本文選題：盆底功能障礙性疾病 + 電刺激�。� 參考：《蘭州大學(xué)》2017年碩士論文

【摘要】：研究目的1.探究妊娠和分娩與產(chǎn)后盆底肌力損傷、壓力性尿失禁(stress urinary incontinence,SUI)以及盆腔器官脫垂(pelvic organ prolapse,POP)等盆底功能障礙性疾病發(fā)生的關(guān)系。2.評價盆底肌肉鍛煉(pelvic floor muscle training,PFMT)聯(lián)合電刺激生物反饋治療產(chǎn)后盆底功能障礙性疾病(pelvic floor dysfunction,PFD)的療效,為臨床防治產(chǎn)后盆底功能障礙性疾病提供理論依據(jù)。研究方法選擇2015年11月-2016年4月在甘肅省婦幼保健院住院分娩,并于產(chǎn)后6~8周進(jìn)行門診產(chǎn)后復(fù)查的單胎產(chǎn)婦共2173例,平均年齡29.49±3.93歲。開展以下研究:(1)通過問卷調(diào)查和收集住院電子病歷信息,內(nèi)容包括產(chǎn)婦基本情況、分娩情況及妊娠合并癥發(fā)生狀況等;(2)應(yīng)用手測肌力法和陰道肌力表檢測盆底肌力,分析所有研究對象的產(chǎn)后盆底肌力損傷情況;(3)采用產(chǎn)后門診臨床診斷和盆腔器官脫垂定量分期法分別診斷壓力性尿失禁(stress urinary incontinence,SUI)、盆腔器官脫垂(pelvic organ prolapse,POP)等疾病,了解所有研究對象產(chǎn)后SUI和POP發(fā)生情況;(4)結(jié)合問卷調(diào)查和病歷信息資料,采用單因素和多因素Logistic回歸方法開展產(chǎn)后盆底肌力損傷、SUI以及POP發(fā)病影響因素分析;(5)在產(chǎn)后復(fù)查中按照納入和排除標(biāo)準(zhǔn)選擇了315例患者,在應(yīng)用盆底肌電生物反饋儀進(jìn)行盆底功能評估的基礎(chǔ)上,采用神經(jīng)肌肉刺激治療儀USB4進(jìn)行電刺激生物反饋聯(lián)合治療,然后比較治療前后盆底表面肌電評估指標(biāo)和盆底肌力、盆底功能障礙(PFDI-20問卷)評分、尿失禁生活質(zhì)量(I-QOL問卷)評分以及SUI癥狀的變化等,評價產(chǎn)后盆底康復(fù)治療的療效。研究結(jié)果1.產(chǎn)后盆底功能障礙性疾病的影響因素分析(1)盆底Ⅰ類、Ⅱ類肌纖維受損檢出率分別為94.29%、83.53%。單因素分析發(fā)現(xiàn),分娩方式和新生兒出生體重與產(chǎn)后盆底肌受損相關(guān)。多因素分析發(fā)現(xiàn)陰道分娩(OR=1.890,95%CI:1.298-2.753)是產(chǎn)后盆底肌力損傷的危險因素。(2)妊娠期SUI和產(chǎn)后SUI檢出率分別為23.19%、8.47%,SUI癥狀從妊娠期持續(xù)到產(chǎn)后,占產(chǎn)后SUI的56.90%。單因素分析發(fā)現(xiàn),年齡、孕前BMI、會陰撕裂、分娩方式、產(chǎn)次以及新生兒頭圍與產(chǎn)后SUI發(fā)生相關(guān)。多因素分析發(fā)現(xiàn):年齡≥35歲的產(chǎn)婦產(chǎn)后SUI發(fā)生的風(fēng)險增加(OR=2.102,95%CI:1.222-3.615);孕前超重和肥胖可增加SUI發(fā)生風(fēng)險(OR=1.895,95%CI:1.105-3.251);陰道分娩(OR=8.869,95%CI:4.231-18.59)和產(chǎn)次(OR=1.510,95%CI:1.011-2.256)也是產(chǎn)后SUI發(fā)生的危險因素。(3)產(chǎn)后陰道前壁膨出、陰道后壁膨出檢出率分別為19.05%、4.23%,兩者合并占產(chǎn)后陰道前后壁膨出總?cè)藬?shù)的17.40%;POP-Q診斷為0、Ⅰ、Ⅱ度的檢出率分別為80.17%、15.97%、3.87%。單因素分析結(jié)果顯示:年齡、孕次、會陰撕裂、分娩方式、產(chǎn)次以及新生兒頭圍與產(chǎn)后陰道前后壁膨出發(fā)生有關(guān)。多因素分析發(fā)現(xiàn):年齡≥30歲可增加產(chǎn)婦產(chǎn)后陰道前后壁膨出的發(fā)生風(fēng)險(30~35歲組OR=1.375,95%CI:1.072-1.765;年齡≥35歲組OR=1.726,95%CI:1.151-2.589);陰道分娩(OR=5.139,95%CI:3.396-7.779)和產(chǎn)次(OR=1.484,95%CI:1.055-2.086)也是產(chǎn)后陰道前后壁膨出發(fā)生的危險因素。2.產(chǎn)后盆底康復(fù)治療效果評價(1)產(chǎn)婦治療后盆底表面肌電評估結(jié)果與治療前相比,治療后Glazer評估快速收縮最大值、持續(xù)收縮平均值以及耐受測試平均值明顯提高,差異有統(tǒng)計學(xué)意義;此外,前基線值和后基線值治療前后比較,差異有統(tǒng)計學(xué)意義(t=-24.969~2.014,P0.05)。(2)產(chǎn)婦治療后盆底肌Ⅰ類肌纖維的平均肌力等級為2.66±1.29級,Ⅱ類肌纖維的平均肌力等級為3.61±1.23級,與治療前比較,盆底�、耦惡廷蝾惣±w維的平均肌力明顯提升,差異均有統(tǒng)計學(xué)意義(P0.05)。治療前盆底�、耦惣±w維受損檢出率為96.19%,治療后為48.25%;治療前Ⅱ類肌纖維受損檢出率為90.16%,治療后為25.71%,治療前后比較差異有統(tǒng)計學(xué)意義(P0.05)。(3)產(chǎn)婦在治療后I-QOL評分高于治療前,PFDI-20評分低于治療前,治療前后比較差異有統(tǒng)計學(xué)意義(P0.05)。(4)產(chǎn)婦治療后SUI癥狀比治療前有所緩解,治療前后比較差異有統(tǒng)計學(xué)意義(P0.05)。研究結(jié)論1.產(chǎn)后復(fù)查的產(chǎn)婦中盆底肌受損檢出率高,并且產(chǎn)后SUI和產(chǎn)后陰道前后壁膨出發(fā)生檢出率也較高。2.陰道分娩是產(chǎn)后盆底肌力受損的危險因素;產(chǎn)婦年齡≥35歲、孕前BMI超重和肥胖、陰道分娩以及產(chǎn)次增多是產(chǎn)后SUI發(fā)生的危險因素;產(chǎn)婦年齡≥30歲、陰道分娩以及產(chǎn)次增多是產(chǎn)后陰道前后壁膨出發(fā)生的危險因素。3.盆底肌肉鍛煉聯(lián)合電刺激生物反饋治療產(chǎn)后盆底功能障礙性疾病具有明顯的臨床治療效果,可以明顯改善產(chǎn)后盆底功能,提高生活質(zhì)量,值得在臨床上推廣。
