健康教育及盆底肌训练对产后盆底功能障碍的影响

黄健　丁岩　程明军

(复旦大学附属妇产科医院妇科，上海　200011)



·论著·

健康教育及盆底肌训练对产后盆底功能障碍的影响

黄健丁岩程明军

(复旦大学附属妇产科医院妇科，上海200011)

摘要目的：探讨健康教育和盆底肌训练对产后盆底功能障碍的防治效果。方法： 选择复旦大学附属妇产科医院2015年1月—3月产后42 d来复诊的足月单胎初产妇312例，根据孕期及产褥期是否接受健康教育及盆底肌训练分为训练组和对照组，训练组64例，对照组248例。测定盆底肌肌力，进行盆腔器官脱垂定量(pelvic organ prolapse quantitation，POP-Q)评分和尿垫试验及性生活质量问卷调查等，产后6个月复查。结果： 训练组产后6个月盆底肌肌力、盆腔脏器脱垂发生率、性生活质量与对照组比较差异均有统计学意义(P<0.05)，两组尿垫试验阳性率差异无统计学意义；产后42 d各项检测结果差异均无统计学意义。结论： 孕期及产褥期开展健康教育及盆底肌训练有助于防治产后盆底功能障碍的发生。

关键词盆底功能障碍；健康教育；盆底肌训练

Effect of Health Education and Pelvic Muscle Training on Postpartum Pelvic Floor Dysfunction

HUANGJianDINGYanCHENGMingjun

DepartmentofGynecology,ObstetricsandGynecologyHospitalofFudanUniversity,Shanghai200011,China

AbstractObjective： To investigate the preventive and therapeutic effect of health education and pelvic muscle training on postpartum pelvic floor dysfunction. Methods： A total of 312 full-term single-fetus primiparas, who came to Obstetrics and Gynecology Hospital of Fudan University for further consultation 42 days after delivery, were enrolled from Jan. 2015 to Mar. 2015. And they were divided into exercise group and control group according to whether they had received health education and pelvic floor muscle exercise during pregnancy and puerperium.There were 64 cases in exercise group and 248 cases in control group. The pelvic floor muscle strength testing, pelvic organ prolapse quantitation(POP-Q) score, urine pad test, and questionnaire of sexual life quality were conducted. And they were conducted again six months after delivery. Results： Six months after delivery, the pelvic floor muscle strength, occurrence rate of pelvic organ prolapse and sexual quality of life in exercise group were all significantly better than those in control group (P<0.05),however there was no significant difference regarding the positive rate of urine pad test.There was no significant difference regarding all those measures 42 days after delivery. Conclusions： Health education and pelvic muscle training is conducive to prevent and treat postpartum pelvic floor dysfunction.

Key WordsPelvic floor dysfunction；Health education；Pelvic muscle training

女性盆底功能障碍性疾病(pelvic floor dysfunction，PFD)是由于各种原因导致的盆腔脏器位置及功能异常的一组疾病，主要包括盆底器官脱垂、压力性尿失禁等，发生率高达19.7%[1]，严重影响妇女的身心健康和生活质量。PFD的诱发因素包括妊娠、分娩损伤、长期腹压增加、肥胖、药物等，其中妊娠和分娩是导致PFD的主要高危因素[2]。因此，在孕期及产褥期进行早期干预治疗对预防PFD的发生及提高生活质量具有重要意义。

1资料与方法

1.1一般资料选择复旦大学附属妇产科医院2015年1月—3月产后42 d来复诊的初产妇312例，年龄25～35岁，足月单胎，经阴道分娩，无产科合并症，无泌尿生殖系统疾病。根据孕期及产褥期是否接受过健康教育及盆底肌训练分为训练组和对照组，训练组64例，对照组248例。训练组和对照组年龄、孕产次、孕周、新生儿出生体质量、产前体质量指数比较，差异均无统计学意义(P>0.05)。

1.2方法产后42 d进行盆底肌肌力测定、盆腔器官脱垂定量(pelvic organ prolapse quantitation，POP-Q)评分、尿垫试验及性生活质量问卷调查，产后6个月复查。

