不同产科因素对女性盆底功能的影响研究
发布时间：2018-11-16 18:53
【摘要】：目的：本研究应用生物反馈仪电刺激评估及盆底超声测定盆底功能改变的临床意义，探讨不同产科因素对盆底功能的影响及女性盆底功能障碍性疾病的发病因素，旨在为其预防和治疗提供理论依据。 方法：采用随机方法选择在石河子大学第一附属医院门诊行问卷调查、POP-Q评估的342例妇女，愿意行盆底超声检测的254例病人，愿意行盆底反馈电刺激治疗仪评估的238例病人。采用方差分析不同产科因素在盆底反馈电刺激治疗仪评估各指标中的比较，分析有无压力性尿失禁在盆底超声测量的改变，并对342例妇女用非条件Logistic回归分析方法确定PFD的相关因素(P0.05)。 结果：①盆底肌组织评估的238例妇女中在盆底肌组织评估中阴道分娩组的盆底肌持续肌力值、盆底肌最大收缩力值等高于剖宫产组，剖宫产组高于未生育组，三组比较均有统计学意义(P＜0.05)；在不同体重指数中，肥胖组在盆底肌组织评估中明显高于超重组，正常组略高于肥胖组，三组比较有统计学意义(P＜0.05)；在新生儿出生体重中，两组在盆底肌组织评估中比较有统计学意义(P＜0.05)。②盆底超声测定的254例妇女，SUI组在测量膀胱颈角度（静息状态与最大Valsalva动作）、膀胱旋转角度及膀胱颈移动度等明显高于正常组，，两组组比较有统计学意义(P＜0.05)。③342例妇女中Logistic回归分析显示，SUI的发生与分娩方式、体重指数、新生儿出生体重等因素有关，与年龄、绝经、孕期体重指数增加、会阴侧切等因素无关(P0.05)。 结论：①通过生物反馈电刺激仪评估盆底肌力各项指标，发现PFD的发生与盆底肌收缩力下降有关，作为盆底功能评估及治疗提供一个客观而实用的参考指标。②不同分娩方式对女性盆底肌力的改变不同，阴道分娩导致盆底肌力下降明显，选择剖宫产对盆底功能有一定的保护作用，但并不能完全避免PFD的发生。③不同体重指数对与PFD的发生密切相关，且盆底肌力随体重指数的增加而降低。④随着新生儿体重的增加，盆底肌力降低，巨大儿对盆底组织有损伤，与PFD的发生密切相关。⑤尿道膀胱解剖学的改变与SUI发生密切相关，盆底超声的测定对SUI的诊断有重要意义⑥Logistic回归结果显示分娩方式、体重指数、新生儿体重等对盆底功能改变的主要因素，分娩使盆底肌力下降，肌肉疲劳增加，尿道膀胱解剖结构改变。⑦年龄、绝经、孕期体重指数增加、会阴侧切等对盆底功能的改变无明显相关，年龄应该是女性盆底功能障碍的发病因素，可能与本次样本量的选择有关，也可能是协同其他因素促进盆腔器官脱垂的发生⑧本次研究采用盆底超声测定与盆底反馈电刺激评估盆底功能的改变，在PFD中诊断中具有重要的临床意义。
[Abstract]:Objective: the purpose of this study was to evaluate the effects of different obstetrical factors on pelvic floor function and to explore the clinical significance of pelvic floor function assessment by biofeedback instrument and pelvic floor ultrasound. The aim is to provide theoretical basis for its prevention and treatment. Methods: a total of 342 women who were assessed by POP-Q in outpatient clinic of the first affiliated Hospital of Shihezi University and 254 patients who were willing to be examined by pelvic floor ultrasound were selected by random method. There were 238 patients who were willing to be evaluated by pelvic floor feedback electric stimulation therapy instrument. Using variance analysis of different obstetrical factors in pelvic floor feedback electrical stimulation apparatus to evaluate the indicators, analysis of whether there is pressure urinary incontinence in pelvic floor ultrasound measurement changes. The relative factors of PFD were determined by non-conditional Logistic regression analysis in 342 women (P0.05). Results: 1 among 238 women with pelvic floor muscle tissue evaluation, the pelvic floor muscle strength and the maximal contractility of pelvic floor muscle in vaginal delivery group were higher than those in caesarean section group, and that in caesarean section group was higher than that in barren group. There was significant difference among the three groups (P < 0.05). In different body mass index, the assessment of pelvic floor muscle tissue in obese group was significantly higher than that in superrecombination group, and that in normal group was slightly higher than that in obese group, and there was statistical significance among the three groups (P < 0.05). In neonatal birth weight, there was significant difference between the two groups in the assessment of pelvic floor muscle tissue (P < 0. 05). 2 in the SUI group, the bladder neck angle (resting state and maximal Valsalva movement) was measured in 254 women with pelvic floor ultrasound. The angle of bladder rotation and the degree of bladder neck movement were significantly higher in the two groups than in the normal group (P < 0. 05). Logistic regression analysis showed that the incidence of SUI was associated with the mode of delivery and body mass index (BMI) in 3342 women. The birth weight of newborn was related to age, menopause, increase of body mass index during pregnancy, lateral perineal resection and so on (P0.05). Conclusion: 1 the indexes of pelvic floor muscle strength were evaluated by biofeedback electrical stimulator. It was found that the occurrence of PFD was related to the decrease of pelvic floor muscle contractility. As an objective and practical reference index for evaluation and treatment of pelvic floor function. 2 the changes of pelvic floor muscle strength in women with different delivery modes were different, and vaginal delivery resulted in a significant decrease in pelvic floor muscle strength. Cesarean section has some protective effect on pelvic floor function, but it can not completely avoid the occurrence of PFD. 3 different body mass index is closely related to the occurrence of PFD. The pelvic floor muscle strength decreased with the increase of body mass index. 4 with the increase of neonatal body weight, pelvic floor muscle strength decreased, and macrosomia caused damage to pelvic floor tissue. 5 the changes of urethral bladder anatomy were closely related to the occurrence of SUI. The pelvic floor ultrasound was of great significance for the diagnosis of SUI. The results of 6Logistic regression showed the mode of delivery and body mass index. The main factors of the changes of pelvic floor function, such as neonatal weight, etc., were that the pelvic floor muscle strength decreased, muscle fatigue increased, urethral bladder anatomical structure changed. 7 years old, menopause, pregnancy body mass index increased, There was no significant correlation between perineal lateral resection and pelvic floor function. Age should be the etiological factor of pelvic floor dysfunction in women, which may be related to the selection of sample size. It is also possible that other factors promote the occurrence of pelvic organ prolapse. This study uses pelvic floor ultrasound and pelvic floor feedback electrical stimulation to evaluate the changes of pelvic floor function, which has important clinical significance in the diagnosis of PFD.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.5
