物理康復(fù)治療對(duì)產(chǎn)婦盆底肌恢復(fù)效果的臨床研究
發(fā)布時(shí)間：2018-11-27 19:16
【摘要】：女性盆底功能障礙性疾�。╬elvic Floor Dysfunction,PFD）是以盆腔臟器脫垂(Pelvic Organ Prolapse,POP)、壓力性尿失禁(Stress Urinary Incontinence,SUI)及慢性盆腔疼痛為主要癥狀的高發(fā)疾病，它嚴(yán)重影響女性的健康和生活質(zhì)量，已經(jīng)成為人們廣泛關(guān)注的醫(yī)療問(wèn)題和突出的社會(huì)問(wèn)題，該病病因多樣，多數(shù)學(xué)者一致認(rèn)為妊娠和分娩是其獨(dú)立危險(xiǎn)因素，妊娠及分娩過(guò)程中機(jī)械壓迫和激素水平的改變可損傷盆底肌及相關(guān)支持系統(tǒng)，產(chǎn)后若是不能及時(shí)有效的恢復(fù)盆底肌功能，其承托盆腔臟器的作用減弱，便容易致使PFD的發(fā)生。由于手術(shù)治療PFD存在諸多缺點(diǎn)，同時(shí)隨著人們對(duì)該疾病認(rèn)識(shí)程度的加深，早預(yù)防、早治療已經(jīng)得到大家的認(rèn)可，而非手術(shù)治療中的盆底物理康復(fù)治療─電刺激+生物反饋+凱格爾運(yùn)動(dòng)受到人們的普遍關(guān)注。 目的 利用PHENIX U8物理康復(fù)治療儀（廣州杉山公司提供）對(duì)產(chǎn)婦盆底肌肌力、疲勞度、動(dòng)態(tài)壓力的檢測(cè)，分析產(chǎn)后盆底肌功能的自我修復(fù)程度以及盆底物理康復(fù)治療對(duì)產(chǎn)婦盆底肌功能的改善情況，及不同分娩方式間療效的差異，說(shuō)明物理康復(fù)治療對(duì)不同分娩方式早期盆底肌功能改善的優(yōu)越性，繼而指導(dǎo)臨床，加強(qiáng)廣大婦女對(duì)產(chǎn)婦盆底肌功能早期預(yù)防的觀念。 材料與方法 1研究對(duì)象 選取2012年11月～2014年1月產(chǎn)后6~8周來(lái)鄭州大學(xué)第三附屬醫(yī)院復(fù)查，符合本研究標(biāo)準(zhǔn)的足月單胎初產(chǎn)婦240例，平均年齡（28.42±2.73）歲，平均分娩孕周為（39±3.57）周，其中陰道分娩120例，選擇性剖宮產(chǎn)120例。 2.研究方法 通過(guò)由專門培訓(xùn)的人員經(jīng)手法檢測(cè)+PHENIX U8物理康復(fù)治療儀（廣州杉山公司提供）檢測(cè)盆底肌肌力、疲勞度、盆底動(dòng)態(tài)壓力值評(píng)估產(chǎn)后早期盆底肌功能。隨機(jī)選取陰道分娩和選擇性剖宮產(chǎn)各60例進(jìn)行物理康復(fù)治療1個(gè)療程，治療方法采用PHENIX U8物理康復(fù)治療儀進(jìn)行電刺激+生物反饋+凱格爾運(yùn)動(dòng)聯(lián)合治療(治療組)，剩余兩組各60例由專業(yè)人員對(duì)產(chǎn)婦進(jìn)行盆底的健康教育1個(gè)療程，方法包括每天150～200次的凱格爾運(yùn)動(dòng)(觀察組)，各組分別進(jìn)行比較。 3統(tǒng)計(jì)學(xué)方法 采用SPSS17.0統(tǒng)計(jì)軟件錄入和分析數(shù)據(jù)，t檢驗(yàn)和秩和檢驗(yàn)為檢驗(yàn)方法，，以α=0.05作為檢驗(yàn)水準(zhǔn)，分析產(chǎn)后盆底肌功能的自我修復(fù)程度以及盆底物理康復(fù)治療對(duì)產(chǎn)婦盆底肌功能的改善情況，及不同分娩方式間療效的差異。 結(jié)果 1.陰道分娩組及選擇性剖宮產(chǎn)組產(chǎn)婦年齡、孕期體重增長(zhǎng)、新生兒體重、新生兒身長(zhǎng)各自比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。 2.產(chǎn)后6-8周選擇性剖宮產(chǎn)組與陰道分娩組盆底肌肌力、疲勞度、盆底動(dòng)態(tài)壓力比較差異無(wú)統(tǒng)計(jì)學(xué)意義（p0.05）。 3.選擇性剖宮產(chǎn)治療后I、II類肌纖維肌力、疲勞度、動(dòng)態(tài)壓力優(yōu)于治療前，兩者比較差異有統(tǒng)計(jì)學(xué)意義(p0.05)；選擇性剖宮產(chǎn)教育后I、II類肌纖維肌力、疲勞度、動(dòng)態(tài)壓力優(yōu)于教育前，兩者比較差異有統(tǒng)計(jì)學(xué)意義(p0.05)。 4.陰道分娩治療后I、II類肌纖維肌力、疲勞度、動(dòng)態(tài)壓力優(yōu)于治療前，兩者比較差異有統(tǒng)計(jì)學(xué)意義(p0.05)；陰道分娩教育后肌力、疲勞度、動(dòng)態(tài)壓力優(yōu)于教育前，兩者比較差異有統(tǒng)計(jì)學(xué)意義(p0.05)。 5.陰道分娩治療后I類、II類肌纖維的肌力、疲勞度、動(dòng)態(tài)壓力優(yōu)于陰道分娩健康教育后，兩者比較差異均有統(tǒng)計(jì)學(xué)意義（p0.05）。 6.選擇性剖宮產(chǎn)治療后優(yōu)于選擇性剖宮產(chǎn)教育后I、II類肌纖維肌力、疲勞度、動(dòng)態(tài)壓力，兩者比較差異均有統(tǒng)計(jì)學(xué)意義（p0.05）。 7.陰道分娩治療后與選擇性剖宮產(chǎn)治療后的I、II類肌纖維肌力、疲勞度、動(dòng)態(tài)壓力比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（p0.05）；選擇性剖宮產(chǎn)教育后I類肌纖維肌力、疲勞度、動(dòng)態(tài)壓力優(yōu)于陰道分娩教育后，兩者比較差異有統(tǒng)計(jì)學(xué)意義（p0.05），但兩組II類肌纖維肌力、疲勞度比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（p0.05）。 結(jié)論 1.健康教育對(duì)產(chǎn)婦盆底肌功能的恢復(fù)有效，產(chǎn)后4個(gè)半月時(shí)陰道分娩產(chǎn)婦盆底肌I類肌纖維恢復(fù)效果較選擇性剖宮產(chǎn)差。 2.物理康復(fù)治療對(duì)產(chǎn)婦盆底肌功能的恢復(fù)效果更明顯，可作為輕中度PFD的首選治療及預(yù)防方法，并可以大規(guī)模推廣。
[Abstract]:The female pelvic floor function (PFD) is a high-incidence disease characterized by pelvic organ prolapse (POP), stress urinary incontinence (SUI) and chronic pelvic pain, which seriously affects the health and quality of life of women. The cause of this disease is diverse, and most scholars agree that pregnancy and delivery are independent risk factors, and the change of mechanical stress and hormone level during pregnancy and delivery can damage the pelvic floor and related support system. If the function of the pelvic floor muscle can not be effectively restored in time after