目的探讨分娩方式及相关因素对女性产后早期盆底功能障碍性疾病(PPFD)产生的影响。方法选择产后6~10周进行复查的产妇1706例,根据分娩方式分为:选择性剖宫产组621例,阴道分娩组1085例。通过问卷调查及盆底肌力检测了解产后盆底功能及产科因素对产后压力性尿失禁(SUI)和盆腔脏器脱垂(POP)的影响。结果 (1)分娩方式对产后盆底肌力无影响,差异无统计学意义(P>0.05),但对产后SUI、POP有影响,差异有统计学意义(P<0.05)。盆底肌I类肌纤维肌力异常率阴道分娩组为62.67%,选择性剖宫产组为58.62%(P>0.05);II类肌纤维肌力的异常率阴道分娩组为60.00%,选择性剖宫产为56.52%(P>0.05);不同分娩方式间差异无统计学意义(P>0.05)。产后SUI阴道分娩组14.01%,剖宫产组5.96%;盆腔脱垂阴道分娩组0度43.04%、I度49.03%、II度7.93%,选择性剖宫产组0度63.76%、I度34.30%、II度1.93%;两组比较差异具有统计学意义(P<0.05)。(2)相关因素的分析显示,年龄、第二产程时间、产次、新生儿出生体重与盆底肌力受损、产后SUI、POP发生呈正相关(P<0.05)。结论妊娠和分娩是PPFD的高危因素,年龄、第二产程时间、产次、新生儿出生体重是其主要影响因素。

Objective To explore the relationship between different modes of delivery and the occurrence of early postpartum pelvic floor dysfunction(PPFD). Methods Medical records of 1706 puerperants who reviewed at postpartum 6-10 weeks. According to the delivery mode they were divided into group of selective cesarean section with 621 cases and group of vaginal delivery with 1085 cases. Early postpartum pelvic floor functions were evaluated by pelvic floor muscle and by using pelvic floor dysfunction clinical questionnaire about obstetric factors to stress urinary incontinence(SUI) and pelvic organ prolapse(POP) influence. Results The rate of type I and type II muscle strength there was no significant difference between the different delivery groups(P > 0. 05),but significant difference in rate of SUI and POP between different modes of delivery. The pelvic floor muscle strength of type I muscle fiber abnormal rate of vaginal delivery group 62. 67%,selective cesarean section group 58. 62%(P > 0. 05); The abnormal rate of pelvic floor muscle fiber type II muscle,vaginal delivery group 60%,elective cesarean section 56. 52%(P > 0. 05); there was no significant difference between the different modes of delivery. The incidence of postpartum SUI was 14. 01% in vaginal delivery and 5. 96% in caesarean section(P < 0. 05). Pelvic prolapse vaginal delivery group 0 degree 43. 04%,I degree 49. 03%,II 7. 93%,selective cesarean section group 0 degrees 63. 76%,I 34. 30%,II 1. 93%; two group the difference was statistically significant(P < 0. 05).Analysis of related factors showed that age,parity,and time of the second stage of labor,Newborn Birth Weight(NBW) were positively correlated to the occurrence of pelvic floor muscle damage,SUI and POP(P < 0. 05). Conclusion Pregnancy and delivery are risk factors for postpartum pelvic floor dysfunction,age,parity,NBW and duration of the second stage of labor is the main influencing factors.