初產(chǎn)婦產(chǎn)后盆底功能障礙性疾病早期康復(fù)治療最佳時期選擇
發(fā)布時間：2019-07-06 10:28
【摘要】：女性盆底功能障礙性疾病(female pelvic floor dysfunc-tion,FPFD)是影響女性生活質(zhì)量的五大慢性疾病之一,包括尿失禁、便失禁、盆腔器官脫垂、慢性盆腔痛以及性功能障礙,國內(nèi)資料報道其發(fā)病率可高達(dá)25.8%~35.3%。女性盆底功能障礙性疾病(pelvic floor dysfunc-tion,PFD)是一種多因素性疾病,其病理生理發(fā)病機(jī)制并不完全清楚,目前已知的危險因素主要有年齡、肥胖、妊娠和分娩、產(chǎn)次、第二產(chǎn)程延長、生殖系統(tǒng)炎癥、糖尿病、結(jié)締組織疾病、神經(jīng)系統(tǒng)疾病及遺傳等;這些危險因素大多可進(jìn)行或多或少的人為干預(yù)(如:改變生活方式)來降低PFD的發(fā)生率,但是妊娠和分娩卻是幾乎每個女性都無法逃避的問題,流行病學(xué)數(shù)據(jù)表明:妊娠和分娩是PFD的獨立危險因素【1-2】。產(chǎn)后FPFD發(fā)病率明顯增加,大大降低了產(chǎn)婦的生活質(zhì)量;目前大量研究已證實盆底康復(fù)治療療效顯著【3-5】,可有效預(yù)防和治療盆底障礙性疾病【6-7】,提高女性生活質(zhì)量,但迄今為止對于康復(fù)治療最佳時期的研究仍舊較少,且國內(nèi)外迄今仍沒有統(tǒng)一的定論;通過對在產(chǎn)后不同時期進(jìn)行盆底康復(fù)治療的產(chǎn)婦,產(chǎn)后1年盆底功能恢復(fù)情況的對比,進(jìn)而找出產(chǎn)后早期最佳康復(fù)治療時期,旨在為PFD的防治提供臨床依據(jù)。研究目的通過對在產(chǎn)后不同時期進(jìn)行盆底康復(fù)治療的產(chǎn)婦,產(chǎn)后1年盆底功能恢復(fù)情況的對比,進(jìn)而找出產(chǎn)后早期最佳康復(fù)治療時期,旨在為PFD的防治提供臨床依據(jù)。研究對象與方法1研究對象與分組選取2014.11—2015.11在鄭州大學(xué)第三附屬醫(yī)院進(jìn)行常規(guī)產(chǎn)后42天盆底篩查出肌力3級、有子宮脫垂、存在漏尿癥狀3次的初產(chǎn)婦478例;根據(jù)個人意愿分為治療組256例和未治療組222例,治療組根據(jù)產(chǎn)后開始治療時間的不同,又分為42天,3個月和6個月治療組;產(chǎn)后1年進(jìn)行隨訪、復(fù)查(剔除中途放棄治療、失訪、再次懷孕及數(shù)據(jù)記錄錯誤人數(shù)外),最終得到42天組40例、3個月組30例、6個月組30例,未治療組100例,并對這200例初產(chǎn)婦盆底功能的恢復(fù)情況進(jìn)行對比。2研究方法產(chǎn)后42天由婦產(chǎn)科�？漆t(yī)師進(jìn)行手法檢測+PHENIX U8低頻神經(jīng)肌肉刺激治療儀(廣州杉山醫(yī)藥器械實業(yè)有限公司提供)檢測盆底肌情況。治療組采用盆底肌肉康復(fù)系統(tǒng)進(jìn)行盆底肌康復(fù)治療,主要包括生物反饋+低頻電刺激,每次治療30min,每周治療2次,治療10次為1療程,治療期滿一療程后,囑產(chǎn)婦在家自行做Kegel運動+家庭盆底康復(fù)器(陰道啞鈴)收縮鍛煉。未治療組僅給與常規(guī)的產(chǎn)后健康教育,壓力性尿失禁由調(diào)查問卷的方式完成。3監(jiān)測指標(biāo)肌力:根據(jù)Oxford骨盆底肌力評分(0-5級),≥3級屬于正常;(2)盆底肌纖維疲勞度:盆底肌肉由Ⅰ類肌纖維(即與臟器支持作用相關(guān)的慢收縮纖維)和Ⅱ類肌纖維(即在腹壓上升時關(guān)閉尿道的快收縮纖維)組成。起點的最高點到6 s終點的最高點之間的下降比率的百分比為疲勞度,正常值為0%或正值,負(fù)值為異常;(3)盆底肌最大肌電位值:即為盆底收縮時參與收縮的肌纖維肌電位的總和,范圍為1—30uv;(4)子宮脫垂分度:按第8版“婦產(chǎn)科學(xué)”盆腔器官脫垂分度(POP-Q分度法)評分標(biāo)準(zhǔn)進(jìn)行評分;(5)壓力性尿失禁(SUI):參考國際尿失禁問卷表簡表(ICIQ-SF)以“腹壓增加時,如:打噴嚏、咳嗽、大笑或提重物時,尿液不自主漏出”,為SUI癥狀。出現(xiàn)漏尿次數(shù)大于等于3次。4統(tǒng)計學(xué)方法采用SPSS21.0軟件進(jìn)行數(shù)據(jù)錄入與分析。計量資料以(`X±S)表示,數(shù)據(jù)符合正態(tài)分布,計量資料中多組間比較采用單因素方差分析法,組內(nèi)兩兩比較采用LSD檢驗;計數(shù)資料用卡方檢驗,多組比較P0.05,差異有統(tǒng)計學(xué)意義;多個實驗組與對照組比較的校正檢驗水準(zhǔn)α=0.01,P0.01差異有統(tǒng)計學(xué)意義;多個實驗組間兩兩比較的校正檢驗水準(zhǔn)α=0.0167,P0.0167差異有統(tǒng)計學(xué)意義。結(jié)果1.產(chǎn)后42天篩查結(jié)果顯示:4組產(chǎn)婦盆底功能差異無統(tǒng)計學(xué)意義(P0.05);2.產(chǎn)后1年隨訪復(fù)查結(jié)果顯示:盆底肌力:42天治療組與3個月治療組(P0.0167),6個月治療組與未治療組(P0.01)比較差異無統(tǒng)學(xué)意義,其余各組比較差異均有統(tǒng)計學(xué)意義;盆底肌疲勞度:42天治療組與3個月治療組療效基本相同,差異無統(tǒng)計學(xué)意義(P0.0167),其余各組比較差異均有統(tǒng)計學(xué)意義;最大肌電位:4組兩兩比較差異均具有統(tǒng)計學(xué)意義;子宮脫垂與尿失禁:42天治療組發(fā)生率明顯低于未治療組,差異有統(tǒng)計學(xué)意義(P0.01),其余各組比較差異均無統(tǒng)計學(xué)意義;結(jié)論1..產(chǎn)后3個月內(nèi)是改善盆底肌力及肌纖維疲勞度的最佳時期;2.產(chǎn)后42天是治療子宮脫垂及壓力性尿失禁的最佳時期;
[Abstract]:The female pelvic floor dysfunc-tion (FPFD) is one of the five chronic diseases that affect the quality of women's life, including urinary incontinence, incontinence, pelvic organ prolapse, chronic pelvic pain and sexual dysfunction. female pelvic floor dysfunc-tion (pfd) is a multi-factor disease, and its pathophysiological mechanism is not entirely clear, and the currently known risk factors are mainly age, obesity, pregnancy and delivery, secondary labor, second stage of labor, inflammation of the reproductive system, and diabetes, connective tissue diseases, nervous system diseases, and inheritance; most of these risk factors can be used for more or less human intervention (e.g., lifestyle changes) to reduce the incidence of the PFD, but pregnancy and delivery are a problem that almost every woman cannot escape, and the epidemiological data indicate that: Pregnancy and delivery are independent risk factors for PFD[1-2]. The incidence of post-partum FPFD is obviously increased, and the quality of life of the parturient is greatly reduced; a large number of studies have shown that the curative effect of the pelvic floor rehabilitation therapy is remarkable[3-5], and can effectively prevent and treat the pelvic floor disorder[6-7] and improve the quality of life of the female, but so far, the research on the best period of rehabilitation therapy is still relatively small, and there is no single conclusion to date at home and abroad; and through the comparison of the recovery of