产后盆底功能障碍性疾病的影响因素分析及治疗效果评价

发布时间：2018-05-09 21:03

本文选题：盆底功能障碍性疾病 + 电刺激　；参考：《兰州大学》2017年硕士论文

【摘要】：研究目的1.探究妊娠和分娩与产后盆底肌力损伤、压力性尿失禁(stress urinary incontinence,SUI)以及盆腔器官脱垂(pelvic organ prolapse,POP)等盆底功能障碍性疾病发生的关系。2.评价盆底肌肉锻炼(pelvic floor muscle training,PFMT)联合电刺激生物反馈治疗产后盆底功能障碍性疾病(pelvic floor dysfunction,PFD)的疗效,为临床防治产后盆底功能障碍性疾病提供理论依据。研究方法选择2015年11月-2016年4月在甘肃省妇幼保健院住院分娩,并于产后6~8周进行门诊产后复查的单胎产妇共2173例,平均年龄29.49±3.93岁。开展以下研究:(1)通过问卷调查和收集住院电子病历信息,内容包括产妇基本情况、分娩情况及妊娠合并症发生状况等;(2)应用手测肌力法和阴道肌力表检测盆底肌力,分析所有研究对象的产后盆底肌力损伤情况;(3)采用产后门诊临床诊断和盆腔器官脱垂定量分期法分别诊断压力性尿失禁(stress urinary incontinence,SUI)、盆腔器官脱垂(pelvic organ prolapse,POP)等疾病,了解所有研究对象产后SUI和POP发生情况;(4)结合问卷调查和病历信息资料,采用单因素和多因素Logistic回归方法开展产后盆底肌力损伤、SUI以及POP发病影响因素分析;(5)在产后复查中按照纳入和排除标准选择了315例患者,在应用盆底肌电生物反馈仪进行盆底功能评估的基础上,采用神经肌肉刺激治疗仪USB4进行电刺激生物反馈联合治疗,然后比较治疗前后盆底表面肌电评估指标和盆底肌力、盆底功能障碍(PFDI-20问卷)评分、尿失禁生活质量(I-QOL问卷)评分以及SUI症状的变化等,评价产后盆底康复治疗的疗效。研究结果1.产后盆底功能障碍性疾病的影响因素分析(1)盆底Ⅰ类、Ⅱ类肌纤维受损检出率分别为94.29%、83.53%。单因素分析发现,分娩方式和新生儿出生体重与产后盆底肌受损相关。多因素分析发现阴道分娩(OR=1.890,95%CI:1.298-2.753)是产后盆底肌力损伤的危险因素。(2)妊娠期SUI和产后SUI检出率分别为23.19%、8.47%,SUI症状从妊娠期持续到产后,占产后SUI的56.90%。单因素分析发现,年龄、孕前BMI、会阴撕裂、分娩方式、产次以及新生儿头围与产后SUI发生相关。多因素分析发现:年龄≥35岁的产妇产后SUI发生的风险增加(OR=2.102,95%CI:1.222-3.615);孕前超重和肥胖可增加SUI发生风险(OR=1.895,95%CI:1.105-3.251);阴道分娩(OR=8.869,95%CI:4.231-18.59)和产次(OR=1.510,95%CI:1.011-2.256)也是产后SUI发生的危险因素。(3)产后阴道前壁膨出、阴道后壁膨出检出率分别为19.05%、4.23%,两者合并占产后阴道前后壁膨出总人数的17.40%;POP-Q诊断为0、Ⅰ、Ⅱ度的检出率分别为80.17%、15.97%、3.87%。单因素分析结果显示:年龄、孕次、会阴撕裂、分娩方式、产次以及新生儿头围与产后阴道前后壁膨出发生有关。多因素分析发现:年龄≥30岁可增加产妇产后阴道前后壁膨出的发生风险(30~35岁组OR=1.375,95%CI:1.072-1.765;年龄≥35岁组OR=1.726,95%CI:1.151-2.589);阴道分娩(OR=5.139,95%CI:3.396-7.779)和产次(OR=1.484,95%CI:1.055-2.086)也是产后阴道前后壁膨出发生的危险因素。2.产后盆底康复治疗效果评价(1)产妇治疗后盆底表面肌电评估结果与治疗前相比,治疗后Glazer评估快速收缩最大值、持续收缩平均值以及耐受测试平均值明显提高,差异有统计学意义;此外,前基线值和后基线值治疗前后比较,差异有统计学意义(t=-24.969~2.014,P0.05)。(2)产妇治疗后盆底肌Ⅰ类肌纤维的平均肌力等级为2.66±1.29级,Ⅱ类肌纤维的平均肌力等级为3.61±1.23级,与治疗前比较,盆底肌Ⅰ类和Ⅱ类肌纤维的平均肌力明显提升,差异均有统计学意义(P0.05)。治疗前盆底肌Ⅰ类肌纤维受损检出率为96.19%,治疗后为48.25%;治疗前Ⅱ类肌纤维受损检出率为90.16%,治疗后为25.71%,治疗前后比较差异有统计学意义(P0.05)。(3)产妇在治疗后I-QOL评分高于治疗前,PFDI-20评分低于治疗前,治疗前后比较差异有统计学意义(P0.05)。(4)产妇治疗后SUI症状比治疗前有所缓解,治疗前后比较差异有统计学意义(P0.05)。研究结论1.产后复查的产妇中盆底肌受损检出率高,并且产后SUI和产后阴道前后壁膨出发生检出率也较高。2.阴道分娩是产后盆底肌力受损的危险因素;产妇年龄≥35岁、孕前BMI超重和肥胖、阴道分娩以及产次增多是产后SUI发生的危险因素;产妇年龄≥30岁、阴道分娩以及产次增多是产后阴道前后壁膨出发生的危险因素。3.盆底肌肉锻炼联合电刺激生物反馈治疗产后盆底功能障碍性疾病具有明显的临床治疗效果,可以明显改善产后盆底功能,提高生活质量,值得在临床上推广。
[Abstract]:Objective 1. to explore the relationship between pregnancy and childbirth and postpartum pelvic floor muscle damage, stress urinary incontinence (stress urinary incontinence, SUI) and pelvic organ prolapse (pelvic organ prolapse, POP) and other pelvic floor disorders. The treatment of postpartum pelvic floor dysfunction (pelvic floor dysfunction, PFD) provides a theoretical basis for the clinical prevention and treatment of postpartum pelvic floor dysfunction. The study method was selected in April -2016 in November 2015 in Gansu maternal and child health care hospital, and 2173 cases of single parturients reexamined after postpartum were reviewed after postpartum 6~8 weeks. The age was 29.49 + 3.93 years. The following studies were carried out: (1) through