摘要
目的:分析盆底超声联合盆底肌力评分在不同分娩方式产后盆底功能障碍患者中的应用.方法:选择2021年6月至2022年2月河北省沧州中西医结合医院收治的64例盆底功能障碍产妇,根据分娩方式的不同将其分为顺产组(32例)和剖宫产组(32例),对比两组产妇的基线资料,分析两组产妇的盆底肌力评分和盆底超声指标,采用Pearson分析盆底超声联合盆底肌力评分与产后盆底功能障碍的相关性,绘制受试者工作特征(ROC)曲线,分析盆底超声联合盆底肌力评分对产后盆底功能障碍的评估价值.结果:顺产组产妇的年龄、平均体质量指数(BMI)与剖宫产组相比,差异无统计学意义(P＞0.05).顺产组产妇的盆底肌力评分为(2.22±0.40)分,明显低于剖宫产组的(3.13±0.39)分,膀胱颈角度(152.71±14.87)°、静息状态膀胱颈角度(119.00±9.63)°、膀胱颈移动度(33.29±4.7)mm以及膀胱颈旋转角度(35.06±2.79)°均明显高于剖宫产组,差异均有统计学意义(t=9.21、4.69、3.07、3.10、4.41,P＜0.05).静息状态下,顺产组产妇的耻骨内肌厚度明显低于剖宫产组,肛提肌裂孔前后径和肛提肌裂孔容积均明显高于剖宫产组,差异有统计学意义(t=5.92、4.89、3.23,P＜0.05).Pearson相关结果显示,产妇的盆底肌力评分、耻骨内肌厚度与产后盆底功能障碍呈负相关(r=-0.635、-0.465,P＜0.05),膀胱颈角度、静息状态膀胱颈角度、膀胱颈移动度、膀胱颈旋转角度、肛提肌裂孔前后径、肛提肌裂孔容积与产后盆底功能障碍呈正相关(r=0.592、0.679、0.627、0.562、0.492、0.558,P＜0.05).ROC曲线显示,盆底超声联合盆底肌力评分的曲线下面积为0.837,表明盆底超声联合盆底肌力评分可作为评估产后盆底功能障碍的指标.结论:顺产与剖宫产产妇的盆底超声指标与盆底肌力评分具有明显的差异;盆底超声联合盆底肌力评分可用作评价不同分娩方式产妇产后的盆底功能水平,为盆底功能障碍的诊治提供临床依据.
Abstract
Objective:To analyze the application of pelvic floor ultrasound combined with pelvic floor muscle strength score in patients with postpartum pelvic floor dysfunction of different delivery modes.Methods:A total of 64 parturient women with pelvic floor dysfunction admitted to Hebei Province Cangzhou Hospital of Integrated TCM-WM hospital from June 2021 to February 2022 were selected as the research objects.According to the different delivery methods,parturient women were divided into vaginal delivery group(32 cases)and cesarean delivery group(32 cases).The baseline data of parturient women between the two groups were compared to analyze the pelvic floor muscle strength score and pelvic floor ultrasound indexes.Pearson analysis was used to analyze the correlation between pelvic floor ultrasound combined with pelvic floor muscle strength score and postpartum pelvic floor dysfunction.Receiver operating characteristic(ROC)curve was drawn to analyze the assessment value of pelvic floor ultrasound combined with pelvic floor muscle strength score on postpartum pelvic floor dysfunction.Results:There were no significant differences in maternal age and body mass index(BMI)between vaginal delivery group and cesarean delivery group(P>0.05).The pelvic floor muscle strength score(2.22±0.40)in the vaginal delivery group was significantly lower than that(3.13±0.39)in the cesarean section group,and the bladder neck angle[(152.71±14.87)°],resting bladder neck angle[(119.00±9.63)°],bladder neck mobility[(33.29±4.7)mm]and bladder neck rotation angle[(35.06±2.79)°]in the vaginal delivery group were significantly higher than those in the cesarean delivery group(t=9.21,4.69,3.07,3.10,4.41,P<0.05),respectively.Under the resting state,the thickness of internal pectineal muscle in the vaginal delivery group was significantly lower than that in the cesarean delivery group,and the anterior and posterior diameters and volumes of levator ani hiatus in the vaginal delivery group were significantly higher than those in the cesarean delivery group(t=5.92,4.89,3.23,P<0.05),respectively.The results of Pearson correlation showed that pelvic floor muscle strength score and the thickness of internal pectineal muscle were negatively correlated with postpartum pelvic floor dysfunction(r=-0.635,-0.465,P<0.05),while bladder neck angle,resting bladder neck angle,bladder neck mobility,bladder neck rotation angle,anterior and posterior diameter of levator ani hiatus and volume of levator ani hiatus were positively correlated with postpartum pelvic floor dysfunction(r=0.592,0.679,0.627,0.562,0.492,0.558,P<0.05),respectively.ROC curve showed that the area under curve(AUC)of pelvic floor ultrasound combined with pelvic floor muscle strength score was 0.837,which indicated that pelvic floor ultrasound combined with pelvic floor muscle strength score can be used as an indicator to assess postpartum pelvic floor dysfunction.Conclusion:There were significant differences in pelvic floor ultrasound index and pelvic floor muscle strength score of parturient women between vaginal delivery and cesarean delivery.Pelvic floor ultrasound combined with pelvic floor muscle strength score can be used to evaluate the level of pelvic floor function of different delivery modes,and to provide clinical basis for the diagnosis and treatment of pelvic floor dysfunction.
基金项目
河北省卫生健康委医学科学研究课题(20220684)
国家科技期刊平台
NSTL
万方数据