發(fā)布時間：2018-04-30 15:05

  本文選題：再生育 + 盆底肌　； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:研究再生育對產(chǎn)后盆底功能的影響,觀察再生育產(chǎn)后盆底功能的自然康復(fù)狀況。方法:本課題為雙向觀察性研究。研究對象為產(chǎn)后42天健康檢查的女性。自制調(diào)查問卷,部分回顧性調(diào)查產(chǎn)婦的相關(guān)基本情況及妊娠期尿失禁情況。對產(chǎn)后42天健康檢查的女性開展常規(guī)的盆底功能篩查,包括盆底肌力測定、尿失禁篩查、盆腔臟器脫垂評估,并前瞻性的隨訪觀察該人群的產(chǎn)后3月、6月、1年的盆底功能狀況。采用SPSS22.0統(tǒng)計軟件包,選擇經(jīng)陰道分娩和選擇性剖宮產(chǎn)兩種分娩方式人群,分產(chǎn)后四個不同恢復(fù)階段(42天、3月、6月、1年),比較分析二次再生育與初產(chǎn)兩組間的盆底肌受損比例(≤2級)、尿失禁發(fā)生率、盆腔臟器脫垂量化值的差異,進而探討再生育對產(chǎn)后盆底功能的影響,并通過同組內(nèi)產(chǎn)后不同恢復(fù)階段間的比較分析,觀察再生育后1年內(nèi)盆底功能的自然恢復(fù)過程及結(jié)局。結(jié)果:盆底肌受損情況:再次經(jīng)陰道分娩者產(chǎn)后42天I類肌受損率明顯低于初次經(jīng)陰道分娩者,差異有統(tǒng)計學(xué)意義(p0.01),產(chǎn)后3月、6月、1年Ⅰ類肌受損率兩組間均無統(tǒng)計學(xué)差異(P0.05);經(jīng)陰道分娩后Ⅱ類肌受損率在產(chǎn)后42天、3月、6月、1年各個恢復(fù)階段兩組間比較均無統(tǒng)計學(xué)差異(P均0.05)。選擇性剖宮產(chǎn)后各個恢復(fù)階段盆底肌(Ⅰ類肌和Ⅱ類肌)受損率兩組間均不存在統(tǒng)計學(xué)差異(P0.05)。再生育產(chǎn)后盆底肌恢復(fù)過程總體比初產(chǎn)婦緩慢,經(jīng)陰道分娩者到產(chǎn)后6月盆底肌受損會出現(xiàn)明顯改善,選擇性剖宮產(chǎn)者產(chǎn)后1年內(nèi)盆底肌受損情況并未見明顯的改善。尿失禁發(fā)生情況:再次經(jīng)陰道分娩者妊娠期和產(chǎn)后較遠期(1年)尿失禁發(fā)生率明顯大于初次經(jīng)陰道分娩者,兩組間比較有統(tǒng)計學(xué)差異(P均0.05),而在產(chǎn)后42天、3月、6月這三個時段兩組間比較不存在統(tǒng)計學(xué)差異(P均0.05)。選擇性剖宮產(chǎn)妊娠期、產(chǎn)后42天、3月、6月、1年各階段尿失禁發(fā)生率兩組比較均無統(tǒng)計學(xué)差異(P均0.05)。再生育產(chǎn)后尿失禁自然恢復(fù)狀況與初產(chǎn)婦近似,經(jīng)陰道分娩者尿失禁發(fā)生率在產(chǎn)后3月出現(xiàn)明顯下降,3月后下降速度明顯減慢,選擇性剖宮產(chǎn)后產(chǎn)婦尿失禁癥狀改善都是不明顯的。盆腔臟器脫垂情況:再次經(jīng)陰道分娩者陰道前壁、子宮、陰道后壁脫垂量化值在產(chǎn)后近期(42天)和較遠期(1年)明顯大于初次經(jīng)陰道分娩者,兩組間比較均存在統(tǒng)計學(xué)差異(P均0.05)。再次經(jīng)陰道分娩者陰道前壁恢復(fù)與初次經(jīng)陰道分娩者近似,陰道前壁在產(chǎn)后6月內(nèi)恢復(fù)快且顯著,再次經(jīng)陰道分娩者子宮與陰道后壁脫垂比初次經(jīng)陰道分娩者恢復(fù)慢。再次選擇性剖宮產(chǎn)者陰道前壁脫垂產(chǎn)后42天比初次選擇性剖宮產(chǎn)者明顯,兩組比較有統(tǒng)計學(xué)差異(P0.05),在產(chǎn)后3月到6月得到顯著改善,之后產(chǎn)后3月、6月、1年兩組間比較均不存在顯著性差異(P均0.05);子宮、陰道后壁脫垂量化值產(chǎn)后各階段兩組間比較均不存在統(tǒng)計學(xué)差異(P0.05)。再次選擇性剖宮產(chǎn)的陰道后壁、子宮脫垂恢復(fù)都是不明顯的,與初次選擇性剖宮產(chǎn)者近似。結(jié)論:1、再次經(jīng)陰道分娩對盆底肌的損傷影響并不大,初次經(jīng)陰道分娩對盆底肌的影響可能是最大的,再次妊娠對盆底肌的影響是不明顯的。再生育產(chǎn)后盆底肌恢復(fù)過程總體比初產(chǎn)婦緩慢而不顯著。2、再次經(jīng)陰道分娩者產(chǎn)后近期尿失禁的癥狀不一定會表現(xiàn)出來,到產(chǎn)后較遠期(1年)左右尿失禁癥狀會明顯高于初次經(jīng)陰道分娩者。選擇性剖宮產(chǎn)可能對產(chǎn)后盆底功能有一定的保護作用,再次選擇性剖宮產(chǎn)后尿失禁的近期與遠期發(fā)生率與初次選擇性剖宮產(chǎn)者近似。再次經(jīng)陰道分娩后尿失禁自然恢復(fù)狀況與初產(chǎn)婦近似,至產(chǎn)后3月出現(xiàn)明顯改善,3個月后改善速度明顯減慢,再次選擇性剖宮產(chǎn)后尿失禁癥狀改善都是不明顯的。3、再次經(jīng)陰道分娩對產(chǎn)后近期和遠期盆腔臟器脫垂的影響都明顯大于初次經(jīng)陰道分娩。選擇性剖宮產(chǎn)可能對產(chǎn)后盆底臟器脫垂有一定的保護作用,再次妊娠的過程可能會短暫性加重原有的盆底前腔臟器脫垂,但可自行修復(fù),其遠期影響是不明顯的,再次選擇性剖宮產(chǎn)者產(chǎn)后較遠期盆腔臟器脫垂程度與初次選擇性剖宮產(chǎn)者近似。再次經(jīng)陰道分娩者陰道前壁脫垂恢復(fù)速度與初次經(jīng)陰道分娩者近似,子宮與陰道后壁脫垂恢復(fù)比初次經(jīng)陰道分娩差。