questionnaire survey and collection of inpatient electronic medical records information, including maternal basic situation, delivery and pregnancy complications; (2) the use of hand test and vaginal strength table test pelvic floor muscle strength, analysis of all subjects postpartum pelvic floor muscle damage; (3) The diagnosis of pressure urinary incontinence (stress urinary incontinence, SUI), pelvic organ prolapse (pelvic organ prolapse, POP) and other diseases were used to diagnose the occurrence of SUI and POP in all the subjects after postpartum clinic diagnosis and pelvic organ prolapse, respectively. (4) a single factor and a single factor were used in combination with questionnaire survey and medical record information. Multi factor Logistic regression method was used to carry out postpartum pelvic floor muscle damage, SUI and the influencing factors of POP; (5) 315 patients were selected according to the inclusion and exclusion criteria during postpartum reexamination, and on the basis of pelvic floor function evaluation by using pelvic floor electromyography biofeedback instrument, the neuromuscular stimulation therapy instrument USB4 was used for electrical stimulation. Feedback combined treatment, and then compare the evaluation index of pelvic floor surface electromyography and pelvic floor muscle strength, pelvic floor dysfunction (PFDI-20 questionnaire) score, urinary incontinence quality of life (I-QOL questionnaire) and SUI symptoms, and so on to evaluate the curative effect of postpartum pelvic floor rehabilitation. Results 1. the influencing factors of postpartum pelvic floor dysfunction Analysis (1) type I of pelvic floor, the detection rate of muscle fiber damage in class II was 94.29%. 83.53%. single factor analysis found that delivery mode and newborn birth weight were associated with postpartum pelvic floor muscle damage. Multiple factor analysis found that vaginal delivery (OR=1.890,95%CI:1.298-2.753) was a risk factor for postpartum pelvic floor muscle damage. (2) SUI and postpartum SUI test during pregnancy. The incidence of 23.19%, 8.47%, SUI symptoms from pregnancy to postpartum, accounting for postpartum SUI 56.90%. single factor analysis found that age, pre pregnancy BMI, perineum tear, delivery mode, birth, and neonatal head circumference and postpartum SUI incidence. Multivariate analysis found that the risk of postpartum SUI in women aged over 35 years (OR=2.102,95%CI:1.22) increased (OR=2.102,95%CI:1.22 2-3.615); overweight and obesity before pregnancy can increase the risk of SUI (OR=1.895,95%CI:1.105-3.251); vaginal delivery (OR=8.869,95%CI:4.231-18.59) and birth (OR=1.510,95%CI:1.011-2.256) are also the risk factors for postpartum SUI. (3) postpartum vaginal prevaginal wall bulge, vaginal posterior wall bulge detection rate is 19.05%, 4.23%, both of the combination of postpartum vaginal. The total number of bulging in the anterior and posterior wall of the canal was 17.40%, and the detection rate of POP-Q was 0, I, and II was 80.17%, 15.97%. The results of 3.87%. single factor analysis showed