摘要
目的应用盆底肌表面肌电位(sEMG)和生活质量影响量表评价选择性会阴侧切术对初产妇产后半年内盆底肌功能的影响,并比较sEMG与尿失禁影响量表(IIQ-7) 、盆底疾病影响量表(PFIQ-7)评分的相关性。方法选取2018年1月至2019年6月在北京医院和云南省第一人民医院接受盆底功能筛查、并经阴道分娩的1 250例初产妇作为研究对象,按照分娩时是否接受会阴侧切术分为会阴侧切组(n=676)和非会阴侧切组(n=574)。产后随访6个月,分别测量两组产妇在产后6~8周和产后6个月时盆底肌sEMG值和盆底疾病生活质量量表评分,并且比较这两种盆底肌功能评价方法之间的相关性。结果会阴侧切组产后6~8周、6个月的快速收缩最大肌电位分别为(17.7±5.3)、(29.6±8.7)μV,强直收缩肌电位分别为(14.8±7.4)、(22.2±8.9)μV。非会阴侧切组产后6~8周、6个月的快速收缩最大肌电位分别为(20.0±7.9)、(35.4±10.7)μV,强直收缩肌电位分别为(17.8±9.0)、(27.5±8.9)μV。同产后6~8周相比,两组产妇在产后6个月时的快速收缩最大肌电位和强直收缩肌电位均升高,差异均有统计学意义(均P<0.01)。会阴侧切组在产后6~8周和产后6个月时的快速收缩最大肌电位和强直收缩肌电位均显著低于非会阴侧切组(均P<0.01)。与产后6~8周相比,两组产妇产后6个月时的IIQ-7评分和PFIQ评分均有显著改善。在产后6~8周及产后6个月时,两组产妇之间的IIQ-7评分和PFIQ-7评分差异均有统计学意义(均P<0.05)。在产后6~8周和产后6个月,两组产妇的盆底肌收缩肌电位与IIQ-7和PFIQ-7评分均呈负相关(均P<0.05),相关性随产后时间延长而减弱。结论选择性会阴侧切术在产后半年内对初产妇盆底肌收缩电生理功能有持续的不良影响。盆底肌sEMG值与盆底疾病生活质量量表评分存在负相关。盆底肌sEMG可以作为产后盆底功能随访的候选评估方法。
Objective To compare the impact of mediolateral episiotomy on pelvic floor muscle(PFM)function through surface electromyography(sEMG)and quality of life questionnaire assessment.Methods From January 2018 to June 2019,1250 eligible primiparous women were enrolled in Beijing Hospital and the First People′s Hospital of Yunnan Province.Participants were divided into episiotomy group(n=676)and non-episiotomy group(n=574).Both groups underwent clinical pelvic examination,sEMG assessment,and quality of life(QOL)questionnaire assessment at two fixed time points:6-8 weeks,6 months after vaginal delivery.Follow-up of sEMG amplitudes and their correlation with QOL questionnaire scores were evaluated.Results Among the women delivered with episiotomy,the peak amplitude of phasic contraction(PPC)was(17.7±5.3)μV at 6-8 weeks after childbirth and(29.6±8.7)μV at 6 months after childbirth.The mean amplitude of tonic contraction(MTC)was(14.8±7.4)μV and(22.2±8.9)μV,respectively.In the non-episiotomy group,PPC was(20.0±7.9)μV and(35.4±10.7)μV at 6-8 weeks and 6 months,and MTC was(17.8±9.0)μV and(27.5±8.9)μV,respectively.Compared with EMG amplitudes at 6-8 weeks,both PPC and MTC significantly improved at 6 months in both groups(all P<0.01).Moreover,episiotomy was related with significantly lower PPC and MTC at both fixed checkups.Besides,both IIQ-7 and PFIQ-7 questionnaire scores improved at 6 months compared with those at 6-8 weeks in both groups(all P<0.001).There was consistently significant difference in QOL scores between episiotomy and non-episiotomy group at two checkups(all P<0.05).A negative correlation was observed between PFM contractile amplitudes and QOL scores at both time points after childbirth(all P<0.05),and the correlation weakened with time.Conclusion Episiotomy has a negative impact on the postpartum PFM contractile function within 6 months after childbirth.The negative correlation between the sEMG and QOL scores indicates that sEMG is a candidate assessment for PFM function follow-up after child
作者
李旻
董旭东
吕爱明
冯庆
改天姿
王少为
Li Min;Dong Xudong;Lyu Aiming;Feng Qing;Gai Tianzi;Wang Shaowei(Department of Obstetrics and Gynecology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Acadamy of Medical Sciences,Beijing 100730,China;Department of Gynecology,the First People′s Hospital of Yunnan Province,Affiliated Hospital of Kunming University of Science and Technology,Kunming 650032,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2021年第5期339-344,共6页
National Medical Journal of China
基金
北京医院临床研究121项目(BJ-2018-204)
云南省左合治彦专家工作站项目(202005AF150033)。
关键词
产后期
骨盆底
尿失禁
肌电描记术
会阴侧切术
Postpartum period
Pelvic floor
Urinary incontinence
Electromyography
Episiotomy
