初产妇产后盆底功能障碍性疾病早期康复治疗最佳时期选择
发布时间：2019-07-06 10:28
【摘要】：女性盆底功能障碍性疾病(female pelvic floor dysfunc-tion,FPFD)是影响女性生活质量的五大慢性疾病之一,包括尿失禁、便失禁、盆腔器官脱垂、慢性盆腔痛以及性功能障碍,国内资料报道其发病率可高达25.8%~35.3%。女性盆底功能障碍性疾病(pelvic floor dysfunc-tion,PFD)是一种多因素性疾病,其病理生理发病机制并不完全清楚,目前已知的危险因素主要有年龄、肥胖、妊娠和分娩、产次、第二产程延长、生殖系统炎症、糖尿病、结缔组织疾病、神经系统疾病及遗传等;这些危险因素大多可进行或多或少的人为干预(如:改变生活方式)来降低PFD的发生率,但是妊娠和分娩却是几乎每个女性都无法逃避的问题,流行病学数据表明:妊娠和分娩是PFD的独立危险因素【1-2】。产后FPFD发病率明显增加,大大降低了产妇的生活质量;目前大量研究已证实盆底康复治疗疗效显著【3-5】,可有效预防和治疗盆底障碍性疾病【6-7】,提高女性生活质量,但迄今为止对于康复治疗最佳时期的研究仍旧较少,且国内外迄今仍没有统一的定论;通过对在产后不同时期进行盆底康复治疗的产妇,产后1年盆底功能恢复情况的对比,进而找出产后早期最佳康复治疗时期,旨在为PFD的防治提供临床依据。研究目的通过对在产后不同时期进行盆底康复治疗的产妇,产后1年盆底功能恢复情况的对比,进而找出产后早期最佳康复治疗时期,旨在为PFD的防治提供临床依据。研究对象与方法1研究对象与分组选取2014.11—2015.11在郑州大学第三附属医院进行常规产后42天盆底筛查出肌力3级、有子宫脱垂、存在漏尿症状3次的初产妇478例;根据个人意愿分为治疗组256例和未治疗组222例,治疗组根据产后开始治疗时间的不同,又分为42天,3个月和6个月治疗组;产后1年进行随访、复查(剔除中途放弃治疗、失访、再次怀孕及数据记录错误人数外),最终得到42天组40例、3个月组30例、6个月组30例,未治疗组100例,并对这200例初产妇盆底功能的恢复情况进行对比。2研究方法产后42天由妇产科专科医师进行手法检测+PHENIX U8低频神经肌肉刺激治疗仪(广州杉山医药器械实业有限公司提供)检测盆底肌情况。治疗组采用盆底肌肉康复系统进行盆底肌康复治疗,主要包括生物反馈+低频电刺激,每次治疗30min,每周治疗2次,治疗10次为1疗程,治疗期满一疗程后,嘱产妇在家自行做Kegel运动+家庭盆底康复器(阴道哑铃)收缩锻炼。未治疗组仅给与常规的产后健康教育,压力性尿失禁由调查问卷的方式完成。3监测指标肌力:根据Oxford骨盆底肌力评分(0-5级),≥3级属于正常;(2)盆底肌纤维疲劳度:盆底肌肉由Ⅰ类肌纤维(即与脏器支持作用相关的慢收缩纤维)和Ⅱ类肌纤维(即在腹压上升时关闭尿道的快收缩纤维)组成。起点的最高点到6 s终点的最高点之间的下降比率的百分比为疲劳度,正常值为0%或正值,负值为异常;(3)盆底肌最大肌电位值:即为盆底收缩时参与收缩的肌纤维肌电位的总和,范围为1—30uv;(4)子宫脱垂分度:按第8版“妇产科学”盆腔器官脱垂分度(POP-Q分度法)评分标准进行评分;(5)压力性尿失禁(SUI):参考国际尿失禁问卷表简表(ICIQ-SF)以“腹压增加时,如:打喷嚏、咳嗽、大笑或提重物时,尿液不自主漏出”,为SUI症状。出现漏尿次数大于等于3次。4统计学方法采用SPSS21.0软件进行数据录入与分析。计量资料以(`X±S)表示,数据符合正态分布,计量资料中多组间比较采用单因素方差分析法,组内两两比较采用LSD检验;计数资料用卡方检验,多组比较P0.05,差异有统计学意义;多个实验组与对照组比较的校正检验水准α=0.01,P0.01差异有统计学意义;多个实验组间两两比较的校正检验水准α=0.0167,P0.0167差异有统计学意义。结果1.产后42天筛查结果显示:4组产妇盆底功能差异无统计学意义(P0.05);2.产后1年随访复查结果显示:盆底肌力:42天治疗组与3个月治疗组(P0.0167),6个月治疗组与未治疗组(P0.01)比较差异无统学意义,其余各组比较差异均有统计学意义;盆底肌疲劳度:42天治疗组与3个月治疗组疗效基本相同,差异无统计学意义(P0.0167),其余各组比较差异均有统计学意义;最大肌电位:4组两两比较差异均具有统计学意义;子宫脱垂与尿失禁:42天治疗组发生率明显低于未治疗组,差异有统计学意义(P0.01),其余各组比较差异均无统计学意义;结论1..产后3个月内是改善盆底肌力及肌纤维疲劳度的最佳时期;2.产后42天是治疗子宫脱垂及压力性尿失禁的最佳时期;
[Abstract]:The female pelvic floor dysfunc-tion (FPFD) is one of the five chronic diseases that affect the quality of women's life, including urinary incontinence, incontinence, pelvic organ prolapse, chronic pelvic pain and sexual dysfunction. female pelvic floor dysfunc-tion (pfd) is a multi-factor disease, and its pathophysiological mechanism is not entirely clear, and the currently known risk factors are mainly age, obesity, pregnancy and delivery, secondary labor, second stage of labor, inflammation of the reproductive system, and diabetes, connective tissue diseases, nervous system diseases, and inheritance; most of these risk factors can be used for more or less human intervention (e.g., lifestyle changes) to reduce the incidence of the PFD, but pregnancy and delivery are a problem that almost every woman cannot escape, and the epidemiological data indicate that: Pregnancy and delivery are independent risk factors for PFD[1-2]. The incidence of post-partum FPFD is obviously increased, and the quality of life of the parturient is greatly reduced; a large number of studies have shown that the curative effect of the pelvic floor rehabilitation therapy is remarkable[3-5], and can effectively prevent and treat the pelvic floor disorder[6-7] and improve the quality of life of the female, but so far, the research on the best period of rehabilitation therapy is still relatively small, and there is no single conclusion to date at home and abroad; and through the comparison of the recovery of the pelvic floor function in the postpartum period of one year after the delivery of the pelvic floor rehabilitation in different periods of the post-partum period, In order to provide a clinical basis for the prevention and treatment of the PFD. The purpose of this study was to provide a clinical basis for the prevention and treatment of the PFD by comparing the recovery of the pelvic floor function during the postpartum period. The study object and method 1 study object and group selection was 2014.11-2015.11, in the third affiliated hospital of