the pelvic floor function in the postpartum period of one year after the delivery of the pelvic floor rehabilitation in different periods of the post-partum period, In order to provide a clinical basis for the prevention and treatment of the PFD. The purpose of this study was to provide a clinical basis for the prevention and treatment of the PFD by comparing the recovery of the pelvic floor function during the postpartum period. The study object and method 1 study object and group selection was 2014.11-2015.11, in the third affiliated hospital of Zhengzhou University, the third affiliated hospital of Zhengzhou University was screened out the third grade of the muscle strength, with the uterus prolapsed, and the first of the 478 cases with the symptoms of leakage of urine were found in 478 cases; According to the individual's will, the treatment group was divided into the treatment group (256 cases) and the untreated group (222 cases). The treatment group was divided into two groups (42 days,3 months and 6 months) according to the difference of the treatment time after the postpartum period. The follow-up was carried out for 1 year after the delivery, and the treatment and the lost-to-follow-up were carried out in one year after the delivery. In addition to that number of re-pregnancy and data record,40 of the 42-day group,30 in the 3-month group,30 in the 6-month group and 100 in the untreated group were obtained. In this paper, the recovery of pelvic floor function in 200 cases of primary parturient was compared. The method was used to detect the pelvic floor muscle in 42 days after the delivery of the method by the obstetrician of the department of obstetrics and gynecology. The therapeutic apparatus of the low frequency neuromuscular stimulation of PHENIX U8 (provided by Hupershan Medical Device Industry Co., Ltd.) was used to detect the pelvic floor. the treatment group adopts a pelvic floor muscle rehabilitation system to perform pelvic floor muscle rehabilitation treatment, mainly comprises biofeedback and low-frequency electrical stimulation, The woman is told to do the Kegel exercise and the family pelvic floor rehabilitation device (the vaginal dumbbell) to shrink and exercise. In the untreated group, only routine post-natal health education was given, and the stress urinary incontinence was completed in the form of a questionnaire.3 Monitoring index muscle strength: according to the Oxford pelvic floor muscle strength score (grade 0-5), the level 3 was normal; (2) pelvic floor muscle fatigue: The pelvic floor is composed of type I muscle fibers (i.e., slow-shrinkage fibers associated with organ support) and type II muscle fibers (i.e., fast-contracting fibers that close the urethra when the abdominal pressure rises). the percentage of the descending ratio between the highest point of the starting point and the highest point of the end point of the 6 s is fatigue, the normal value is 0% or the positive value, the negative value is abnormal, and (3) the maximum muscle potential value of the pelvic floor muscle is the sum of the potential of the muscle fiber muscle participating in the contraction when the pelvic floor is contracted, and the range is 1 to 30 uv; (4) Classification of the Prolapse of the Uterus: Score according to the Standard of the "Obstetrics and Gynecology" of the Pelvic Organ Prolapse (POP-Q) of the 8th edition; (5) Stress Urinary Incontinence (SUI): Refer to the Summary of the International Urinary Incontinence Questionnaire (ICIQ-SF) for "When the abdominal pressure is increased, such as sneezing, coughing, laughing or lifting the weight, the urine does not leak spontaneously" and the symptoms of SUI. The number of urine leakage was greater than or equal to 3 times. The data entry and analysis were performed using the SPSS21.0 software in the statistical method. The data was expressed as (% X-S). The data met the normal distribution. The single-factor analysis of variance method was used to compare the two groups in the measurement data. The level of the correction test compared with the control group was statistically significant (P = 0.01, P 0.01). The corrected level of the two comparisons between the two experimental groups was equal