不同產(chǎn)科因素對女性盆底功能的影響研究
發(fā)布時間：2018-11-16 18:53
【摘要】：目的：本研究應(yīng)用生物反饋儀電刺激評估及盆底超聲測定盆底功能改變的臨床意義，探討不同產(chǎn)科因素對盆底功能的影響及女性盆底功能障礙性疾病的發(fā)病因素，旨在為其預(yù)防和治療提供理論依據(jù)。 方法：采用隨機方法選擇在石河子大學第一附屬醫(yī)院門診行問卷調(diào)查、POP-Q評估的342例婦女，愿意行盆底超聲檢測的254例病人，愿意行盆底反饋電刺激治療儀評估的238例病人。采用方差分析不同產(chǎn)科因素在盆底反饋電刺激治療儀評估各指標中的比較，分析有無壓力性尿失禁在盆底超聲測量的改變，并對342例婦女用非條件Logistic回歸分析方法確定PFD的相關(guān)因素(P0.05)。 結(jié)果：①盆底肌組織評估的238例婦女中在盆底肌組織評估中陰道分娩組的盆底肌持續(xù)肌力值、盆底肌最大收縮力值等高于剖宮產(chǎn)組，剖宮產(chǎn)組高于未生育組，三組比較均有統(tǒng)計學意義(P＜0.05)；在不同體重指數(shù)中，肥胖組在盆底肌組織評估中明顯高于超重組，正常組略高于肥胖組，三組比較有統(tǒng)計學意義(P＜0.05)；在新生兒出生體重中，兩組在盆底肌組織評估中比較有統(tǒng)計學意義(P＜0.05)。②盆底超聲測定的254例婦女，SUI組在測量膀胱頸角度（靜息狀態(tài)與最大Valsalva動作）、膀胱旋轉(zhuǎn)角度及膀胱頸移動度等明顯高于正常組，，兩組組比較有統(tǒng)計學意義(P＜0.05)。③342例婦女中Logistic回歸分析顯示，SUI的發(fā)生與分娩方式、體重指數(shù)、新生兒出生體重等因素有關(guān)，與年齡、絕經(jīng)、孕期體重指數(shù)增加、會陰側(cè)切等因素無關(guān)(P0.05)。 結(jié)論：①通過生物反饋電刺激儀評估盆底肌力各項指標，發(fā)現(xiàn)PFD的發(fā)生與盆底肌收縮力下降有關(guān)，作為盆底功能評估及治療提供一個客觀而實用的參考指標。②不同分娩方式對女性盆底肌力的改變不同，陰道分娩導(dǎo)致盆底肌力下降明顯，選擇剖宮產(chǎn)對盆底功能有一定的保護作用，但并不能完全避免PFD的發(fā)生。③不同體重指數(shù)對與PFD的發(fā)生密切相關(guān)，且盆底肌力隨體重指數(shù)的增加而降低。④隨著新生兒體重的增加，盆底肌力降低，巨大兒對盆底組織有損傷，與PFD的發(fā)生密切相關(guān)。⑤尿道膀胱解剖學的改變與SUI發(fā)生密切相關(guān)，盆底超聲的測定對SUI的診斷有重要意義⑥Logistic回歸結(jié)果顯示分娩方式、體重指數(shù)、新生兒體重等對盆底功能改變的主要因素，分娩使盆底肌力下降，肌肉疲勞增加，尿道膀胱解剖結(jié)構(gòu)改變。⑦年齡、絕經(jīng)、孕期體重指數(shù)增加、會陰側(cè)切等對盆底功能的改變無明顯相關(guān)，年齡應(yīng)該是女性盆底功能障礙的發(fā)病因素，可能與本次樣本量的選擇有關(guān)，也可能是協(xié)同其他因素促進盆腔器官脫垂的發(fā)生⑧本次研究采用盆底超聲測定與盆底反饋電刺激評估盆底功能的改變，在PFD中診斷中具有重要的臨床意義。
[Abstract]:Objective: the purpose of this study was to evaluate the effects of different obstetrical factors on pelvic floor function and to explore the clinical significance of pelvic floor function assessment by biofeedback instrument and pelvic floor ultrasound. The aim is to provide theoretical basis for its prevention and treatment. Methods: a total of 342 women who were assessed by POP-Q in outpatient clinic of the first affiliated Hospital of Shihezi University and 254 patients who were willing to be examined by pelvic floor ultrasound were selected by random method. There were 238 patients who were willing to be evaluated by pelvic floor feedback electric stimulation therapy instrument. Using variance analysis of different obstetrical factors in pelvic floor feedback electrical stimulation apparatus to evaluate the indicators, analysis of whether there is pressure urinary incontinence in pelvic floor ultrasound measurement changes. The relative factors of PFD were determined by non-conditional Logistic regression analysis in 342 women (P0.05). Results: 1 among 238 women with pelvic floor muscle tissue evaluation, the pelvic floor muscle strength and the maximal contractility of pelvic floor muscle in vaginal delivery group were higher than those in caesarean section group, and that in caesarean section group was higher than that in barren group. There was significant difference among the three groups (P < 0.05). In different body mass index, the assessment of pelvic floor muscle tissue in obese group was significantly higher than that in superrecombination group, and that in normal group was slightly higher than that in obese group, and there was statistical significance among the three groups (P < 0.05). In neonatal birth weight, there was significant difference between the two groups in the assessment of pelvic floor muscle tissue (P < 0. 05). 2 in the SUI group, the bladder neck angle (resting state and maximal Valsalva movement) was measured in 254 women with pelvic floor ultrasound. The angle of bladder rotation and the degree of bladder neck movement were significantly higher in the two groups than in the normal group (P < 0. 05). Logistic regression analysis showed that the incidence of SUI was associated with the mode of delivery and body mass index (BMI) in 3342 women. The birth weight of newborn was related to age, menopause, increase of body mass index during pregnancy, lateral perineal resection and so on (P0.05). Conclusion: 1 the indexes of pelvic floor muscle strength were evaluated by biofeedback electrical stimulator. It was found that the occurrence of PFD was related to the decrease of pelvic floor muscle contractility. As an objective and practical reference index for evaluation and treatment of pelvic floor function. 2 the changes of pelvic floor muscle strength in women with different delivery modes were different, and vaginal delivery resulted in a significant decrease in pelvic floor muscle strength. Cesarean section has some protective effect on pelvic floor function, but it can not completely avoid the occurrence of PFD. 3 different body mass index is closely related to the occurrence of PFD. The pelvic floor muscle strength decreased with the increase of body mass index. 4 with the increase of neonatal body weight, pelvic floor muscle strength decreased, and macrosomia caused damage to pelvic floor tissue. 5 the changes of urethral bladder anatomy were closely related to the occurrence of SUI. The pelvic floor ultrasound was of great significance for the diagnosis of SUI. The results of 6Logistic regression showed the mode of delivery and body mass index. The main factors of the changes of pelvic floor function, such as neonatal weight, etc., were that the pelvic floor muscle strength decreased, muscle fatigue increased, urethral bladder anatomical structure changed. 7 years old, menopause, pregnancy body mass index increased, There was no significant correlation between perineal lateral resection and pelvic floor function. Age should be the etiological factor of pelvic floor dysfunction in women, which may be related to the selection of sample size. It is also possible that other factors promote the occurrence of pelvic organ prolapse. This study uses pelvic floor ultrasound and pelvic floor feedback electrical stimulation to evaluate the changes of pelvic floor function, which has important clinical significance in the diagnosis of PFD.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R711.5