the birth, the function of supporting the pelvic organs is weakened, and the occurrence of the PFD can be easily caused. Because of the shortcomings of the operation in the treatment of the PFD, as well as the understanding of the disease, the early prevention and early treatment have been recognized, and the physical rehabilitation of the pelvic floor in the non-operative treatment is the general concern of the people. Objective To study the self-repairing degree of pelvic floor muscle function and the function of pelvic floor in the pelvic floor by using PHOENIX U8 physical rehabilitation therapy instrument (provided by Guangzhou Sequoia Company) to detect the muscle strength, fatigue and dynamic pressure of the pelvic floor. The effect of physical rehabilitation on the function of pelvic floor in the early stage of different delivery methods is explained by the difference of the good condition and the difference of the curative effect between different delivery methods. The idea. Materials and parties Method 1 The subjects were selected from November, 2012 to January, 2014 for re-examination at the Third Affiliated Hospital of Zhengzhou University. The average age (28. 42, 2.73) years and the average time of delivery were (28. 42 to 2.73). 39 (3.57) weeks, in which 120 cases of vaginal delivery, selected alternative cesarean section 1 20 cases. 2. The method of the study was to test the muscle strength, fatigue and the dynamic pressure of the pelvic floor by means of a specially trained person by means of a manipulation test + PHOENIX U8 physical rehabilitation therapy instrument (provided by the Guangzhou Sequoia Company). The function of early pelvic floor muscle was evaluated by force value. 60 cases of vaginal delivery and selective caesarean section were randomly selected for physical rehabilitation for one course of treatment. The treatment was conducted by using the PHENIX U8 physical rehabilitation apparatus for electrical stimulation + biofeedback + Kay. In the combined treatment (treatment group), 60 patients in the remaining two groups were given a course of treatment for the health education of the pelvic floor by the professional staff. The method included 150 to 200 kanger's movement per day (treatment group). observation group), each The three statistical methods were used to record and analyze the data, t-test and rank sum test as the test method, and the self-repair degree and the basin-bottom physical function of the postpartum pelvic floor were analyzed by using SPSS17.0. The effect of rehabilitation therapy on the function of pelvic floor a good condition The results of the difference of the curative effect between different delivery methods. Results 1. The age of the pregnant women in the vaginal delivery group and the selective caesarean section group, the weight of the pregnant women, the weight of the newborn and the length of the newborn The difference was not significant (p0.05). 2. The muscle strength and fatigue of the pelvic floor of the vaginal delivery group were selected for 6-8 weeks after delivery. There was no significant difference in dynamic pressure of pelvic floor (p0.05). Muscle strength, fatigue and dynamic pressure of the following I and II muscle fibers Compared with the pre-treatment, there was a significant difference between the two groups (p0.05). 