摘要
目的 探讨妊娠期盆底肌训练联合核心肌群稳定性训练对产妇盆底功能的影响.方法 前瞻性选取2022年3月至2024年2月唐山妇幼保健院收治的210例孕妇作为研究对象,按照数字表法将其分为两组,各105例.观察组妊娠期盆底肌训练从孕16周训练至分娩前,于产后7 d继续锻炼至42 d,产后第2天开始联合核心肌群稳定性训练.对照组无盆底肌训练,仅在产后做核心肌群稳定性训练.比较两组产程时间,产后8周的盆底表面肌电(前静息阶段平均值与变异性、Ⅰ类肌纤维平均值与变异性、Ⅱ类肌纤维最大值、上升时间与恢复时间、后静息阶段平均值与变异性)、盆底肌收缩力量、盆底超声[子宫颈外口移动度(CD)、肛提肌裂孔直径差值(LHD-d)、肛提肌裂孔横径差值(LHLR-d)、直肠壶腹移动度(RAD)、膀胱颈移动度(BND)]、肛门功能(肛管静息压、肛管收缩压、直肠静息压、直肠排便压)、盆腔器官脱垂(POP)、排尿功能[压力性尿失禁(SUI)、急迫性尿失禁(UUI)、混合性尿失禁(MUI)及尿失禁(UI)总发生率].结果 观察组的第一至第三产程耗时及总产程耗时均低于对照组,差异均有统计学意义(P＜0.05).观察组的前静息阶段平均值、Ⅰ类肌纤维平均值、Ⅱ类肌纤维最大值、后静息阶段平均值高于对照组,前静息阶段、Ⅰ类肌纤维、后静息阶段的变异性均小于对照组,Ⅱ类肌纤维上升时间和恢复时间均低于对照组,差异均有统计学意义(P＜0.05).观察组盆底肌收缩力量Ⅱ级、Ⅲ级率为0、18.10％,低于对照组(20.00％、34.29％),观察组V级以及Ⅳ～Ⅴ级率分别为43.81％、81.90％,高于对照组(18.10％、45.71％),差异均有统计学意义(P＜0.05).观察组的肛管静息压、肛管收缩压、直肠静息压、直肠排便压均高于对照组,差异均有统计学意义(P＜0.05).观察组产后未发生POP,观察组POP、UI总发生率分别为0、19.05％,均低于对照组(4.76％、34.29％),差异均有统计学意义(P＜0.05).结论 妊娠期盆底肌训练联合核心肌群稳定性训练可缩短产程,促进产妇盆底功能恢复,提高盆底肌肌力,减少尿失禁发生.
Abstract
Objective To explore the effect of pelvic floor muscle training combined with core muscle stability training during pregnancy on pelvic floor function in parturients.Methods A total of 210 pregnant women admitted to Tangshan Maternal and Child Health Hospital from March 2022 to February 2024 were prospectively selected as the research objects,and they were divided into two groups according to the digital ta-ble method,105 cases in each group.The observation group received pelvic floor muscle training during pregnancy from 16 weeks of gestation until delivery,and continued to exercise from 7 days postpartum until 42 days postpartum.On the second day postpartum,a combination of core muscle stability training was started.The control group did not receive pelvic floor muscle training and only underwent core muscle stability training after delivery.The duration of labor,pelvic floor surface electromyography(mean and variability of pre resting phase,mean and variability of type Ⅰmuscle fibers,maximum value of type Ⅱ muscle fibers,rise time and recovery time,mean and variability of post resting phase),pelvic floor mus-cle contraction strength,pelvic ultrasound[cervix down distance(CD),bladder neck down distance(BND),the differences of levator hiatal later-al diameter(LHLR-d),the differences of levator hiatal diameter(LHD-d),rectal ampulla diameter(RAD)],anal function(anal resting pres-sure,anal systolic pressure,rectal resting pressure,rectal defecation pressure),pelvic organ prolapse(POP),urinary function[stress urinary in-continence(SUI),urgency urinary incontinence(UUI),mixed urinary incontinence(MUI),and overall urinary incontinence(UI)incidence]at 8 weeks postpartum were compared between the two groups.Results The time of the first to third stage of labor and the total labor time in the observation group were lower than those in the control group,and the differences were statistically significant(P＜0.05).The average values of pre resting stage,class I muscle fibers,maximum class Ⅱ muscle fibers,and post resting stage in the observation group were higher than those in the control group,the variability of pre resting stage,class Ⅰ muscle fibers,and post resting stage was lower than that in the control group,the rise time and recovery time of class Ⅱ muscle fibers were significantly lower than those in the control group,and the differences were statistically significant(P＜0.05).The rates of pelvic floor muscle contraction strength grade Ⅱ and grade Ⅲ in the observation group were 0 and 18.10％,respectively,which were lower than those in the control group(20.00％,34.29％),the rates of grade Ⅴ and grade Ⅳ-Ⅴ in the observation group were 43.81％and 81.90％,respectively,which were higher than those in the control group(18.10％,45.71％),the differences were statistically significant(P＜0.05).The CD,BND,LHLR-d,LHD-D,and RAD in the observation group were all lower than those in the control group,and the differences were statistically significant(P＜0.05).The resting pressure of the anal canal,the systolic pressure of the a-nal canal,the resting pressure of the rectum,and the defecation pressure of the rectum in the observation group were higher than those in the con-trol group,and the differences were statistically significant(P＜0.05).There was no POP in the observation group after delivery.The total inci-dence of POP and UI in the observation group was 0 and 19.05％,respectively,which were lower than those in the control group(4.76％,34.29％),and the differences were statistically significant(P＜0.05).Conclusion Pelvic floor muscle training combined with core muscle stability training during pregnancy can shorten the delivery process,promote pelvic floor function recovery,improve pelvic floor muscle strength,and reduce urinary incontinence.
维普
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