平均肌电压(H60 s)剖宫产组为(21.74±10.71)μV、顺产组为(19.06±8.87)μV，两组相比，t=-4.119，P<0.01。春、夏、秋、冬季接受盆底肌力检查者的Dmax分别为(35.99±11.10)、(34.10±13.00)、(33.45±16.86)、(33.86±14.85)μV，组间相比，F=1.256, P>0.05。春、夏、秋、冬季接受盆底肌力检查者的H60 s分别为(24.87±8.82)、(20.74±8.83)、(17.89±10.33)、(18.55±9.77)μV，组间相比，F=22.721，P<0.01；春、夏季接受检查者的H60 s均明显高于秋季检查者(t分别为7.386、3.193，P均<0.01)。分别以Dmax、H60 s为应变量，以孕次、分娩方式、受检季节为自变量，建立多元线性回归模型，分析显示，分娩方式与Dmax、H60 s有关(P均<0.01)，受检季节与H60 s有关(P<0.01)。结论 产后妇女盆底肌肌力与分娩方式有关，剖宫产产妇的盆底肌力较顺产者高；产后妇女盆底肌持续收缩力与受检季节有关，春、夏季比较高。

关键词：盆底肌；盆底功能障碍性疾病；盆底肌表面肌电信号；产妇；分娩方式

doi：10.3969/j.issn.1002-266X.2015.43.004

中图分类号：R714.14文献标志码：A

基金项目：国家自然科学基金资助项目(81100412);安徽医科大学2011年校科研基金资助项目(2011xkj060)。

作者简介：第一刘浏(1985-)，女，硕士，医师，主要研究方向为妇女保健。E-mail: liuliuflawless@qq.com

作者简介：通信张妤(1963-)，女，学士，主任医师，主要研究方向为围产医学。E-mail: zhangyu8648@163.com

收稿日期：(2015-04-24)

Relationship of postnatal pelvic floor muscle strength with delivery mode and delivery season

LIULiu,ZHANGYu,WEIBing,WANGWen-yan

(TheSecondAffiliatedHospitalofAnhuiMedicalUniversity,Hefei230601,China)

Abstract:ObjectiveTo investigate the relationship between delivery mode, delivery season and postnatal pelvic floor muscle strength. Methods A total of 902 postpartum women, including 410 cases of cesarean delivery (cesarean delivery group) and 492 cases of spontaneous delivery (spontaneous delivery group), were screened for pelvic floor muscle strength after childbirth. The pelvic floor muscle strength of all eligible pregnant women was measured, and the measure time was from 35 to 118 days postpartum. There were 191 cases of pregnant women in the spring, 231 in the summer, 233 in the autumn and 247 in the winter. Glazer protocol was used to measure surface muscle voltage of pelvic floor muscle. Results The maximum muscle voltage of pelvic floor muscle in 5 times of fast-contracting (Dmax) was (37.01±15.65) μV in the cesarean delivery group, and (31.98±12.56) μV in the spontaneous delivery group, and there was significant difference between these two groups(P<0.01). The mean value of 60 s continuous contraction of pelvic floor muscles (H60 s) was (21.74±10.71) μV in the cesarean delivery group, and (19.06±8.87) μV in the spontaneous delivery group, and there was significant difference between these two groups(P<0.01). The mean value of Dmax was(35.99±11.10)μV among pregnant women in the spring,(34.10±13.00) μV in the summer, (33.45±16.86)μV in the autumn, and (33.86±14.85)μV in the winter, and there was no significant difference among these groups (F=1.256, P>0.05). The mean value of H60 s was (24.87±8.82) μV among pregnant women in the spring, (20.74±8.83)μV in the summer, (17.89±10.33)μV in the autumn and (18.55±9.77)μV in the winter, and there was significant difference among these groups (F=22.721, P<0.01).The mean value of H60 s of the women in the spring and summer was significant higher than that in the autumn(t=7.386, 3.193; all P<0.01). If we took Dmax, H60 s, gravidity, delivery mode and the delivery seasons as the independent variable to make the multiple liner regression models, it showed that the delivery mode was related with Dmax and H60 s(P<0.01), and the delivery season was related with H60 s(P<0.01). ConclusionsThe postnatal pelvic floor muscle strength is statistically related with delivery mode, and the postnatal pelvic floor muscle strength is higher in women with cesarean delivery than that with spontaneous delivery. The continuous contraction of pelvic floor muscles is related with the delivery season, which is high in the spring and summer.

Key words: pelvic floor muscle; pelvic floor dysfunction; surface electromyography of pelvic floor muscle; postpartum women; delivery mode

妊娠和分娩是导致女性盆底功能障碍性疾病(PFD)发病的重要独立危险因素。目前，国内外多通过促进盆底肌功能的康复而达到预防PFD的目的。动物实验[1～4]发现，蟾蜍、牛蛙腓肠肌的收缩力随温度的升高而增强，在25 ℃时肌肉收缩力最强，25 ℃后随温度的持续升高，肌肉收缩力出现迅速下降趋势。推测人体肌力可能也会受到温度或者气温的影响，但至今国内外尚未见相关研究报道。……