盆底肌电在产后盆底功能障碍性疾病诊断和治疗中的价值*

Value of pelvic floor electromyography in diagnosis and treatment of postpartum pelvic floor dysfunction*

摘要:

目的 探讨顺产和剖宫产后盆底肌功能状况，了解盆底肌电在产后盆底功能障碍性疾病诊断和治疗 中的应用价值。方法 选取2016年1月—2018年3月在天津医院分娩的产妇365例（顺产202例，剖宫产163例） 作为研究对象，进行常规产后42 d盆底功能检测，了解不同分娩方式后的盆底疾病发生率、肌力情况及肌电特 点；并通过比较筛查出压力性尿失禁（137例）和盆腔器官脱垂患者（212例）的盆底肌电指标，探讨2种疾病的 发病机制；最后对经盆底肌电筛查确诊并接受治疗的过度活动型（42例）和松弛型（70例）患者，予以1个疗程 盆底肌电治疗后，进行疗效评估。结果 顺产组与剖宫产组子宫脱垂和压力性尿失禁发生率比较，差异无统计意 义（P >0.05）；阴道前壁脱垂和后壁脱垂发生率比较，差异有统计学意义（P <0.05）。顺产组与剖宫产组产后盆 底牛津肌力分布比较，差异无统计学意义（P >0.05），大部分≥2级。顺产组盆底肌电评估指标（前静息值、后静 息值、快速收缩最大值、紧张收缩值、耐力收缩值）低于剖宫产组（P <0.05）。压力性尿失禁组前静息值、后静 息值、紧张收缩值、耐力收缩值高于盆腔器官脱垂组（P <0.05），快速收缩最大值较盆腔器官脱垂组低（P < 0.05）。疗程治疗后，过度活动型患者后静息值下降（P <0.05），松弛型患者快速收缩最大值、紧张收缩值和耐力 收缩值上升（P <0.05）；过度活动型患者中，顺产组与剖宫产组治疗前和治疗后的后静息电位比较，差异无统计 学意义（P >0.05）；松弛型患者中，顺产组与剖宫产组治疗前和治疗后的持快速收缩最大值、紧张收缩值和耐力 收缩值比较，差异无统计学意义（P >0.05）。结论 分娩方式虽从一定程度上影响产后盆底肌功能，但不能以此 作为选择分娩方式的依据。盆底肌电指标有助于判断产后盆底肌功能状况，并可用于评估产后康复效果。盆底肌 电治疗可有效改善产后早期盆底肌功能。

Abstract:

Objective To investigate the function of pelvic floor muscles after different delivery modes, and to understand the value of EMG evaluation and treatment in the diagnosis and treatment of pelvic floor dysfunction. Methods A total of 365 parturients (202 vaginal delivery and 163 selective cesarean section) delivered in Tianjin Hospital from January 2016 to March 2018 were enrolled in the study. The function of pelvic floor was tested to find out the incidence of pelvic floor diseases, the muscle strength, and the characteristics of electromyography at 42 days after deliveries. We explored the pathogenesis of stress urinary incontinence (n = 137) and pelvic organ prolapse (n =212) by comparing the electromyographicindices. Finally, we evaluated the effect of electromyography improvement in patients with excessive activity (n = 42) and relaxation activity (n = 70) after one course of pelvic floor electromyography treatment. Results There was no statistical difference in the incidences of uterine prolapse and stress urinary incontinence between vaginal delivery group and cesarean section group (P > 0.05). There was significant difference between the incidence of anterior vaginal wall prolapse and posterior vaginal wall prolapse (P < 0.05). There was no significant difference in the distribution of Oxford muscle strength in the pelvic floor between the spontaneous delivery group and the cesarean section group (P > 0.05), and the most of patients were in grade 2 or above. The indexes of Glazer electromyogram (resting value, rapid contraction value, tension contraction value, and endurance contraction value) of vaginal delivery group and cesarean section group were significantly different (P < 0.05). The contractility and resting value of pelvic floor muscle in cesarean section group were higher than those in vaginal delivery group (P < 0.05). The resting value, tension contraction value and endurance contraction value of stress urinary incontinence group were higher than those of pelvic organ prolapse group (P < 0.05), and the rapid contraction value was lower (P < 0.05). After treatment, resting baseline values of excessiveactivity patients decreased (P < 0.05), while the mean value of sustained contraction, maximum value of rapid contraction, and endurance contraction of relaxation-activity patients increased significantly (P < 0.05). There was no statistical difference in resting potential of excessive-activity patients between the spontaneous delivery group and the cesarean section group before and after treatment (P > 0.05). In the relaxation group, there was also no statistical difference in the mean of sustained contraction, maximum rapid contraction and endurance contraction before and after treatment between the two different deliver mode groups (P > 0.05). Conclusions Although the mode of delivery affects the function of pelvic floor muscle at some limits, it can not be used as the basis for the choice of the mode of delivery. Pelvic floor electromyography index is helpful to detect the postpartum pelvic floor muscle function and can be used as the evaluation method of postpartum rehabilitation effect. Pelvic floor electromyography treatment can effectively improve the early postpartum pelvic floor muscle function.