初產婦經陰道分娩與剖宮產對產后壓力性尿失禁及盆底肌力的影響

尚禹

摘要：目的 ?探討初產婦經陰道分娩與剖宮產對產后壓力性尿失禁（SUI）發生情況及盆底肌力的影響。方法 ?選擇2019年1月～2020年1月在我院住院分娩的初產婦320例，依據分娩方式分為剖宮產組153例，陰道分娩組167例。比較兩組產后SUI發生情況、產后不同時間（產后4周及8周）尿道旋轉角度、膀胱頸活動度（UVJ-M）及盆底肌圖值的活力值。結果 ?剖宮產組產后SUI發生率為9.80%，低于陰道分娩組的19.76%，差異有統計學意義（P<0.05）;產后4周及8周陰道分娩組尿道旋轉角度及UVJ-M大于剖宮產組，差異有統計學意義（P<0.05）;陰道分娩組左右兩側活力值低于剖宮產組，差值高于剖宮產組，差異有統計學意義（P<0.05）。結論 ?經陰道分娩的初產婦產后SUI發生率高于剖宮產，且對盆底肌功能影響較大，應注重陰道分娩產婦產后康復。

關鍵詞：剖宮產;陰道分娩;壓力性尿失禁;盆底肌力

中圖分類號：R711.5 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻標識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2020.18.035

文章編號：1006-1959（2020）18-0107-02

Influence of Vaginal Delivery and Cesarean Section of Primipara on Postpartum Stress Urinary Incontinence and Pelvic Floor Muscle Strength

SHANG Yu

（Department of Obstetrics and Gynecology，Tianjin Third Central Hospital，Tianjin 300170，China）

Abstract：Objective ?To explore the effects of vaginal delivery and cesarean section of primipara on the occurrence of postpartum stress urinary incontinence （SUI） and pelvic floor muscle strength.Methods ?A total of 320 primiparas who were hospitalized in our hospital for delivery from January 2019 to January 2020 were selected. According to the delivery method， they were divided into 153 cases of cesarean section and 167 cases of vaginal delivery. The occurrence of postpartum SUI， urethral rotation angle， bladder neck mobility （UVJ-M） and pelvic floor muscles at different times （4 and 8 weeks postpartum） were compared between the two groups.Results ?The incidence of postpartum SUI in the cesarean section was 9.80%， which was lower than 19.76% in the vaginal delivery group，the difference was statistically significant （P<0.05）;The urethral rotation angle and UVJ-M of the vaginal delivery group at 4 weeks and 8 weeks postpartum were greater than those of the cesarean section group， the difference was statistically significant （P<0.05）;The vitality value of the left and right sides of the vaginal delivery group was lower than that of the cesarean section group， and the difference was higher than that of the cesarean section group， the difference was statistically significant （P<0.05）.Conclusion ?The incidence of postpartum SUI in primiparas with vaginal delivery was higher than that of cesarean section， and it had a greater impact on pelvic floor muscle function. The postpartum rehabilitation of vaginal delivery women should be emphasized.

Key words：Cesarean section;Vaginal delivery;Stress urinary incontinence;Pelvic floor muscle strength

壓力性尿失禁（stress urinary incontinence，SUI）是指咳嗽或噴嚏時增高腹壓，而不能自主控制尿液流出的情況，不僅影響患者的日常生活及工作，同時給其身心造成較大壓力。SUI與盆底軟組織損傷密切相關，而妊娠及陰道分娩是影響盆底肌肉功能的危險因素之一，因妊娠過程會機械性壓迫盆底，陰道分娩會進一步損傷盆底軟組織，影響盆腔器官功能[1]。研究顯示[2]，實施剖宮產的產婦可減少盆底肌損傷，進而保護盆底功能，改善產婦產后生活質量。鑒于此，本研究探討初產婦應用經陰道分娩與剖宮產對產后SUI發生情況及盆底肌力的影響，現報道如下。

1資料與方法

1.1一般資料 ?選擇2019年1月～2020年2月在天津市第三中心醫院婦產科住院分娩的初產婦320例臨床資料，依據分娩方式分為剖宮產組153例，陰道分娩組167例。剖宮產組年齡23～35歲，平均年齡（28.67±3.14）歲;孕周37～41周，平均孕周（38.92±1.02）周;新生兒體重2.08～4.20 kg，平均體重（3.28±0.29）kg。陰道分娩組年齡22～36歲，平均年齡（28.78±3.25）歲;孕周37～41周，平均孕周（39.13±1.07）周;新生兒體重2.17～4.09 kg，平均體重（3.26±0.24）kg。……