4. The muscle strength, fatigue and dynamic pressure of the I and II muscle fibers after the vaginal delivery were better than those before the treatment (p0.05); the muscle strength, fatigue, and the dynamics of the vaginal delivery education were statistically significant (p0.05). The results showed that the muscle strength, fatigue and dynamic pressure of Class I and II muscle fibers after vaginal delivery were superior to that of yin. After the delivery of health education, the difference between the two groups was statistically significant (p0.05). 6. The selective cesarean section was superior to that of the I and II muscle fibers after the selective cesarean section. The difference of force, fatigue and dynamic pressure was statistically significant (p0.05). 7. There was no significant difference in the muscle strength, fatigue and dynamic pressure of I and II muscle fibers after vaginal delivery (p0.05). After the selective cesarean section, the muscle strength, fatigue and dynamic pressure of the type I muscle fibers were better than that of the vaginal delivery, and the difference of the two groups was statistically significant (p0.05). but two Conclusion 1. The effect of health education on the function of the pelvic floor muscle of the parturient is not significant (p0.05). The effect of the recovery of the muscle fibers of the pelvic floor in the vaginal delivery is less than that of the selective cesarean section at 4 and a half months after the delivery.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R711.5
本文編號(hào)：2361777
[Abstract]:The female pelvic floor function (PFD) is a high-incidence disease characterized by pelvic organ prolapse (POP), stress urinary incontinence (SUI) and chronic pelvic pain, which seriously affects the health and quality of life of women. The cause of this disease is diverse, and most scholars agree that pregnancy and delivery are independent risk factors, and the change of mechanical stress and hormone level during pregnancy and delivery can damage the pelvic floor and related support system. If the function of the pelvic floor muscle can not be effectively restored in time after the birth, the function of supporting the pelvic organs is weakened, and the occurrence of the PFD can be easily caused. Because of the shortcomings of the operation in the treatment of the PFD, as well as the understanding of the disease, the early prevention and early treatment have been recognized, and the physical rehabilitation of the pelvic floor in the non-operative treatment is the general concern of the people. Objective To study the self-repairing degree of pelvic floor muscle function and the function of pelvic floor in the pelvic floor by using PHOENIX U8 physical rehabilitation therapy instrument (provided by Guangzhou Sequoia Company) to detect the muscle strength, fatigue and dynamic pressure of the pelvic floor. The effect of physical rehabilitation on the function of pelvic floor in the early stage of different delivery methods is explained by the difference of the good condition and the difference of the curative effect between different delivery methods. The idea. Materials and parties Method 1 The subjects were selected from November, 2012 to January, 2014 for re-examination at the Third Affiliated Hospital of Zhengzhou University. The average age (28. 42, 2.73) years and the average time of delivery were (28. 42 to 2.73). 39 (3.57) weeks, in which 120 cases of vaginal delivery, selected alternative cesarean section 1 20 cases. 