物理康复治疗对产妇盆底肌恢复效果的临床研究

发布时间：2018-11-27 19:16

【摘要】：女性盆底功能障碍性疾病（pelvic Floor Dysfunction,PFD）是以盆腔脏器脱垂(Pelvic Organ Prolapse,POP)、压力性尿失禁(Stress Urinary Incontinence,SUI)及慢性盆腔疼痛为主要症状的高发疾病，它严重影响女性的健康和生活质量，已经成为人们广泛关注的医疗问题和突出的社会问题，该病病因多样，多数学者一致认为妊娠和分娩是其独立危险因素，妊娠及分娩过程中机械压迫和激素水平的改变可损伤盆底肌及相关支持系统，产后若是不能及时有效的恢复盆底肌功能，其承托盆腔脏器的作用减弱，便容易致使PFD的发生。由于手术治疗PFD存在诸多缺点，同时随着人们对该疾病认识程度的加深，早预防、早治疗已经得到大家的认可，而非手术治疗中的盆底物理康复治疗─电刺激+生物反馈+凯格尔运动受到人们的普遍关注。目的利用PHENIX U8物理康复治疗仪（广州杉山公司提供）对产妇盆底肌肌力、疲劳度、动态压力的检测，分析产后盆底肌功能的自我修复程度以及盆底物理康复治疗对产妇盆底肌功能的改善情况，及不同分娩方式间疗效的差异，说明物理康复治疗对不同分娩方式早期盆底肌功能改善的优越性，继而指导临床，加强广大妇女对产妇盆底肌功能早期预防的观念。材料与方法 1研究对象选取2012年11月～2014年1月产后6~8周来郑州大学第三附属医院复查，符合本研究标准的足月单胎初产妇240例，平均年龄（28.42±2.73）岁，平均分娩孕周为（39±3.57）周，其中阴道分娩120例，选择性剖宫产120例。 2.研究方法通过由专门培训的人员经手法检测+PHENIX U8物理康复治疗仪（广州杉山公司提供）检测盆底肌肌力、疲劳度、盆底动态压力值评估产后早期盆底肌功能。随机选取阴道分娩和选择性剖宫产各60例进行物理康复治疗1个疗程，治疗方法采用PHENIX U8物理康复治疗仪进行电刺激+生物反馈+凯格尔运动联合治疗(治疗组)，剩余两组各60例由专业人员对产妇进行盆底的健康教育1个疗程，方法包括每天150～200次的凯格尔运动(观察组)，各组分别进行比较。 3统计学方法采用SPSS17.0统计软件录入和分析数据，t检验和秩和检验为检验方法，，以α=0.05作为检验水准，分析产后盆底肌功能的自我修复程度以及盆底物理康复治疗对产妇盆底肌功能的改善情况，及不同分娩方式间疗效的差异。结果 1.阴道分娩组及选择性剖宫产组产妇年龄、孕期体重增长、新生儿体重、新生儿身长各自比较，差异均无统计学意义(p0.05)。 2.产后6-8周选择性剖宫产组与阴道分娩组盆底肌肌力、疲劳度、盆底动态压力比较差异无统计学意义（p0.05）。 3.选择性剖宫产治疗后I、II类肌纤维肌力、疲劳度、动态压力优于治疗前，两者比较差异有统计学意义(p0.05)；选择性剖宫产教育后I、II类肌纤维肌力、疲劳度、动态压力优于教育前，两者比较差异有统计学意义(p0.05)。 4.阴道分娩治疗后I、II类肌纤维肌力、疲劳度、动态压力优于治疗前，两者比较差异有统计学意义(p0.05)；阴道分娩教育后肌力、疲劳度、动态压力优于教育前，两者比较差异有统计学意义(p0.05)。 5.阴道分娩治疗后I类、II类肌纤维的肌力、疲劳度、动态压力优于阴道分娩健康教育后，两者比较差异均有统计学意义（p0.05）。 6.选择性剖宫产治疗后优于选择性剖宫产教育后I、II类肌纤维肌力、疲劳度、动态压力，两者比较差异均有统计学意义（p0.05）。 7.阴道分娩治疗后与选择性剖宫产治疗后的I、II类肌纤维肌力、疲劳度、动态压力比较，差异均无统计学意义（p0.05）；选择性剖宫产教育后I类肌纤维肌力、疲劳度、动态压力优于阴道分娩教育后，两者比较差异有统计学意义（p0.05），但两组II类肌纤维肌力、疲劳度比较，差异无统计学意义（p0.05）。结论 1.健康教育对产妇盆底肌功能的恢复有效，产后4个半月时阴道分娩产妇盆底肌I类肌纤维恢复效果较选择性剖宫产差。 2.物理康复治疗对产妇盆底肌功能的恢复效果更明显，可作为轻中度PFD的首选治疗及预防方法，并可以大规模推广。
[Abstract]:The female pelvic floor function (PFD) is a high-incidence disease characterized by pelvic organ prolapse (POP), stress urinary incontinence (SUI) and chronic pelvic pain, which seriously affects the health and quality of life of women. The cause of this disease is diverse, and most scholars agree that pregnancy and delivery are independent risk factors, and the change of mechanical stress and hormone level during pregnancy and delivery can damage the pelvic floor and related support system. If the function of the pelvic floor muscle can not be effectively restored in time after the birth, the function of supporting the pelvic organs is weakened, and the occurrence of the PFD can be easily caused. Because of the shortcomings of the operation in the treatment of the PFD, as well as the understanding of the disease, the early prevention and early treatment have been recognized, and the physical rehabilitation of the pelvic floor in the non-operative treatment is the general concern of the people. Objective To study the self-repairing degree of pelvic floor muscle function and the function of pelvic floor in the pelvic floor by using PHOENIX U8 physical rehabilitation therapy instrument (provided by Guangzhou Sequoia Company) to detect the muscle strength, fatigue and dynamic pressure of the pelvic floor. The effect of physical rehabilitation on the function of pelvic floor in the early stage of different delivery methods is explained by the difference of the good condition and the difference of the curative effect between different delivery methods. The idea. Materials and parties Method 1 The subjects were selected from November, 2012 to January, 2014 for re-examination at the Third Affiliated Hospital of Zhengzhou University. The average age (28. 42, 2.73) years and the average time of delivery were (28. 42 to 2.73). 