再生育妇女产后盆底功能康复的研究

发布时间：2018-04-30 15:05

本文选题：再生育 + 盆底肌　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:研究再生育对产后盆底功能的影响,观察再生育产后盆底功能的自然康复状况。方法:本课题为双向观察性研究。研究对象为产后42天健康检查的女性。自制调查问卷,部分回顾性调查产妇的相关基本情况及妊娠期尿失禁情况。对产后42天健康检查的女性开展常规的盆底功能筛查,包括盆底肌力测定、尿失禁筛查、盆腔脏器脱垂评估,并前瞻性的随访观察该人群的产后3月、6月、1年的盆底功能状况。采用SPSS22.0统计软件包,选择经阴道分娩和选择性剖宫产两种分娩方式人群,分产后四个不同恢复阶段(42天、3月、6月、1年),比较分析二次再生育与初产两组间的盆底肌受损比例(≤2级)、尿失禁发生率、盆腔脏器脱垂量化值的差异,进而探讨再生育对产后盆底功能的影响,并通过同组内产后不同恢复阶段间的比较分析,观察再生育后1年内盆底功能的自然恢复过程及结局。结果:盆底肌受损情况:再次经阴道分娩者产后42天I类肌受损率明显低于初次经阴道分娩者,差异有统计学意义(p0.01),产后3月、6月、1年Ⅰ类肌受损率两组间均无统计学差异(P0.05);经阴道分娩后Ⅱ类肌受损率在产后42天、3月、6月、1年各个恢复阶段两组间比较均无统计学差异(P均0.05)。选择性剖宫产后各个恢复阶段盆底肌(Ⅰ类肌和Ⅱ类肌)受损率两组间均不存在统计学差异(P0.05)。再生育产后盆底肌恢复过程总体比初产妇缓慢,经阴道分娩者到产后6月盆底肌受损会出现明显改善,选择性剖宫产者产后1年内盆底肌受损情况并未见明显的改善。尿失禁发生情况:再次经阴道分娩者妊娠期和产后较远期(1年)尿失禁发生率明显大于初次经阴道分娩者,两组间比较有统计学差异(P均0.05),而在产后42天、3月、6月这三个时段两组间比较不存在统计学差异(P均0.05)。选择性剖宫产妊娠期、产后42天、3月、6月、1年各阶段尿失禁发生率两组比较均无统计学差异(P均0.05)。再生育产后尿失禁自然恢复状况与初产妇近似,经阴道分娩者尿失禁发生率在产后3月出现明显下降,3月后下降速度明显减慢,选择性剖宫产后产妇尿失禁症状改善都是不明显的。盆腔脏器脱垂情况:再次经阴道分娩者阴道前壁、子宫、阴道后壁脱垂量化值在产后近期(42天)和较远期(1年)明显大于初次经阴道分娩者,两组间比较均存在统计学差异(P均0.05)。再次经阴道分娩者阴道前壁恢复与初次经阴道分娩者近似,阴道前壁在产后6月内恢复快且显著,再次经阴道分娩者子宫与阴道后壁脱垂比初次经阴道分娩者恢复慢。再次选择性剖宫产者阴道前壁脱垂产后42天比初次选择性剖宫产者明显,两组比较有统计学差异(P0.05),在产后3月到6月得到显著改善,之后产后3月、6月、1年两组间比较均不存在显著性差异(P均0.05);子宫、阴道后壁脱垂量化值产后各阶段两组间比较均不存在统计学差异(P0.05)。再次选择性剖宫产的阴道后壁、子宫脱垂恢复都是不明显的,与初次选择性剖宫产者近似。结论:1、再次经阴道分娩对盆底肌的损伤影响并不大,初次经阴道分娩对盆底肌的影响可能是最大的,再次妊娠对盆底肌的影响是不明显的。再生育产后盆底肌恢复过程总体比初产妇缓慢而不显著。2、再次经阴道分娩者产后近期尿失禁的症状不一定会表现出来,到产后较远期(1年)左右尿失禁症状会明显高于初次经阴道分娩者。选择性剖宫产可能对产后盆底功能有一定的保护作用,再次选择性剖宫产后尿失禁的近期与远期发生率与初次选择性剖宫产者近似。再次经阴道分娩后尿失禁自然恢复状况与初产妇近似,至产后3月出现明显改善,3个月后改善速度明显减慢,再次选择性剖宫产后尿失禁症状改善都是不明显的。3、再次经阴道分娩对产后近期和远期盆腔脏器脱垂的影响都明显大于初次经阴道分娩。选择性剖宫产可能对产后盆底脏器脱垂有一定的保护作用,再次妊娠的过程可能会短暂性加重原有的盆底前腔脏器脱垂,但可自行修复,其远期影响是不明显的,再次选择性剖宫产者产后较远期盆腔脏器脱垂程度与初次选择性剖宫产者近似。再次经阴道分娩者阴道前壁脱垂恢复速度与初次经阴道分娩者近似,子宫与阴道后壁脱垂恢复比初次经阴道分娩差。
[Abstract]:Objective: To study the effect of reproduction on postpartum pelvic floor function and to observe the natural rehabilitation of pelvic floor function after reproduction. Methods: this subject is a two-way observer study. The subjects are women who have 42 days after postpartum health examination. 42 days after the health examination, women carried out routine pelvic floor screening, including pelvic floor muscle strength test, urinary incontinence screening, pelvic organ prolapse assessment, and prospective follow-up observation of the pelvic floor function of the population in March, June, and 1 years. The SPSS22.0 statistical package was used to select two kinds of labor parties through vaginal delivery and selective cesarean section. The group was divided into four different recovery stages (42 days, March, June, 1 years). The ratio of pelvic floor muscle damage (less than 2), the incidence of urinary incontinence and the difference of quantitative value of pelvic organ prolapse between the two rebirth and primary two groups were compared and analyzed, and then the effect of rebirth on pelvic floor function was discussed, and the different recovery stages between the same group and the same group were discussed. A comparative analysis was made to observe the natural recovery process and outcome of pelvic floor function within 1 years after reproduction. Results: the damage of pelvic floor muscle: the rate of I muscle damage at 42 days after the vaginal delivery was significantly lower than that of the first transvaginal delivery, the difference was statistically significant (P0.01), and there was no statistical difference between the two groups of type I muscle damage in March, June, and 1 years. After vaginal delivery (P0.05), there was no statistical difference between the two groups (P 0.05) between the two groups after 42 days postpartum, in March, June, and 1 years. There was no statistical difference between the two groups in the two groups of pelvic floor muscle (type I and class II muscles) after selective cesarean section. The overall process was slower than the primipara, and the pelvic floor muscle damage in the postpartum period was significantly improved in June. There was no