Zhengzhou University, the third affiliated hospital of Zhengzhou University was screened out the third grade of the muscle strength, with the uterus prolapsed, and the first of the 478 cases with the symptoms of leakage of urine were found in 478 cases; According to the individual's will, the treatment group was divided into the treatment group (256 cases) and the untreated group (222 cases). The treatment group was divided into two groups (42 days,3 months and 6 months) according to the difference of the treatment time after the postpartum period. The follow-up was carried out for 1 year after the delivery, and the treatment and the lost-to-follow-up were carried out in one year after the delivery. In addition to that number of re-pregnancy and data record,40 of the 42-day group,30 in the 3-month group,30 in the 6-month group and 100 in the untreated group were obtained. In this paper, the recovery of pelvic floor function in 200 cases of primary parturient was compared. The method was used to detect the pelvic floor muscle in 42 days after the delivery of the method by the obstetrician of the department of obstetrics and gynecology. The therapeutic apparatus of the low frequency neuromuscular stimulation of PHENIX U8 (provided by Hupershan Medical Device Industry Co., Ltd.) was used to detect the pelvic floor. the treatment group adopts a pelvic floor muscle rehabilitation system to perform pelvic floor muscle rehabilitation treatment, mainly comprises biofeedback and low-frequency electrical stimulation, The woman is told to do the Kegel exercise and the family pelvic floor rehabilitation device (the vaginal dumbbell) to shrink and exercise. In the untreated group, only routine post-natal health education was given, and the stress urinary incontinence was completed in the form of a questionnaire.3 Monitoring index muscle strength: according to the Oxford pelvic floor muscle strength score (grade 0-5), the level 3 was normal; (2) pelvic floor muscle fatigue: The pelvic floor is composed of type I muscle fibers (i.e., slow-shrinkage fibers associated with organ support) and type II muscle fibers (i.e., fast-contracting fibers that close the urethra when the abdominal pressure rises). the percentage of the descending ratio between the highest point of the starting point and the highest point of the end point of the 6 s is fatigue, the normal value is 0% or the positive value, the negative value is abnormal, and (3) the maximum muscle potential value of the pelvic floor muscle is the sum of the potential of the muscle fiber muscle participating in the contraction when the pelvic floor is contracted, and the range is 1 to 30 uv; (4) Classification of the Prolapse of the Uterus: Score according to the Standard of the "Obstetrics and Gynecology" of the Pelvic Organ Prolapse (POP-Q) of the 8th edition; (5) Stress Urinary Incontinence (SUI): Refer to the Summary of the International Urinary Incontinence Questionnaire (ICIQ-SF) for "When the abdominal pressure is increased, such as sneezing, coughing, laughing or lifting the weight, the urine does not leak spontaneously" and the symptoms of SUI. The number of urine leakage was greater than or equal to 3 times. The data entry and analysis were performed using the SPSS21.0 software in the statistical method. The data was expressed as (% X-S). The data met the normal distribution. The single-factor analysis of variance method was used to compare the two groups in the measurement data. The level of the correction test compared with the control group was statistically significant (P = 0.01, P 0.01). The corrected level of the two comparisons between the two experimental groups was equal to 0.0167. Results 1. The results of post-partum 42-day screening showed that there was no significant difference in the function of pelvic floor in group 4 (P <0.05);2. The results of follow-up after 1-year follow-up showed that: Pelvic floor muscle strength:42-day treatment group and 3-month treatment group (P0.0167), the difference of the six-month treatment