39 (3.57) weeks, in which 120 cases of vaginal delivery, selected alternative cesarean section 1 20 cases. 2. The method of the study was to test the muscle strength, fatigue and the dynamic pressure of the pelvic floor by means of a specially trained person by means of a manipulation test + PHOENIX U8 physical rehabilitation therapy instrument (provided by the Guangzhou Sequoia Company). The function of early pelvic floor muscle was evaluated by force value. 60 cases of vaginal delivery and selective caesarean section were randomly selected for physical rehabilitation for one course of treatment. The treatment was conducted by using the PHENIX U8 physical rehabilitation apparatus for electrical stimulation + biofeedback + Kay. In the combined treatment (treatment group), 60 patients in the remaining two groups were given a course of treatment for the health education of the pelvic floor by the professional staff. The method included 150 to 200 kanger's movement per day (treatment group). observation group), each The three statistical methods were used to record and analyze the data, t-test and rank sum test as the test method, and the self-repair degree and the basin-bottom physical function of the postpartum pelvic floor were analyzed by using SPSS17.0. The effect of rehabilitation therapy on the function of pelvic floor a good condition The results of the difference of the curative effect between different delivery methods. Results 1. The age of the pregnant women in the vaginal delivery group and the selective caesarean section group, the weight of the pregnant women, the weight of the newborn and the length of the newborn The difference was not significant (p0.05). 2. The muscle strength and fatigue of the pelvic floor of the vaginal delivery group were selected for 6-8 weeks after delivery. There was no significant difference in dynamic pressure of pelvic floor (p0.05). Muscle strength, fatigue and dynamic pressure of the following I and II muscle fibers Compared with the pre-treatment, there was a significant difference between the two groups (p0.05). 4. The muscle strength, fatigue and dynamic pressure of the I and II muscle fibers after the vaginal delivery were better than those before the treatment (p0.05); the muscle strength, fatigue, and the dynamics of the vaginal delivery education were statistically significant (p0.05). The results showed that the muscle strength, fatigue and dynamic pressure of Class I and II muscle fibers after vaginal delivery were superior to that of yin. After the delivery of health education, the difference between the two groups was statistically significant (p0.05). 6. The selective cesarean section was superior to that of the I and II muscle fibers after the selective cesarean section. The difference of force, fatigue and dynamic pressure was statistically significant (p0.05). 7. There was no significant difference in the muscle strength, fatigue and dynamic pressure of I and II muscle fibers after vaginal delivery (p0.05). After the selective cesarean section, the muscle strength, fatigue and dynamic pressure of the type I muscle fibers were better than that of the vaginal delivery, and the difference of the two groups was statistically significant (p0.05). but two Conclusion 1. The effect of health education on the function of the pelvic floor muscle of the parturient is not significant (p0.05). The effect of the recovery of the muscle fibers of the pelvic floor in the vaginal delivery is less than that of the selective cesarean section at 4 and a half months after the delivery.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.5

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