本文編號：2336350
[Abstract]:Objective: the purpose of this study was to evaluate the effects of different obstetrical factors on pelvic floor function and to explore the clinical significance of pelvic floor function assessment by biofeedback instrument and pelvic floor ultrasound. The aim is to provide theoretical basis for its prevention and treatment. Methods: a total of 342 women who were assessed by POP-Q in outpatient clinic of the first affiliated Hospital of Shihezi University and 254 patients who were willing to be examined by pelvic floor ultrasound were selected by random method. There were 238 patients who were willing to be evaluated by pelvic floor feedback electric stimulation therapy instrument. Using variance analysis of different obstetrical factors in pelvic floor feedback electrical stimulation apparatus to evaluate the indicators, analysis of whether there is pressure urinary incontinence in pelvic floor ultrasound measurement changes. The relative factors of PFD were determined by non-conditional Logistic regression analysis in 342 women (P0.05). Results: 1 among 238 women with pelvic floor muscle tissue evaluation, the pelvic floor muscle strength and the maximal contractility of pelvic floor muscle in vaginal delivery group were higher than those in caesarean section group, and that in caesarean section group was higher than that in barren group. There was significant difference among the three groups (P < 0.05). In different body mass index, the assessment of pelvic floor muscle tissue in obese group was significantly higher than that in superrecombination group, and that in normal group was slightly higher than that in obese group, and there was statistical significance among the three groups (P < 0.05). In neonatal birth weight, there was significant difference between the two groups in the assessment of pelvic floor muscle tissue (P < 0. 05). 2 in the SUI group, the bladder neck angle (resting state and maximal Valsalva movement) was measured in 254 women with pelvic floor ultrasound. The angle of bladder rotation and the degree of bladder neck movement were significantly higher in the two groups than in the normal group (P < 0. 05). Logistic regression analysis showed that the incidence of SUI was associated with the mode of delivery and body mass index (BMI) in 3342 women. The birth weight of newborn was related to age, menopause, increase of body mass index during pregnancy, lateral perineal resection and so on (P0.05). Conclusion: 1 the indexes of pelvic floor muscle strength were evaluated by biofeedback electrical stimulator. It was found that the occurrence of PFD was related to the decrease of pelvic floor muscle contractility. As an objective and practical reference index for evaluation and treatment of pelvic floor function. 2 the changes of pelvic floor muscle strength in women with different delivery modes were different, and vaginal delivery resulted in a significant decrease in pelvic floor muscle strength. Cesarean section has some protective effect on pelvic floor function, but it can not completely avoid the occurrence of PFD. 3 different body mass index is closely related to the occurrence of PFD. The pelvic floor muscle strength decreased with the increase of body mass index. 4 with the increase of neonatal body weight, pelvic floor muscle strength decreased, and macrosomia caused damage to pelvic floor tissue. 5 the changes of urethral bladder anatomy were closely related to the occurrence of SUI. The pelvic floor ultrasound was of great significance for the diagnosis of SUI. The results of 6Logistic regression showed the mode of delivery and body mass index. The main factors of the changes of pelvic floor function, such as neonatal weight, etc., were that the pelvic floor muscle strength decreased, muscle fatigue increased, urethral bladder anatomical structure changed. 7 years old, menopause, pregnancy body mass index increased, There was no significant correlation between perineal lateral resection and pelvic floor function. Age should be the etiological factor of pelvic floor dysfunction in women, which may be related to the selection of sample size. It is also possible that other factors promote the occurrence of pelvic organ prolapse. This study uses pelvic floor ultrasound and pelvic floor feedback electrical stimulation to evaluate the changes of pelvic floor function, which has important clinical significance in the diagnosis of PFD.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R711.5
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本文編號：2336350
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