[Abstract]:Objective: To study the effect of reproduction on postpartum pelvic floor function and to observe the natural rehabilitation of pelvic floor function after reproduction. Methods: this subject is a two-way observer study. The subjects are women who have 42 days after postpartum health examination. 42 days after the health examination, women carried out routine pelvic floor screening, including pelvic floor muscle strength test, urinary incontinence screening, pelvic organ prolapse assessment, and prospective follow-up observation of the pelvic floor function of the population in March, June, and 1 years. The SPSS22.0 statistical package was used to select two kinds of labor parties through vaginal delivery and selective cesarean section. The group was divided into four different recovery stages (42 days, March, June, 1 years). The ratio of pelvic floor muscle damage (less than 2), the incidence of urinary incontinence and the difference of quantitative value of pelvic organ prolapse between the two rebirth and primary two groups were compared and analyzed, and then the effect of rebirth on pelvic floor function was discussed, and the different recovery stages between the same group and the same group were discussed. A comparative analysis was made to observe the natural recovery process and outcome of pelvic floor function within 1 years after reproduction. Results: the damage of pelvic floor muscle: the rate of I muscle damage at 42 days after the vaginal delivery was significantly lower than that of the first transvaginal delivery, the difference was statistically significant (P0.01), and there was no statistical difference between the two groups of type I muscle damage in March, June, and 1 years. After vaginal delivery (P0.05), there was no statistical difference between the two groups (P 0.05) between the two groups after 42 days postpartum, in March, June, and 1 years. There was no statistical difference between the two groups in the two groups of pelvic floor muscle (type I and class II muscles) after selective cesarean section. The overall process was slower than the primipara, and the pelvic floor muscle damage in the postpartum period was significantly improved in June. There was no obvious improvement in the pelvic floor muscle damage in the selective cesarean section 1 years after postpartum. The occurrence of urinary incontinence: the incidence of incontinence in pregnancy and postpartum (1 years) after vaginal delivery was significantly greater than that of the first transvaginal vaginal delivery There were statistical differences between the two groups (P 0.05), but there was no statistical difference between the two groups in the three periods of the 42 day postpartum, March and June (P 0.05). Selective cesarean section, 42 days, March, June, and 1 years had no statistical difference between the two groups (P 0.05). Regenerative postpartum incontinence The incidence of natural recovery was similar to that of primipara. The incidence of urinary incontinence in vaginal delivery decreased significantly in March and decreased significantly after March. The improvement of urinary incontinence symptoms after selective cesarean section was not obvious. Pelvic organ prolapse: vaginal delivery, vaginal delivery, and posterior vaginal wall prolapse were