产后盆底功能障碍性疾病高危因素的研究进展

doi:10.12280/gjfckx.20240762

摘要/Abstract

摘要：

盆底功能障碍性疾病（pelvic floor dysfunction，PFD）是由于盆底支持组织发生退行性变化和损伤，导致支持组织松弛，从而引起盆腔脏器移位并出现一系列病症，主要包括性功能障碍、盆腔器官脱垂、粪失禁和尿失禁等，给患者及其家庭带来了巨大的经济和心理负担。由于患者对PFD认识不足以及治疗方案理解有限，该疾病严重影响女性生活质量并常被忽视。因此，寻找导致该疾病发生的危险因素有助于预防疾病、延缓疾病进展并提高预后效果。目前研究普遍认为PFD可能与分娩方式、胎儿大小、体质量指数（body mass index，BMI）、第二产程延长、产妇年龄、妊娠期糖尿病、分娩次数和激素水平等因素有关，但研究结论并不一致。综述上述几种产后PFD的高危因素，以更深入地了解其机制，并为妇产科医生提供临床决策支持。

关键词: 盆底疾病, 盆腔器官脱垂, 尿失禁, 危险因素, 妊娠

Abstract:

Pelvic floor dysfunction (PFD) is caused by degenerative changes and injuries to the supporting tissues of the pelvic floor, resulting in relaxation of the supporting tissues, which leads to the displacement of the pelvic organs and a series of diseases, mainly including sexual dysfunction, pelvic organ prolapse, fecal incontinence, urinary incontinence, etc., which brings a huge economic and psychological burden to the patients and their families. Due to the lack of awareness of PFD and limited understanding of treatment options, the disease seriously affects women′s quality of life and is often overlooked. Therefore, the search for risk factors contributing to the development of PFD can help prevent the disease, slow its progression, and improve the prognosis. It is widely accepted that PFD may be associated with mode of delivery, fetal size, body mass index (BMI), prolongation of the second stage of labor, maternal age, gestational diabetes mellitus, number of deliveries, and hormone levels, but the findings are inconsistent. The above risk factors for postpartum PFD are reviewed to gain a deeper understanding of their mechanisms and to provide clinical decision support for obstetricians and gynecologists.

Key words: Pelvic floor disorders, Pelvic organ prolapse, Urinary incontinence, Risk factors, Pregnancy

林环宇, 于敏, 路旭宏. 产后盆底功能障碍性疾病高危因素的研究进展[J]. 国际妇产科学杂志, 2024, 51(6): 620-623.

LIN Huan-yu, YU Min, LU Xu-hong. Research Progress on High-Risk Factors for Postpartum Pelvic Floor Dysfunction[J]. Journal of International Obstetrics and Gynecology, 2024, 51(6): 620-623.