obvious improvement in the pelvic floor muscle damage in the selective cesarean section 1 years after postpartum. The occurrence of urinary incontinence: the incidence of incontinence in pregnancy and postpartum (1 years) after vaginal delivery was significantly greater than that of the first transvaginal vaginal delivery There were statistical differences between the two groups (P 0.05), but there was no statistical difference between the two groups in the three periods of the 42 day postpartum, March and June (P 0.05). Selective cesarean section, 42 days, March, June, and 1 years had no statistical difference between the two groups (P 0.05). Regenerative postpartum incontinence The incidence of natural recovery was similar to that of primipara. The incidence of urinary incontinence in vaginal delivery decreased significantly in March and decreased significantly after March. The improvement of urinary incontinence symptoms after selective cesarean section was not obvious. Pelvic organ prolapse: vaginal delivery, vaginal delivery, and posterior vaginal wall prolapse were quantified. The values were significantly greater than those in the first vaginal delivery (42 days) and more long term (1 years). There was a statistical difference between the two groups (P 0.05). Again, the vaginal delivery was similar to the first vaginal delivery, and the anterior vaginal wall was fast and significant during the postpartum period in June, and the vaginal delivery was again the posterior wall of the uterus and vagina. The prolapse of prolapse was slower than that of the first vaginal delivery. The 42 day postpartum vaginal prolapse of the caesarean section was more obvious than the primary cesarean section. The two groups had a statistically significant difference (P0.05), significantly improved from March to June postpartum, and after postpartum March, June, and 1 years, there was no significant difference between the two groups (all 0.05); uterus, There was no statistical difference between the two groups of postpartum vaginal wall prolapse (P0.05). The second selective cesarean section of the posterior vaginal wall, the uterine prolapse recovery was not obvious, similar to the primary cesarean section. Conclusion: 1, the effect of vaginal delivery on the pelvic floor muscle injury is not significant, the first vaginal delivery is the same. The effect of pelvic floor muscle may be the biggest, and the effect of second pregnancy on pelvic floor muscle is not obvious. The recovery process of postpartum pelvic floor muscle is slower and less significant than that of the primipara. The symptoms of short term postpartum incontinence after vaginal delivery are not necessarily shown, and the symptoms of urinary incontinence at about 1 years postpartum (1 years) will be significantly higher. In the first vaginal delivery, selective cesarean section may have a certain protective effect on postpartum pelvic floor function, the short-term and long-term incidence of secondary and postpartum urinary incontinence is similar to that of the first selective cesarean section. After 3 months, the rate of improvement was obviously slowed down, and the symptoms of incontinence after cesarean section were not obvious.3. The effect of vaginal delivery on the pelvic viscera prolapse was obviously greater than that of the first vaginal delivery. Selective cesarean section may have protective effect on postpartum pelvic organ prolapse, and again pregnancy The process of pregnancy may temporarily increase the original pelvic anterior chamber visceral prolapse, but it can be repaired by itself, but its long-term effect is not obvious. The degree of postpartum pelvic organ prolapse after the secondary cesarean section is similar to that of the first selective cesarean section. Similarly, the prolapse of the uterus and posterior wall of the vagina is worse than that of the first vaginal delivery.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.6

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