[Abstract]:Objective 1. to explore the relationship between pregnancy and childbirth and postpartum pelvic floor muscle damage, stress urinary incontinence (stress urinary incontinence, SUI) and pelvic organ prolapse (pelvic organ prolapse, POP) and other pelvic floor disorders. The treatment of postpartum pelvic floor dysfunction (pelvic floor dysfunction, PFD) provides a theoretical basis for the clinical prevention and treatment of postpartum pelvic floor dysfunction. The study method was selected in April -2016 in November 2015 in Gansu maternal and child health care hospital, and 2173 cases of single parturients reexamined after postpartum were reviewed after postpartum 6~8 weeks. The age was 29.49 + 3.93 years. The following studies were carried out: (1) through questionnaire survey and collection of inpatient electronic medical records information, including maternal basic situation, delivery and pregnancy complications; (2) the use of hand test and vaginal strength table test pelvic floor muscle strength, analysis of all subjects postpartum pelvic floor muscle damage; (3) The diagnosis of pressure urinary incontinence (stress urinary incontinence, SUI), pelvic organ prolapse (pelvic organ prolapse, POP) and other diseases were used to diagnose the occurrence of SUI and POP in all the subjects after postpartum clinic diagnosis and pelvic organ prolapse, respectively. (4) a single factor and a single factor were used in combination with questionnaire survey and medical record information. Multi factor Logistic regression method was used to carry out postpartum pelvic floor muscle damage, SUI and the influencing factors of POP; (5) 315 patients were selected according to the inclusion and exclusion criteria during postpartum reexamination, and on the basis of pelvic floor function evaluation by using pelvic floor electromyography biofeedback instrument, the neuromuscular stimulation therapy instrument USB4 was used for electrical stimulation. Feedback combined treatment, and then compare the evaluation index of pelvic floor surface electromyography and pelvic floor muscle strength, pelvic floor dysfunction (PFDI-20 questionnaire) score, urinary incontinence quality of life (I-QOL questionnaire) and SUI symptoms, and so on to evaluate the curative effect of postpartum pelvic floor rehabilitation. Results 1. the influencing factors of postpartum pelvic floor dysfunction Analysis (1) type I of pelvic floor, the detection rate of muscle fiber damage in class II was 94.29%. 83.53%. single factor analysis found that delivery mode and newborn birth weight were associated with postpartum pelvic floor muscle damage. Multiple factor analysis found that vaginal delivery (OR=1.890,95%CI:1.298-2.753) was a risk factor for postpartum pelvic floor muscle damage. (2) SUI and postpartum SUI test during pregnancy. The incidence of 23.19%, 8.47%, SUI symptoms from pregnancy to postpartum, accounting for postpartum SUI 56.90%. single factor analysis found that age, pre pregnancy BMI, perineum tear, delivery mode, birth, and neonatal head circumference and postpartum SUI incidence. Multivariate analysis found that the risk of postpartum SUI in women aged over 35 years (OR=2.102,95%CI:1.22) increased (OR=2.102,95%CI:1.22 2-3.615); overweight and obesity before pregnancy can increase the risk of SUI (OR=1.895,95%CI:1.105-3.251); vaginal delivery (OR=8.869,95%CI:4.231-18.59) and birth (OR=1.510,95%CI:1.011-2.256) are also the risk factors for postpartum SUI. (3) postpartum vaginal prevaginal wall bulge, vaginal posterior wall bulge detection rate is 19.05%, 4.23%, both of the combination of postpartum vaginal. The total number of bulging in the anterior and posterior wall of the canal was 17.40%, and the