IR@PKUHSC  > 北京大学第二临床医学院
学科主题妇产科学
产科因素对女性盆底肌力的近期影响和产后盆底功能恢复状况
王润之
2016-11-17
导师孙秀丽
专业妇产科学
授予单位北京大学
授予地点北京大学第二临床医学院
学位硕士
关键词产科因素 盆底肌功能 尿失禁 泌尿生殖障碍简表
其他题名The short-term effects of obstetric factors on the strength of pelvic
分类号R711.5
摘要

目的:比较女性产后不同时间的盆底功能并探讨不同产科相关因素对产后盆底功能的近期影响。

方法:开展一项横断面调查,选取2016年8月至2016年10月期间在北京大学人民医院产科分娩后6周、10周、14周的健康产妇。对其进行盆底肌功能检查(I、II类肌纤肌力、疲劳度及阴道动态压)、填写泌尿生殖障碍简表(UDI-6),并收集其产科相关资料,进行不同因素的相关性分析和对比。

结果:1. 接受检查产妇共347例,其中产后6周者114例,产后10周者143例,产后14周者90例,对三组病人基本情况进行统计分析,三组产妇平均年龄、孕产次、孕周、孕前和分娩前体重指数、新生儿出生体重、分娩方式、助产比例比较,差异均无统计学意义(P<0.05);2. 产后6周、10周、14周组阴道动态压平均水平分别为62.83cmH2O、95.14cmH2O、90.70cmH2O,产后10周及14周组明显高于于产后6周组,但产后10周和14周间无明显差异。产后6周、10周、14周三组I类肌纤维肌力平均水平分别为3.74、3.71、4.59,其中产后6周和14周之间、产后10周和14周之间肌力有明显差异(P<0.001),但产后6周和10周间无明显差异。三组II类肌纤维肌力平均水平分别为3.71、4.22、4.84,各组间均有明显差异(P<0.01)。三组I类肌纤维疲劳度平均水平分别为-0.86、-0.76、-0.24,II类肌纤维疲劳度平均水平分别为-0.3、-0.27、-0.04,其中产后6周和10周间无明显差异,但它们与产后14周间均有明显差异(P<0.001);3.产后6周的产妇中,第二产程时间超过90分钟后,阴道动态压明显降低,差异具有统计学意义(P=0.047),但90分钟内的第二产程对阴道动态压无明显影响。分娩前BMI与盆底肌II类纤维疲劳度相关(P=0.02);4.产后10周的产妇中,第二产程时间与盆底肌I类肌纤维疲劳度相关(P=0.017);5. 产后14周病例中,孕期增重与盆底肌II类肌纤维疲劳度相关(P=0.049),孕期增重与盆底肌II类肌纤维肌力相关(P=0.039)。6.分娩方式与产后盆底功能无明显相关性。

结论:分娩前BMI、孕期增重、第二产程时间在不同程度上影响盆底功能,推断产后盆底功能随时间呈现自然恢复趋势。

英文摘要

Objective: To investigate the short-term effects of different obstetric factors on pelvic floor muscles and the natural change of the function of pelvic floor in different time after delivery without interference.

Methods: Conduct a cross-sectional survey and women who gave birth in Peking University People’s Hospital during August 2016 to November 2016 were interviewed at 6, 10, 14 weeks after delivery. Measurements of the function of pelvic floor(vaginal pressure, strength of type I muscle, trength of type II muscle and  fatigue of muscles) and Questionnaire of  Urogenital Distress Inventory(UDI-6) were used for evaluation and comparison.

Results: 1.114, 143, 90 cases of women are interviewed at 6, 10, 14 weeks after delivery separately. Analysis the data of common condition of three groups, we found no significant difference in average age, gravidity and oarity history, gestational weeks, BMI before pregnancy and delivery, neonatal birth weight, method of delivery and the rate of assisted delivery. 2. In comparison among three different weeks after delivery, the function of pelvic floor muscle is significantly different. The average vaginal pressure in three groups is 62.83cmH2O, 95.14 cmH2O and 90.70cmH2O. The average vaginal pressure in the 6 weeks postpartum group is significantly lower than that in 10 or 14 weeks postpartum (P<0.001). But the average vaginal pressure in the 10 weeks and  14 weeks postpartum group is not different. The average strength of type I muscle is 3.74, 3.71 and 4.59.  The average strength in the 6 or 10 weeks postpartum group is significantly lower than that in 14 weeks postpartum (P<0.001).  The average strength of type II muscle is 3.71, 4.22 and 4.84 and there are significant differences among three groups. The average degree of fatigue of type I muscle is  -0.86, -0.76 and -0.24,of type II muscle is -0.3,-0.27 and -0.04.The average function of pelvic floor muscle in the 6 or 10 weeks postpartum group is significantly lower than that in 14 weeks postpartum (P<0.001). But the average level of fatigue of both type I and type II muscles between 6 weeks and  10 weeks postpartum group is not different. 3. In cases of 6 weeks postpartum,   antepartum BMI is related to fatigue degree of type II muscle fiber and postpartum scores in UDI-6( P<0.05). 4. In cases of 10 weeks postpartum, the duration of the second stage is related to the fatigue degree of type I muscle fiber (P=0.017). Antepartum BMI and the gaining weight are both related to scores of  UDI-6 during pregnancy( P<0.05); the duration of the first stage of delivery is related to postpartum scores of UDI-6( P=0.021). 5. In cases of 14 weeks after delivery, the gaining weight during pregnancy is related to the fatigue degree and strength of type II muscle fiber, and antepartum scores of UDI-6( P<0.05). BMI before pregnancy is related to postpartum scores of UDI-6( P=0.02).  6. The method of delivery has no significant relationship with postpartum pelvic floor function.

Conclusions: BMI before pregnancy, BMI before delivery and the weight gain have effects on the function of pelvic floor muscle, while other obstetric factors have no significant influence on it, and It suggests the function of pelvic floor could naturally recover during the postpartum time.

语种中文
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文献类型学位论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/124612
专题北京大学第二临床医学院
作者单位北京大学第二临床医学院
推荐引用方式
GB/T 7714
王润之. 产科因素对女性盆底肌力的近期影响和产后盆底功能恢复状况[D]. 北京大学第二临床医学院. 北京大学,2016.
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