参考文献 33

[1]	黎涵玥, 李秉枢, 阳莲, 等. 聚丙烯网片治疗盆底功能障碍性疾病的研究进展[J]. 中国计划生育和妇产科, 2024, 16(3):43-48. doi: 10.3969/j.issn.1674-4020.2024.03.13.
[2]	Kebede BN, Hayelom DH, Birgoda GT, et al. Prevalence of pelvic floor disorder and associated factors among women in Arba Minch Health and Demographic Surveillance Site, Gamo Zone, Southern Ethiopia, 2021[J]. Front Urol, 2023, 3:1196925. doi: 10.3389/fruro.2023.1196925.
[3]	田丹, 韩毓, 陈绵, 等. 海口市女性盆底功能障碍性疾病的流行病学调查研究[J]. 实用妇科内分泌电子杂志, 2023, 10(8):1-6. doi: 10.3969/j.issn.2095-8803.2023.08.001
[4]	郑茗琼, 陈娜. 产后PDF危险因素分析及电刺激联合kegel训练效果[J]. 中国计划生育学杂志, 2023, 31(12):2921-2925. doi: 10.3969/j.issn.1004-8189.2023.12.028.
[5]	张瑞颖. 不同产科因素对产后盆底肌力的影响及生物反馈电刺激在盆底功能障碍中的应用[D]. 南昌: 南昌大学, 2022.
[6]	高洁, 苑翠翠, 解莉, 等. 盆底超声联合盆底肌力评分在不同分娩方式产后盆底功能障碍患者中的应用[J]. 中国医学装备, 2024, 21(4):94-98. doi: 10.3969/j.issn.1672-8270.2024.04.019.
[7]	Chi X, Wen L, Chen L, et al. Delivery Mode and the Pelvic Floor Function of Primiparous Women at Early Postpartum: An Observational Retrospective Cohort Study[J]. Clin Exp Obstet Gynecol, 2024, 51(1):20. doi: 10.31083/j.ceog5101020.
[8]	徐静, 王旭, 房桂英, 等. 不同分娩方式对初产妇产后早期盆底肌电位及肌力的影响[J]. 蚌埠医学院学报, 2023, 48(2):190-194. doi: 10.13898/j.cnki.issn.1000-2200.2023.02.012.
[9]	Huang S, Mao X, Li Y, et al. Are pelvic-abdominal mechanics exercises effective for cesarean delivery rate and postpartum pelvic floor function: A randomized controlled trial[J]. J Sci Med Sport, 2024, 27(10):678-683. doi: 10.1016/j.jsams.2024.04.009. pmid: 38991860
[10]	Rosa CMD, Dockhorn TH, Cardoso JR, et al. Evaluation and Comparison of Respiratory Muscular Strength, Functionality, and Pelvic Floor in the Immediate Postpartum of Normal and Cesarean Birth[J]. Rev Bras Ginecol Obstet, 2023, 45(3):121-126. doi: 10.1055/s-0043-1768457.
[11]	Halle TK, Staer-Jensen J, Hilde G, et al. Change in prevalence of major levator ani muscle defects from 6 weeks to 1 year postpartum, and maternal and obstetric risk factors: A longitudinal ultrasound study[J]. Acta Obstet Gynecol Scand, 2020, 99(10):1403-1410. doi: 10.1111/aogs.13878.
[12]	Jansson MH, Franzén K, Hiyoshi A, et al. Risk factors for perineal and vaginal tears in primiparous women-the prospective POPRACT-cohort study[J]. BMC Pregnancy Childbirth, 2020, 20(1):749. doi: 10.1186/s12884-020-03447-0.
[13]	王琦, 程贤鹦. 初产妇产后早期盆底功能障碍性疾病与分娩相关因素分析[J]. 中华全科医学, 2022, 20(1):76-79. doi:10.16766/j.cnki.issn.1674-4152.002281.
[14]	周颖, 凌玲, 杨瑞嘉, 等. 新生儿体重对初产妇产后早期盆底功能的影响[J]. 现代妇产科进展, 2023, 32(9):688-691. doi: 10.13283/j.cnki.xdfckjz.2023.09.007.
[15]	田志强, 丁玲, 张俊俊, 等. 高龄产妇产后早期盆底功能状况及其影响因素[J]. 护理研究, 2021, 35(7):1262-1266. doi: 10.12102/j.issn.1009-6493.2021.07.029.
[16]	郑莉, 奚卫, 熊英. 再生育女性产后盆底功能与相关影响因素分析[J]. 解放军预防医学杂志, 2019, 37(10):48-49.
[17]	黄静丽, 孙幼峰, 廖腊梅. 超重和肥胖妇女孕期体质量管理及主要危险因素对产后盆底功能的影响[J]. 中国妇幼保健, 2022, 37(17):3138-3141. doi: 10.19829/j.zgfybj.issn.1001-4411.2022.17.010.