1.2.1人工法和机器法检测盆底肌肌力(1)人工法：将中指和食指放在产妇阴道后穹隆并后退1.5 cm，使手指与阴道肌肉接触，根据Ortiz标准评估盆底肌肌力(分0～5级)。(2)机器法：使用法国神经肌肉刺激治疗仪(PHENIX USB4)，将压力探头放入阴道内，评估盆底Ⅰ/Ⅱ类肌纤维的肌力。产妇盆底肌肌力的综合评分为：80%仪器评分+20%指检评分。

1.2.2性生活质量问卷调查采用盆腔器官脱垂及尿失禁性生活质量问卷(pelvic organ prolapse-urinary incontinence sexual questionnaire，PISQ-12)[3]调查产妇产后性生活质量。

1.2.3盆腔脏器脱垂由同一位盆底康复师按照国际统一的POP-Q分度法进行分度。

1.2.4压力性尿失禁在产妇有明显尿意、无急迫感时，让其用最大力屏气和咳嗽，观察有无尿液流出，并做尿垫试验和尿失禁问卷，根据结果做出压力性尿失禁的诊断。

1.3统计学处理采用SPSS 13.0软件进行统计学分析，计数资料组间比较采用χ2检验，计量资料组间比较采用t检验。以P<0.05为差异有统计学意义。

2结果

2.1健康教育及盆底肌训练对产后盆底肌肌力及性生活质量的影响训练组产后42 d盆底肌肌力、性生活质量与对照组比较差异均无统计学意义，产后6个月盆底肌肌力、性生活质量与对照组比较差异均有统计学意义(P<0.05)，见表1。

2.2健康教育及盆底肌训练对产后盆底脏器脱垂的影响训练组产后42 d POP-Q Ⅰ、Ⅱ度脏器脱垂率与对照组比较，差异均无统计学意义；训练组产后6个月POP-Q Ⅰ、Ⅱ度脏器脱垂率与对照组比较差异均有统计学意义(P<0.05)，见表2。

±s)

注：与对照组比较，*P<0.05

表2　2组产妇产后盆腔脏器脱垂发生率的比较 (n，%)

注：与对照组比较，*P<0.05

2.3健康教育及盆底肌训练对产后尿失禁的影响训练组尿垫试验阳性率为4.68%(3/64)，对照组为5.24%(13/248)，差异无统计学意义。

3讨论

妊娠和分娩可能对盆底肌肉造成不同程度的损伤，从而影响产后性生活质量，引起产后尿失禁、盆腔器官脱垂等症状[4-7]，是女性PFD的主要危险因素[8]。盆底肌训练(Kegel训练)指有意识地对以肛提肌为主的盆底肌肉进行自主性收缩、加强控尿能力及盆底肌肉力量，是PFD最常用的非手术治疗方法[9]。产后早期就进行盆底肌训练，对提高产后性生活质量，预防和治疗产后尿失禁、盆腔器官脱垂有重要意义[10-13]。

本研究中产后42 d问卷调查结果显示，仅有20.51%(64/312)产妇了解孕前、产后盆底相关知识并进行盆底肌训练，说明孕妇学校、医生的宣传力度不够或者不够重视；训练组产妇经过健康教育及盆底肌训练后，其产后6个月盆底肌肌力、盆底脏器脱垂及性生活质量与对照组比较均有明显改善(P<0.05)，与文献报道相符，但在产后42 d时效果不明显，说明长期的盆底肌训练才会有效。另外，健康教育及盆底肌训练对尿失禁疗效不理想，可能与本研究样本量不够大有关。因此，如果能够在孕期及产褥期尽早对孕产妇进行健康教育和指导盆底肌训练，并长期坚持，则可以降低PFD的发生。

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中图分类号R711.5

文献标志码A

通讯作者程明军，E-mail：chengmingjun04@163.com

基金项目：上海市卫生和计划生育委员会青年科研项目(编号：20124Y054)；上海市科学技术委员会西医引导类项目(编号：124119a5501)；上海市申康医院管理集团新兴前沿项目(编号：SHDC12013120)