group and the non-treatment group (P0.01) was not significant, the other groups had statistical significance, and the pelvic floor muscle fatigue degree: the curative effect of the 42-day treatment group was basically the same as that of the 3-month treatment group, There was no significant difference in the difference between the two groups (P 0.0167), and the difference of the other groups was statistically significant; the maximum muscle potential: two of the four groups had statistical significance; the incidence of uterine prolapse and urinary incontinence:42-day treatment group was significantly lower than that of the untreated group (P0.01). Conclusion 1. The optimal period for improving the strength of the pelvic floor and the fatigue of the muscle fiber within 3 months after delivery is the best period for the treatment of the prolapse of the uterus and the stress urinary incontinence.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.6
本文编号：2510946
[Abstract]:The female pelvic floor dysfunc-tion (FPFD) is one of the five chronic diseases that affect the quality of women's life, including urinary incontinence, incontinence, pelvic organ prolapse, chronic pelvic pain and sexual dysfunction. female pelvic floor dysfunc-tion (pfd) is a multi-factor disease, and its pathophysiological mechanism is not entirely clear, and the currently known risk factors are mainly age, obesity, pregnancy and delivery, secondary labor, second stage of labor, inflammation of the reproductive system, and diabetes, connective tissue diseases, nervous system diseases, and inheritance; most of these risk factors can be used for more or less human intervention (e.g., lifestyle changes) to reduce the incidence of the PFD, but pregnancy and delivery are a problem that almost every woman cannot escape, and the epidemiological data indicate that: Pregnancy and delivery are independent risk factors for PFD[1-2]. The incidence of post-partum FPFD is obviously increased, and the quality of life of the parturient is greatly reduced; a large number of studies have shown that the curative effect of the pelvic floor rehabilitation therapy is remarkable[3-5], and can effectively prevent and treat the pelvic floor disorder[6-7] and improve the quality of life of the female, but so far, the research on the best period of rehabilitation therapy is still relatively small, and there is no single conclusion to date at home and abroad; and through the comparison of the recovery of the pelvic floor function in the postpartum period of one year after the delivery of the pelvic floor rehabilitation in different periods of the post-partum period, In order to provide a clinical basis for the prevention and treatment of the PFD. The purpose of this study was to provide a clinical basis for the prevention and treatment of the PFD by comparing the recovery of the pelvic floor function during the postpartum period. The study object and method 1 study object and group selection was 2014.11-2015.11, in the third affiliated hospital of Zhengzhou University, the third affiliated hospital of Zhengzhou University was screened out the third grade of the muscle strength, with the uterus prolapsed, and the first of the 478 cases with the symptoms of leakage of urine were found in 478 cases; According to the individual's will, the treatment group was divided into the treatment group (256 cases) and the untreated group (222 cases). The treatment group was divided into two groups (42 days,3 months and 6 months) according to the difference of the treatment time after the postpartum period. The follow-up was carried out for 1 year after the delivery, and the treatment and the lost-to-follow-up were carried out in one year after the delivery. In addition to that number of re-pregnancy and data record,40 of the 42-day group,30 in the 3-month group,30 in the 6-month group and 100 in the untreated group were obtained. In this paper, the recovery of pelvic floor function in 200 cases of primary parturient was compared. The method was used to detect