to 0.0167. Results 1. The results of post-partum 42-day screening showed that there was no significant difference in the function of pelvic floor in group 4 (P <0.05);2. The results of follow-up after 1-year follow-up showed that: Pelvic floor muscle strength:42-day treatment group and 3-month treatment group (P0.0167), the difference of the six-month treatment group and the non-treatment group (P0.01) was not significant, the other groups had statistical significance, and the pelvic floor muscle fatigue degree: the curative effect of the 42-day treatment group was basically the same as that of the 3-month treatment group, There was no significant difference in the difference between the two groups (P 0.0167), and the difference of the other groups was statistically significant; the maximum muscle potential: two of the four groups had statistical significance; the incidence of uterine prolapse and urinary incontinence:42-day treatment group was significantly lower than that of the untreated group (P0.01). Conclusion 1. The optimal period for improving the strength of the pelvic floor and the fatigue of the muscle fiber within 3 months after delivery is the best period for the treatment of the prolapse of the uterus and the stress urinary incontinence.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.6
本文編號：2510946
[Abstract]:The female pelvic floor dysfunc-tion (FPFD) is one of the five chronic diseases that affect the quality of women's life, including urinary incontinence, incontinence, pelvic organ prolapse, chronic pelvic pain and sexual dysfunction. female pelvic floor dysfunc-tion (pfd) is a multi-factor disease, and its pathophysiological mechanism is not entirely clear, and the currently known risk factors are mainly age, obesity, pregnancy and delivery, secondary labor, second stage of labor, inflammation of the reproductive system, and diabetes, connective tissue diseases, nervous system diseases, and inheritance; most of these risk factors can be used for more or less human intervention (e.g., lifestyle changes) to reduce the incidence of the PFD, but pregnancy and delivery are a problem that almost every woman cannot escape, and the epidemiological data indicate that: Pregnancy and delivery are independent risk factors for PFD[1-2]. The incidence of post-partum FPFD is obviously increased, and the quality of life of the parturient is greatly reduced; a large number of studies have shown that the curative effect of the pelvic floor rehabilitation therapy is remarkable[3-5], and can effectively prevent and treat the pelvic floor disorder[6-7] and improve the quality of life of the female, but so far, the research on the best period of rehabilitation therapy is still relatively small, and there is no single conclusion to date at home and abroad; and through the comparison of the recovery of the pelvic floor function in the postpartum period of one year after the delivery of the pelvic floor rehabilitation in different periods of the post-partum period, In order to provide a clinical basis for the prevention and treatment of the PFD. The purpose of this study was to provide a clinical basis for the prevention and treatment of the PFD by comparing the recovery of the pelvic floor function during the postpartum period. The study object and method 1 study object and group selection was 2014.11-2015.11, in the third affiliated hospital of Zhengzhou University, the third affiliated hospital of Zhengzhou University was screened out the third grade of the muscle strength, with the uterus prolapsed, and the first of the 478 cases with the symptoms of leakage of urine were found in 478 cases; According to the individual's will, the treatment group was divided into the treatment group (256 cases) and the untreated group (222 cases). The treatment group was divided into two groups (42 days,3 months and 6 months) according to the difference of the treatment time after the postpartum period. The follow-up was carried out for 1 year after the delivery, and the treatment and the lost-to-follow-up were carried out in one year after the delivery. In addition to that number of re-pregnancy and data record,40 of the 42-day group,30 in the 3-month group,30 in the 6-month group