that age, pregnancy, perineum tear, mode of delivery, birth, and neonatal head circumference were related to postpartum vaginal wall bulge. The analysis of multiple factors found that the age of older than 30 could increase puerperal postpartum. The risk of prolapse of anterior and posterior vaginal wall (group 30~35 OR=1.375,95%CI:1.072-1.765; age group OR=1.726,95%CI:1.151-2.589 > 35 years old); vaginal delivery (OR=5.139,95%CI:3.396-7.779) and birth (OR=1.484,95%CI:1.055-2.086) is also a risk factor for postpartum vaginal wall swelling (.2.) evaluation of the effect of postpartum pelvic floor rehabilitation (1) parturients After treatment, the results of electromyography of pelvic floor surface were compared with that before treatment. After treatment, the maximum value of rapid contraction, the average value of sustained contraction and the mean value of tolerance test were significantly increased, and the difference was statistically significant. In addition, the difference was statistically significant (t=-24.969~2.014, P0.05) before and after treatment (2). (2) parturients (2) The average muscle strength grade of type I muscle fiber of pelvic floor muscle was 2.66 + 1.29 grades after treatment. The average muscle strength grade of class II muscle fibers was 3.61 + 1.23 grades. Compared with before treatment, the average muscle strength of type I and class II muscle fibers of pelvic floor muscle improved significantly (P0.05). The detection rate of type I muscle fiber damage of pelvic floor muscle before treatment was 96.19%. After treatment, 48.25%, the detection rate of class II muscle fiber damage before treatment was 90.16%, after treatment was 25.71%, before and after treatment, the difference was statistically significant (P0.05). (3) the I-QOL score of parturients was higher than before treatment, PFDI-20 score was lower than before treatment, and before and after treatment, the difference was statistically significant (P0.05). (4) SUI symptoms after the treatment of parturients were compared. Before and after treatment, the difference was statistically significant (P0.05). Conclusion 1. postpartum reexamination of the maternal pelvic floor muscle damage detection rate is high, and postpartum SUI and postpartum vaginal wall swelling detection rate is also higher.2. vaginal delivery is a risk factor for postpartum pelvic floor muscle damage; maternal age is more than 35 years old, pre pregnancy BMI overweight Obesity, vaginal delivery and increased production are the risk factors for postpartum SUI, the age of parturients is more than 30 years, vaginal delivery and increased production are the risk factors for postpartum vaginal wall swelling,.3. pelvic floor muscle exercise combined with biofeedback therapy for postpartum pelvic floor dysfunction has obvious clinical therapeutic effect. It can obviously improve postpartum pelvic floor function and improve the quality of life. It is worthy of clinical promotion.

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

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