本文编号：2336350
[Abstract]:Objective: the purpose of this study was to evaluate the effects of different obstetrical factors on pelvic floor function and to explore the clinical significance of pelvic floor function assessment by biofeedback instrument and pelvic floor ultrasound. The aim is to provide theoretical basis for its prevention and treatment. Methods: a total of 342 women who were assessed by POP-Q in outpatient clinic of the first affiliated Hospital of Shihezi University and 254 patients who were willing to be examined by pelvic floor ultrasound were selected by random method. There were 238 patients who were willing to be evaluated by pelvic floor feedback electric stimulation therapy instrument. Using variance analysis of different obstetrical factors in pelvic floor feedback electrical stimulation apparatus to evaluate the indicators, analysis of whether there is pressure urinary incontinence in pelvic floor ultrasound measurement changes. The relative factors of PFD were determined by non-conditional Logistic regression analysis in 342 women (P0.05). Results: 1 among 238 women with pelvic floor muscle tissue evaluation, the pelvic floor muscle strength and the maximal contractility of pelvic floor muscle in vaginal delivery group were higher than those in caesarean section group, and that in caesarean section group was higher than that in barren group. There was significant difference among the three groups (P < 0.05). In different body mass index, the assessment of pelvic floor muscle tissue in obese group was significantly higher than that in superrecombination group, and that in normal group was slightly higher than that in obese group, and there was statistical significance among the three groups (P < 0.05). In neonatal birth weight, there was significant difference between the two groups in the assessment of pelvic floor muscle tissue (P < 0. 05). 2 in the SUI group, the bladder neck angle (resting state and maximal Valsalva movement) was measured in 254 women with pelvic floor ultrasound. The angle of bladder rotation and the degree of bladder neck movement were significantly higher in the two groups than in the normal group (P < 0. 05). Logistic regression analysis showed that the incidence of SUI was associated with the mode of delivery and body mass index (BMI) in 3342 women. The birth weight of newborn was related to age, menopause, increase of body mass index during pregnancy, lateral perineal resection and so on (P0.05). Conclusion: 1 the indexes of pelvic floor muscle strength were evaluated by biofeedback electrical stimulator. It was found that the occurrence of PFD was related to the decrease of pelvic floor muscle contractility. As an objective and practical reference index for evaluation and treatment of pelvic floor function. 2 the changes of pelvic floor muscle strength in women with different delivery modes were different, and vaginal delivery resulted in a significant decrease in pelvic floor muscle strength. Cesarean section has some protective effect on pelvic floor function, but it can not completely avoid the occurrence of PFD. 3 different body mass index is closely related to the occurrence of PFD. The pelvic floor muscle strength decreased with the increase of body mass index. 4 with the increase of neonatal body weight, pelvic floor muscle strength decreased, and macrosomia caused damage to pelvic floor tissue. 5 the changes of urethral bladder anatomy were closely related to the occurrence of SUI. The pelvic floor ultrasound was of great significance for the diagnosis of SUI. The results of 6Logistic regression showed the mode of delivery and body mass index. The main factors of the changes of pelvic floor function, such as neonatal weight, etc., were that the pelvic floor muscle strength decreased, muscle fatigue increased, urethral bladder anatomical structure changed. 7 years old, menopause, pregnancy body mass index increased, There was no significant correlation between perineal lateral resection and pelvic floor function. Age should be the etiological factor of pelvic floor dysfunction in women, which may be related to the selection of sample size. It is also possible that other factors promote the occurrence of pelvic organ prolapse. This study uses pelvic floor ultrasound and pelvic floor feedback electrical stimulation to evaluate the changes of pelvic floor function, which has important clinical significance in the diagnosis of PFD.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.5
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相关期刊论文 前2条
1 王建六;曹冬;张晓红;王世军;李小平;吴俊改;陈捷;;北京郊区女性尿失禁及盆腔脏器脱垂发病情况及其对生活质量影响的抽样调查[J];中国妇产科临床杂志;2007年01期
2 单学敏;陆叶;苏士萍;张冬;廖秦平;;产后盆底肌力筛查及其临床意义[J];中国妇产科临床杂志;2012年02期
本文编号：2336350
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