and 100 in the untreated group were obtained. In this paper, the recovery of pelvic floor function in 200 cases of primary parturient was compared. The method was used to detect the pelvic floor muscle in 42 days after the delivery of the method by the obstetrician of the department of obstetrics and gynecology. The therapeutic apparatus of the low frequency neuromuscular stimulation of PHENIX U8 (provided by Hupershan Medical Device Industry Co., Ltd.) was used to detect the pelvic floor. the treatment group adopts a pelvic floor muscle rehabilitation system to perform pelvic floor muscle rehabilitation treatment, mainly comprises biofeedback and low-frequency electrical stimulation, The woman is told to do the Kegel exercise and the family pelvic floor rehabilitation device (the vaginal dumbbell) to shrink and exercise. In the untreated group, only routine post-natal health education was given, and the stress urinary incontinence was completed in the form of a questionnaire.3 Monitoring index muscle strength: according to the Oxford pelvic floor muscle strength score (grade 0-5), the level 3 was normal; (2) pelvic floor muscle fatigue: The pelvic floor is composed of type I muscle fibers (i.e., slow-shrinkage fibers associated with organ support) and type II muscle fibers (i.e., fast-contracting fibers that close the urethra when the abdominal pressure rises). the percentage of the descending ratio between the highest point of the starting point and the highest point of the end point of the 6 s is fatigue, the normal value is 0% or the positive value, the negative value is abnormal, and (3) the maximum muscle potential value of the pelvic floor muscle is the sum of the potential of the muscle fiber muscle participating in the contraction when the pelvic floor is contracted, and the range is 1 to 30 uv; (4) Classification of the Prolapse of the Uterus: Score according to the Standard of the "Obstetrics and Gynecology" of the Pelvic Organ Prolapse (POP-Q) of the 8th edition; (5) Stress Urinary Incontinence (SUI): Refer to the Summary of the International Urinary Incontinence Questionnaire (ICIQ-SF) for "When the abdominal pressure is increased, such as sneezing, coughing, laughing or lifting the weight, the urine does not leak spontaneously" and the symptoms of SUI. The number of urine leakage was greater than or equal to 3 times. The data entry and analysis were performed using the SPSS21.0 software in the statistical method. The data was expressed as (% X-S). The data met the normal distribution. The single-factor analysis of variance method was used to compare the two groups in the measurement data. The level of the correction test compared with the control group was statistically significant (P = 0.01, P 0.01). The corrected level of the two comparisons between the two experimental groups was equal to 0.0167. Results 1. The results of post-partum 42-day screening showed that there was no significant difference in the function of pelvic floor in group 4 (P <0.05);2. The results of follow-up after 1-year follow-up showed that: Pelvic floor muscle strength:42-day treatment group and 3-month treatment group (P0.0167), the difference of the six-month treatment group and the non-treatment group (P0.01) was not significant, the other groups had statistical significance, and the pelvic floor muscle fatigue degree: the curative effect of the 42-day treatment group was basically the same as that of the 3-month treatment group, There was no significant difference in the difference between the two groups (P 0.0167), and the difference of the other groups was statistically significant; the maximum muscle potential: two of the four groups had statistical significance; the incidence of uterine prolapse and urinary incontinence:42-day treatment group was significantly lower than that of the untreated group (P0.01). Conclusion 1. The optimal period for improving the strength of the pelvic floor and the fatigue of the muscle fiber within 3 months after delivery is the best period for the treatment of the prolapse of the uterus and the stress urinary incontinence.
【學(xué)位授予單位】：鄭州大學(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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