[18]	曹瑾. 不同分娩方式产后盆底功能现状调查及盆底功能障碍疾病影响因素分析[J]. 吉林医学, 2021, 42(12):2821-2824. doi: 10.3969/j.issn.1004-0412.2021.12.001.
[19]	Xuan R, Yang M, Gao Y, et al. A Simulation Analysis of Maternal Pelvic Floor Muscle[J]. Int J Environ Res Public Health, 2021, 18(20):10821. doi: 10.3390/ijerph182010821.
[20]	黄泽萍, 钱佩佩, 白植斌, 等. 经会阴三维盆底超声评估第二产程时长对产后早期盆底功能的影响[J]. 中国超声医学杂志, 2022, 38(5):558-561. doi: 10.3969/j.issn.1002-0101.2022.05.022.
[21]	Bergendahl S, Sandström A, Zhao H, et al. Pelvic floor dysfunction after intervention, compared with expectant management, in prolonged second stage of labour: A population-based questionnaire and cohort study[J]. BJOG, 2024, 131(9):1279-1289. doi: 10.1111/1471-0528.17792.
[22]	Schütze S, Heinloth M, Uhde M, et al. The effect of pelvic floor muscle training on pelvic floor function and sexuality postpartum. A randomized study including 300 primiparous[J]. Arch Gynecol Obstet, 2022, 306(3):785-793. doi: 10.1007/s00404-022-06542-z. pmid: 35377043
[23]	Groutz A, Helpman L, Gold R, et al. First vaginal delivery at an older age: Does it carry an extra risk for the development of stress urinary incontinence?[J]. Neurourol Urodyn, 2007, 26(6):779-782. doi:10.1002/nau.20414.
[24]	陶乃菊, 陆欢, 陈芸. 产后盆底功能障碍性疾病的危险因素及风险模型构建[J]. 中国妇幼保健, 2022, 37(18):3417-3420. doi: 10.19829/j.zgfybj.issn.1001-4411.2022.18.033.
[25]	金盼盼. 高龄阴道分娩产妇产后发生盆底功能障碍的危险因素分析[J]. 中国现代药物应用, 2022, 16(12):57-59. doi:10.14164/j.cnki.cn11-5581/r.2022.12.017.
[26]	朱晓庆, 马致南. 妊娠期糖尿病与孕期骨密度、维生素D水平及产后盆底功能障碍的相关性研究[J]. 实用妇科内分泌电子杂志, 2023, 10(17):1-4. doi: 10.3969/j.issn.2095-8803.2023.17.001.
[27]	Sarma AV, Kanaya AM, Nyberg LM, et al. Urinary incontinence among women with type 1 diabetes--how common is it?[J]. J Urol, 2009, 181(3):1224-1230. doi: 10.1016/j.juro.2008.11.024. pmid: 19152930
[28]	Li S, Zou J, WANG Z, et al. Correlation Between Insulin Resistance and Urinary Incontinence in Female Patients with Type 2 Diabetes Mellitus[J]. Int Urogynecol J, 2024, 35(2):431-440. doi:10.1007/s00192-023-05715-x.
[29]	谢莹, 薛红琴, 兰玉. 妊娠期糖尿病对产后盆底功能的影响[J]. 中国实用医药, 2022, 17(9):17-19. doi: 10.14163/j.cnki.11-5547/r.2022.09.006.
[30]	杨正一, 朱颜颜, 金志春. 雌激素水平与早孕期妊娠结局的关系及预测价值[J]. 中国优生与遗传杂志, 2022, 30(6):971-977.
[31]	Pearson SJ, Burgess KE, Onambélé GL. Serum relaxin levels affect the in vivo properties of some but not all tendons in normally menstruating young women[J]. Exp Physiol, 2011, 96(7):681-688. doi: 10.1113/expphysiol.2011.057877. pmid: 21478257
[32]	陈晓菲, 张梦, 唐艳荣. 孕晚期血清松弛素、分娩方式对初产妇产后早期盆底功能障碍影响的交互作用分析[J]. 临床误诊误治, 2024, 37(1):64-69. doi: 10.3969/j.issn.1002-3429.2024.01.013.
[33]	Tim S, Mazur-Bialy AI. The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor[J]. Life(Basel), 2021, 11(12):1397. doi: 10.3390/life11121397.