余彩茶 水旭娟 焦岩 林海玲 滕慧

[摘要] 目的 探讨经会阴盆底超声在产后盆底康复疗效评价中的应用价值。 方法 随机选取2018年6月～2019年6月就诊于温州市人民医院产后门诊的初次分娩产妇100例。按照随机且自愿的原则，将产后妇女分成四组，A组接受常规盆底健康宣教、B组接受盆底肌肉训练、C组接受生物反馈电刺激治疗、D组接受盆底肌肉训练和生物反馈电刺激联合治疗。并应用经会阴盆底超声分别于产后6周（治疗前）和产后12周（治疗后）观察膀胱颈移动度（BND）、膀胱尿道旋转角、膀胱尿道后角、肛提肌裂孔面积等指标观察患者盆腔功能情况，通过各超声指标数值的改变比较不同康复方法的疗效。 结果 治疗前四组产妇年龄、体质量指数以及盆腔各超声指标结果差异无统计学意义（P>0.05）;治療后复查所有入选产妇依从性为100%;超声结果显示四组产妇盆底情况均有不同程度改善，改善程度D组最理想、A组最不理想，差异有统计学意义（P<0.05）。 结论 产后早期进行盆底功能训练能有效促进盆底功能恢复，超声对盆底功能训练的有效评估能进一步指导盆底功能训练的个性化开展，从而进一步提高产后妇女的生活质量。

[关键词] 产后;妇女;超声;盆底功能障碍;盆底康复

[中图分类号] R445.1;R714.6          [文献标识码] B          [文章编号] 1673-9701（2020）18-0124-04

Application value of transperineal pelvic floor ultrasound in evaluating the efficacy of postpartum pelvic floor rehabilitation

YU Caicha1   SHUI Xujuan1    JIAO Yan1   LIN Hailing2   TENG Hui1

1.Department of Obstetric Ultrasound， Wenzhou Peoples Hospital in Zhejiang Province， Wenzhou   325000， China; 2.Pelvic Floor Rehabilitation Center， Wenzhou Peoples Hospital in Zhejiang Province， Wenzhou   325000， China

[Abstract] Objective To investigate the application value of transperineal pelvic floor ultrasound in evaluating the efficacy of postpartum pelvic floor rehabilitation. Methods One hundred primiparas who attended the postpartum clinic of Wenzhou Peoples Hospital from June 2018 to June 2019 were randomly selected. Based on the principle of randomization and voluntariness， postpartum women were divided into four groups. Group A received conventional pelvic floor health education， group B received pelvic floor muscle training， group C received biofeedback electrical stimulation therapy， and group D received pelvic floor muscle training and biofeedback electrical stimulation combined therapy.Transperineal pelvic floor ultrasound was used to observe bladder neck mobility， bladder urethra rotation angle， posterior urethrovesical angle， area of levator ani hiatus and other indicators at six weeks（baseline） and twelve weeks（post-treatment） respectively to observe the pelvic function of patients， and the therapeutic efficacies of different rehabilitation methods were compared through the changes of ultrasound index values. Results There was no significant difference in maternal age， body mass index and pelvic ultrasound indexes among the four groups before treatment（P>0.05）， which was comparable. Compliance of all selected parturients was 100% after treatment. Ultrasound results showed that the pelvic floor conditions of the four groups of parturients were improved to different degrees， with the improvement degree being the most ideal in group D and the least ideal in group A， with statistically significant difference（P<0.05）. Conclusion Pelvic floor function training in the early postpartum period effectively promotes the recovery of pelvic floor function. The effective evaluation of pelvic floor function training by ultrasound further guides the personalized development of pelvic floor function training， thus further improving the activity of daily living of postpartum women.

[Key words] Postpartum; Women; Ultrasound; Pelvic floor dysfunction; Pelvic floor rehabilitation

女性盆底是由一系列盆底肌肉等组织构成的类似吊床样的结构，这些结构能很好地保障盆底器官维持正常的位置和功能，当盆底组织受损、盆底支持结构功能下降时，则会出现一系列盆腔功能障碍性疾病[1]，妊娠及分娩被认为是发生这些疾病最主要的原因和危险因素[2，3]。这些疾病早期可无症状，只是盆底支持结构的电生理及生化发生变化[4]，這些变化在产后6周在一定程度上会自行恢复，若无自行恢复，又没有及时干预，则会成为以后发生尿失禁、盆底器官脱垂等疾病的巨大隐患[5]。因此……