quantified. The values were significantly greater than those in the first vaginal delivery (42 days) and more long term (1 years). There was a statistical difference between the two groups (P 0.05). Again, the vaginal delivery was similar to the first vaginal delivery, and the anterior vaginal wall was fast and significant during the postpartum period in June, and the vaginal delivery was again the posterior wall of the uterus and vagina. The prolapse of prolapse was slower than that of the first vaginal delivery. The 42 day postpartum vaginal prolapse of the caesarean section was more obvious than the primary cesarean section. The two groups had a statistically significant difference (P0.05), significantly improved from March to June postpartum, and after postpartum March, June, and 1 years, there was no significant difference between the two groups (all 0.05); uterus, There was no statistical difference between the two groups of postpartum vaginal wall prolapse (P0.05). The second selective cesarean section of the posterior vaginal wall, the uterine prolapse recovery was not obvious, similar to the primary cesarean section. Conclusion: 1, the effect of vaginal delivery on the pelvic floor muscle injury is not significant, the first vaginal delivery is the same. The effect of pelvic floor muscle may be the biggest, and the effect of second pregnancy on pelvic floor muscle is not obvious. The recovery process of postpartum pelvic floor muscle is slower and less significant than that of the primipara. The symptoms of short term postpartum incontinence after vaginal delivery are not necessarily shown, and the symptoms of urinary incontinence at about 1 years postpartum (1 years) will be significantly higher. In the first vaginal delivery, selective cesarean section may have a certain protective effect on postpartum pelvic floor function, the short-term and long-term incidence of secondary and postpartum urinary incontinence is similar to that of the first selective cesarean section. After 3 months, the rate of improvement was obviously slowed down, and the symptoms of incontinence after cesarean section were not obvious.3. The effect of vaginal delivery on the pelvic viscera prolapse was obviously greater than that of the first vaginal delivery. Selective cesarean section may have protective effect on postpartum pelvic organ prolapse, and again pregnancy The process of pregnancy may temporarily increase the original pelvic anterior chamber visceral prolapse, but it can be repaired by itself, but its long-term effect is not obvious. The degree of postpartum pelvic organ prolapse after the secondary cesarean section is similar to that of the first selective cesarean section. Similarly, the prolapse of the uterus and posterior wall of the vagina is worse than that of the first vaginal delivery.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.6

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