妊娠期盆底肌训练对产后盆底功能康复效果及对血清RLN、CTGF、MMP-1水平的影响

Effect of pelvic floor muscle training during gestation on postpartum pelvic floor function rehabilitation and its effect on serum RLN,CTGF and MMP-1

暂未订购

导出

摘要目的观察妊娠期盆底肌训练对产后盆底功能康复效果及对血清松弛素(RLN)、结缔组织生长因子(CTGF)、基质金属蛋白酶-1(MMP-1)水平的影响。方法前瞻性选取2022年4月至2024年5月唐山市妇幼保健院产科门诊孕检建表的196例孕妇作为研究对象。按照随机数字表法将其分为观察组与对照组,各98例。对照组在产后次日进行核心肌群稳定性训练,产后42 d进行生物反馈电刺激;观察组在对照组基础上,于孕16周开始,进行盆底肌训练至分娩前,并于产后第8天继续锻炼至产后42 d。观察指标包括盆底肌收缩力量、盆底表面肌电、盆底超声检查[子宫颈外口移动度(CD)、膀胱颈移动度(BND)、肛提肌裂孔横径差值(LHLR-d)、肛提肌裂孔直径差值(LHD-d)、直肠壶腹移动度(RAD)]、血清因子(RLN、CTGF、MMP-1)水平,以及盆腔器官脱垂、尿失禁发生情况。结果观察组Ⅴ级、Ⅳ~Ⅴ级占比分别为43.88%、81.63%,均高于对照组(19.39%、69.39%),差异均有统计学意义(P<0.05)。观察组前静息阶段、后静息阶段的平均值均明显高于对照组,变异性小于对照组,Ⅰ类肌纤维平均值、Ⅱ类肌纤维最大值均高于对照组,Ⅰ类肌纤维变异性小于对照组,Ⅱ类肌纤维恢复时间短于对照组,差异均有统计学意义(P<0.05)。观察组产后8周的CD、BND、LHLR-d、LHD-d以及RAD分别为(0.83±0.15)、(0.96±0.24)、(0.32±0.14)、(0.27±0.09)、(0.73±0.14)mm,均明显低于对照组[(1.15±0.13)、(1.15±0.21)、(0.51±0.13)、(0.42±0.14)、(0.93±0.19)mm],差异均有统计学意义(P<0.05)。观察组产后8周的血清RLN、CTGF、MMP-1为(52.54±9.64)pg/mL、(30.23±8.37)μg/L、(5.47±2.53)μg/L,均低于对照组[(59.34±14.35)pg/mL、(69.56±15.48)μg/L、(7.59±3.28)μg/L],差异均有统计学意义(P<0.05)。观察组盆腔器官脱垂、混合性尿失禁、尿失禁总发生率分别为0、4.08%、9.18%,均明显低于对照组(8.16%、14.29%、32.65%),差异均有统计学意义(P<0.05)。结论孕16周起进行盆底肌训练有利于产后盆底功能恢复,盆底肌收缩力量较强,降低血清RLN、CTGF、MMP-1水平,并降低产后盆腔器官脱垂及尿失禁的发生率。 Objective To observe the effect of pelvic floor muscle training during gestation on postpartum pelvic floor function rehabilitation and its effect on serum relaxin(RLN),connective tissue growth factor(CTGF)and matrix metalloproteinase-1(MMP-1)levels.Methods A total of 196 pregnant women in the Obstetric clinic of Tangshan Maternal and Child Health Hospital from April 2022 to May 2024 were prospectively selected as the research objects.According to the random number table method,they were divided into the observation group and the control group,98 cases in each group.Both groups received core muscle stability training on the next day after delivery,and biofeedback electrical stimulation was performed 42 days after delivery.The observation group began pelvic floor muscle training at 16 weeks of gestation until delivery,and continued to exercise on the 8 th day after delivery until 42 days after delivery.The observation indexes included pelvic floor muscle contraction strength,pelvic floor surface electromyography,pelvic floor ultrasonography[cervix down distance(CD),bladder neck down distance(BND),the differences of levator hiatal lateral diameter(LHLR-d),the differences of levator hiatal diameter(LHD-d),rectal ampulla diameter(RAD)],serum factors(RLN,CTGF,MMP-1)levels,and the occurrence of pelvic organ prolapse and urinary incontinence.Results The proportions of grade V and gradeⅣ-Ⅴin the observation group were 43.88%and 81.63%,respectively,which were higher than those in the control group(19.39%,69.39%),and the differences were statistically significant(P<0.05).The average values of the preresting stage and postresting stage of the observation group were significantly higher than those of the control group,the variability was smaller than that of the control group,the average value of typeⅠmuscle fibers and the maximum value of typeⅡmuscle fibers were higher than those of the control group,the variability of typeⅠmuscle fibers was smaller than that of the control group,and the recovery time of typeⅡmuscle fibers was shorter than that of the control group,the differences were statistically significant(P<0.05).At 8 weeks after delivery,the CD,BND,LHLR-d,LHD-d and RAD of the observation group were(0.83±0.15),(0.96±0.24),(0.32±0.14),(0.27±0.09)and(0.73±0.14)mm,respectively,which were significantly lower than those in the control group[(1.15±0.13),(1.15±0.21),(0.51±0.13),(0.42±0.14),(0.93±0.19)mm],the differences were statistically significant(P<0.05).At 8 weeks after delivery,the serum RLN,CTGF and MMP-1 in the observation group were(52.54±9.64)pg/mL,(30.23±8.37)μg/L and(5.47±2.53)μg/L,which were lower than those in the control group[(59.34±14.35)pg/mL,(69.56±15.48)μg/L,(7.59±3.28)μg/L],the differences were statistically significant(P<0.05).The total incidences of pelvic organ prolapse,mixed urinary incontinence and urinary incontinence in the observation group were 0,4.08%and 9.18%,respectively,which were significantly lower than those in the control group(8.16%,14.29%and 32.65%),and the differences were statistically significant(P<0.05).Conclusion Pelvic floor muscle training from 16 weeks of pregnancy is beneficial to the recovery of postpartum pelvic floor function,the contraction strength of pelvic floor muscle is strong,the levels of serum RLN,CTGF and MMP-1 are reduced,and the incidence of postpartum pelvic organ prolapse and urinary incontinence is reduced.

作者马雪莲李荣华刘威卢艳郭淑惠 MA Xue-lian;LI Rong-hua;LIU Wei(Department of Obstetrics,Tangshan Maternal and Child Health Hospital,Tangshan Hebei 063000,China)

机构地区唐山市妇幼保健院产科

出处《临床和实验医学杂志》 2025年第10期1066-1070,共5页 Journal of Clinical and Experimental Medicine

基金河北省2018年度医学科学研究重点课题计划(编号:20181329)。

关键词妊娠期盆底肌训练盆底功能松弛素结缔组织生长因子基质金属蛋白酶-1 Gestation Pelvic floor muscle training Pelvic floor function Relaxin Connective tissue growth factor Matrix metalloproteinase-1

分类号 R714.3 [医药卫生—妇产科学]