2. The method of the study was to test the muscle strength, fatigue and the dynamic pressure of the pelvic floor by means of a specially trained person by means of a manipulation test + PHOENIX U8 physical rehabilitation therapy instrument (provided by the Guangzhou Sequoia Company). The function of early pelvic floor muscle was evaluated by force value. 60 cases of vaginal delivery and selective caesarean section were randomly selected for physical rehabilitation for one course of treatment. The treatment was conducted by using the PHENIX U8 physical rehabilitation apparatus for electrical stimulation + biofeedback + Kay. In the combined treatment (treatment group), 60 patients in the remaining two groups were given a course of treatment for the health education of the pelvic floor by the professional staff. The method included 150 to 200 kanger's movement per day (treatment group). observation group), each The three statistical methods were used to record and analyze the data, t-test and rank sum test as the test method, and the self-repair degree and the basin-bottom physical function of the postpartum pelvic floor were analyzed by using SPSS17.0. The effect of rehabilitation therapy on the function of pelvic floor a good condition The results of the difference of the curative effect between different delivery methods. Results 1. The age of the pregnant women in the vaginal delivery group and the selective caesarean section group, the weight of the pregnant women, the weight of the newborn and the length of the newborn The difference was not significant (p0.05). 2. The muscle strength and fatigue of the pelvic floor of the vaginal delivery group were selected for 6-8 weeks after delivery. There was no significant difference in dynamic pressure of pelvic floor (p0.05). Muscle strength, fatigue and dynamic pressure of the following I and II muscle fibers Compared with the pre-treatment, there was a significant difference between the two groups (p0.05). 4. The muscle strength, fatigue and dynamic pressure of the I and II muscle fibers after the vaginal delivery were better than those before the treatment (p0.05); the muscle strength, fatigue, and the dynamics of the vaginal delivery education were statistically significant (p0.05). The results showed that the muscle strength, fatigue and dynamic pressure of Class I and II muscle fibers after vaginal delivery were superior to that of yin. After the delivery of health education, the difference between the two groups was statistically significant (p0.05). 6. The selective cesarean section was superior to that of the I and II muscle fibers after the selective cesarean section. The difference of force, fatigue and dynamic pressure was statistically significant (p0.05). 7. There was no significant difference in the muscle strength, fatigue and dynamic pressure of I and II muscle fibers after vaginal delivery (p0.05). After the selective cesarean section, the muscle strength, fatigue and dynamic pressure of the type I muscle fibers were better than that of the vaginal delivery, and the difference of the two groups was statistically significant (p0.05). but two Conclusion 1. The effect of health education on the function of the pelvic floor muscle of the parturient is not significant (p0.05). The effect of the recovery of the muscle fibers of the pelvic floor in the vaginal delivery is less than that of the selective cesarean section at 4 and a half months after the delivery.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R711.5
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