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目的探讨不同分娩方式及相关产科因素对盆底功能障碍的影响。方法选择四川省妇幼保健院产后42 d进行产后复查的妇女1 381例为研究对象,其中经阴道分娩712例,剖宫产669例,专人询问并填写孕期及产后尿失禁(urinary incontinence,UI)问卷调查表,并进行盆底肌力筛查,观察不同分娩方式及产科影响因素与盆底肌力的相关性。结果Ⅰ类肌纤维肌力异常检出率阴道分娩组(69.38%)与剖宫产组(67.71%)比较差异无统计学意义(P>0.05);Ⅱ类肌纤维肌力异常检出率阴道分娩组(67.56%)高于剖宫产组(61.73%)(P<0.05)。孕期压力性尿失禁(stress urinary incontinence,SUI)293例(21.22%),其中阴道分娩组157例(22.05%),剖宫产组136例(20.33%);产后SUI 133例(9.63%),其中阴道分娩组114例(16.01%),剖宫产组19例(2.84%),阴道分娩组产后SUI发病率明显高于剖宫产组(P<0.05)。结论分娩前体质量指数是I类、Ⅱ类肌纤维肌力异常的高危因素;剖宫产为Ⅱ类肌纤维肌力异常、产后发生SUI的保护性因素;年龄为产后SUI发生的高危因素。应严格控制孕期体重,给予孕产妇保护盆底功能充分的宣教,指导其进行盆底肌锻炼。
Objective To investigate the effects of different modes of delivery and related obstetric factors on pelvic floor dysfunction. Methods A total of 1 381 women at postpartum 42 days postpartum were selected as research objects. Among them, 712 were delivered vaginally and 669 were cesarean. Patients were asked to fill in urinary incontinence (UI) Questionnaire, pelvic floor muscle power screening and observation of different modes of delivery and obstetric factors and pelvic floor muscle strength. Results The detection rate of myofiber abnormality in type Ⅰ myofibers was no significant difference between vaginal delivery group (69.38%) and cesarean section group (67.71%) (P> 0.05) (67.56%) than cesarean section (61.73%) (P <0.05). There were 293 cases (21.22%) of pregnancy stress urinary incontinence (SUI), 157 cases (22.05%) in the vaginal delivery group and 136 cases (20.33%) in the cesarean section, 133 cases (9.63% Including vaginal delivery group 114 cases (16.01%), cesarean section group 19 cases (2.84%), vaginal delivery group postpartum SUI incidence was significantly higher than the cesarean section group (P <0.05). Conclusions The body mass index before delivery is the risk factor for abnormal muscular strength of type I and II fibers. Cesarean section is the muscle strength abnormality of type II myofibers and the protective factor of SUI in postpartum. The age is the risk factor of SUI in postpartum. Pregnancy should be strictly controlled body weight, give protection of pelvic floor maternal function full of education, to guide their pelvic floor muscle exercise.