detection rate of POP-Q was 0, I, and II was 80.17%, 15.97%. The results of 3.87%. single factor analysis showed that age, pregnancy, perineum tear, mode of delivery, birth, and neonatal head circumference were related to postpartum vaginal wall bulge. The analysis of multiple factors found that the age of older than 30 could increase puerperal postpartum. The risk of prolapse of anterior and posterior vaginal wall (group 30~35 OR=1.375,95%CI:1.072-1.765; age group OR=1.726,95%CI:1.151-2.589 > 35 years old); vaginal delivery (OR=5.139,95%CI:3.396-7.779) and birth (OR=1.484,95%CI:1.055-2.086) is also a risk factor for postpartum vaginal wall swelling (.2.) evaluation of the effect of postpartum pelvic floor rehabilitation (1) parturients After treatment, the results of electromyography of pelvic floor surface were compared with that before treatment. After treatment, the maximum value of rapid contraction, the average value of sustained contraction and the mean value of tolerance test were significantly increased, and the difference was statistically significant. In addition, the difference was statistically significant (t=-24.969~2.014, P0.05) before and after treatment (2). (2) parturients (2) The average muscle strength grade of type I muscle fiber of pelvic floor muscle was 2.66 + 1.29 grades after treatment. The average muscle strength grade of class II muscle fibers was 3.61 + 1.23 grades. Compared with before treatment, the average muscle strength of type I and class II muscle fibers of pelvic floor muscle improved significantly (P0.05). The detection rate of type I muscle fiber damage of pelvic floor muscle before treatment was 96.19%. After treatment, 48.25%, the detection rate of class II muscle fiber damage before treatment was 90.16%, after treatment was 25.71%, before and after treatment, the difference was statistically significant (P0.05). (3) the I-QOL score of parturients was higher than before treatment, PFDI-20 score was lower than before treatment, and before and after treatment, the difference was statistically significant (P0.05). (4) SUI symptoms after the treatment of parturients were compared. Before and after treatment, the difference was statistically significant (P0.05). Conclusion 1. postpartum reexamination of the maternal pelvic floor muscle damage detection rate is high, and postpartum SUI and postpartum vaginal wall swelling detection rate is also higher.2. vaginal delivery is a risk factor for postpartum pelvic floor muscle damage; maternal age is more than 35 years old, pre pregnancy BMI overweight Obesity, vaginal delivery and increased production are the risk factors for postpartum SUI, the age of parturients is more than 30 years, vaginal delivery and increased production are the risk factors for postpartum vaginal wall swelling,.3. pelvic floor muscle exercise combined with biofeedback therapy for postpartum pelvic floor dysfunction has obvious clinical therapeutic effect. It can obviously improve postpartum pelvic floor function and improve the quality of life. It is worthy of clinical promotion.

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

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 馮艷霞;張潔;張月;王影;;產(chǎn)后盆底康復(fù)治療研究進(jìn)展[J];中國計劃生育和婦產(chǎn)科;2016年08期

2 何浪馳;葉明;黃柳;胡順平;;分娩鎮(zhèn)痛對產(chǎn)程及早期盆底肌力的影響[J];中國生育健康雜志;2016年04期

3 李e，

本文編號：1867415