周莉芳

【摘要】 目的：探討不同分娩方式对初产妇产后盆底结构及肌力状态的影响比较。方法：选取2019年

6月-2020年6月在本院分娩的210例初产妇为研究对象。根据不同的分娩方式，将其分为顺产组（n=107）和剖宫产组（n=103）。于产后第6周，比较两组产妇产后盆腔结构指标、盆底肌力、盆腔器官脱垂（POP）及压力性尿失禁（SUI）发生情况。结果：静息状态下，两组产妇的BNP、PUA比较，差异均无统计学意义（P>0.05）;最大Valsalva动作下，两组产妇BND比较，差异无统计学意义（P>0.05），顺产组的URA、PUA均显著高于剖宫产组，差异均有统计学意义（P<0.05）。顺产组盆底深层肌力及盆底浅层肌力受损情况与剖宫产组相比，差异均无统计学意义（P>0.05）。顺产组POP、SUI的发生率分别为27.10%、22.43%，均显著高于剖宫产组的11.65%、8.74%，差异均有统计学意义（P<0.05）。结论：经会阴盆底超声检查对产妇临床症状能做出有效评估，有助于对FPFD患者及时调控及干预。两种分娩方式均对女性盆底结构及功能产生不同程度损伤，其中阴道分娩比剖宫产对产后早期盆底结构造成的损伤更为显著。

【关键词】 阴道顺产 剖宫产 初产妇 盆底结构 肌力状态

Comparison of the Effects of Different Delivery Methods on the Postpartum Pelvic Floor Structure and Muscle Strength State of Primipara/ZHOU Lifang. //Medical Innovation of China， 2021， 18（13）： -122

[Abstract] Objective： To investigate the effects of different delivery methods on the postpartum pelvic floor structure and muscle strength state of primipara. Method： A total of 210 primiparas who delivered in our hospital from June 2019 to June 2020 were selected as the research object. According to different delivery methods， they were divided into natural delivery group （n=107） and cesarean section group （n=103）. At 6th week postpartum， the pelvic structure indexes， pelvic floor muscle strength， incidence of pelvic organ prolapse （POP） and stress urinary incontinence （SUI） were compared between the two groups. Result： In the resting state， there were no significant differences in BNP and PUA between the two groups （P>0.05）. Under the maximum Valsalva movement， there was no significant difference in BND between the two groups （P>0.05）. The URA and PUA of the natural delivery group were significantly higher than those of the cesarean section group， the differences were statistically significant （P<0.05）. Compared with the cesarean section group， there were no significant differences in the damage of pelvic floor deep muscle strength and superficial muscle strength in the natural delivery group （P>0.05）. The incidence of POP and SUI in the natural delivery group were 27.10% and 22.43%， which were significantly higher than 11.65% and 8.74% in the cesarean section group， the differences were statistically significant （P<0.05）. Conclusion： The perineal pelvic floor ultrasound examination can effectively evaluate the clinical symptoms of parturient women， which is helpful for timely regulation and intervention of patients with FPFD. The two delivery methods have different degrees of damage to female pelvic floor structure and function， and vaginal delivery caused more significant damage to the pelvic floor structure in early postpartum period than cesarean delivery.

[Key words] Vaginal delivery Cesarean section Primipara Pelvic floor structure Muscle strength state

First-authors address： Xinzhou Maternal and Child Health Hospital， Wuhan 430415， China

doi：10.3969/j.issn.1674-4985.2021.13.029

女性盆底功能障碍疾病（female pelvic floor dysfunction， FPFD）是由盆底组织结构及肌肉损伤或盆底功能缺陷引起的妇科疾病[1]。妊娠和分娩过程中，子宫随胎儿生长发育不断增大，出现盆底负重增加及盆底结构变化，导致盆底软组织受损，盆底肌功能降低。另一方面，女性分娩中，随盆底肌肉扩张及拉伸，造成阴部神经组织、盆底肌肉、筋膜撕裂，血管和神经组织阻断等症状，易引起盆底结构变化出现盆腔脏器脱垂（pelvic organ prolapse， POP）、压力性尿失禁（stress urinary incontinence， SUI）、产后性功能障碍、子宫脱垂等症状，同时也是造成FPFD及盆底肌功能下降的重要因素[2-3]。近年来，FPFD发病人数呈逐年增长趋势，其中分娩导致POP、SUI的患病率高达16%～34%[4]。研究指出，POP、SUI症状已对产妇造成极大的生理及心理困扰[5-6]，严重影响产妇健康生活质量。因此，及时诊断、评估盆底功能对降低FPFD发病率，提高产妇的生活质量尤为重要。