the pelvic floor muscle in 42 days after the delivery of the method by the obstetrician of the department of obstetrics and gynecology. The therapeutic apparatus of the low frequency neuromuscular stimulation of PHENIX U8 (provided by Hupershan Medical Device Industry Co., Ltd.) was used to detect the pelvic floor. the treatment group adopts a pelvic floor muscle rehabilitation system to perform pelvic floor muscle rehabilitation treatment, mainly comprises biofeedback and low-frequency electrical stimulation, The woman is told to do the Kegel exercise and the family pelvic floor rehabilitation device (the vaginal dumbbell) to shrink and exercise. In the untreated group, only routine post-natal health education was given, and the stress urinary incontinence was completed in the form of a questionnaire.3 Monitoring index muscle strength: according to the Oxford pelvic floor muscle strength score (grade 0-5), the level 3 was normal; (2) pelvic floor muscle fatigue: The pelvic floor is composed of type I muscle fibers (i.e., slow-shrinkage fibers associated with organ support) and type II muscle fibers (i.e., fast-contracting fibers that close the urethra when the abdominal pressure rises). the percentage of the descending ratio between the highest point of the starting point and the highest point of the end point of the 6 s is fatigue, the normal value is 0% or the positive value, the negative value is abnormal, and (3) the maximum muscle potential value of the pelvic floor muscle is the sum of the potential of the muscle fiber muscle participating in the contraction when the pelvic floor is contracted, and the range is 1 to 30 uv; (4) Classification of the Prolapse of the Uterus: Score according to the Standard of the "Obstetrics and Gynecology" of the Pelvic Organ Prolapse (POP-Q) of the 8th edition; (5) Stress Urinary Incontinence (SUI): Refer to the Summary of the International Urinary Incontinence Questionnaire (ICIQ-SF) for "When the abdominal pressure is increased, such as sneezing, coughing, laughing or lifting the weight, the urine does not leak spontaneously" and the symptoms of SUI. The number of urine leakage was greater than or equal to 3 times. The data entry and analysis were performed using the SPSS21.0 software in the statistical method. The data was expressed as (% X-S). The data met the normal distribution. The single-factor analysis of variance method was used to compare the two groups in the measurement data. The level of the correction test compared with the control group was statistically significant (P = 0.01, P 0.01). The corrected level of the two comparisons between the two experimental groups was equal to 0.0167. Results 1. The results of post-partum 42-day screening showed that there was no significant difference in the function of pelvic floor in group 4 (P <0.05);2. The results of follow-up after 1-year follow-up showed that: Pelvic floor muscle strength:42-day treatment group and 3-month treatment group (P0.0167), the difference of the six-month treatment group and the non-treatment group (P0.01) was not significant, the other groups had statistical significance, and the pelvic floor muscle fatigue degree: the curative effect of the 42-day treatment group was basically the same as that of the 3-month treatment group, There was no significant difference in the difference between the two groups (P 0.0167), and the difference of the other groups was statistically significant; the maximum muscle potential: two of the four groups had statistical significance; the incidence of uterine prolapse and urinary incontinence:42-day treatment group was significantly lower than that of the untreated group (P0.01). Conclusion 1. The optimal period for improving the strength of the pelvic floor and the fatigue of the muscle fiber within 3 months after delivery is the best period for the treatment of the prolapse of the uterus and the stress urinary incontinence.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.6
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