多维疗法在产后康复中的应用

关键词：产后居家康复  盆底功能损伤  腹直肌分离  体重滞留  产后心理抑郁

Keywords:postpartum home rehabilitation  pelvic floor muscle injury  diastasis recti abdominis  weight retention  postpartum psychological depression

摘要：

      摘要 目的：探讨多维疗法在产妇产后康复中的作用。 方法：将符合入选标准的150例产妇随机分为对照组和试验组。对照组接受常规产康宣教与指导，试验组在此基础上行产后康复多维疗法（postpartum rehabilitation multidimensional therapy，PRMT）干预，分别测量两组干预前后体重滞留、体态变化、体脂分布、盆底肌表面肌电压和腹直肌分离间距（IRD）、尿失禁生存质量问卷（I-QOL）、盆底功能影响问卷简表 （PFIQ-7）及爱丁堡产后抑郁量表（ EPDS ）评分等观察干预效果，并通过自制问卷调研产妇使用PRMT满意度。 结果：干预40天后，试验组体重（BW）、腰围（WC）、体质量指数（BMI）和腰臀比（WHR）均显著降低（P＜0.01），且BMI、WC、WHR显著低于对照组（P＜0.01）；试验组体脂百分比（PBF）、内脏脂肪面积（VFA）、体脂肪量（BFM）、脂肪指数（FMI）均显著下降（P＜0.01），且PBF、BFM、FMI均明显低于对照组（P＜0.05）；试验组盆底Ⅰ、Ⅱ类肌电压、评估总得分、I-QOL评分均明显升高（P＜0.01），PFIQ-7评分明显下降（P＜0.01），且Ⅰ、Ⅱ类肌电压、评估总得分和I-QOL评分均明显高于对照组（P＜0.05）；试验组静息和屈曲状态下各位点处IRD均明显缩小（P＜0.05或P＜0.01），且静息状态下脐上缘、脐下缘和屈曲状态下脐下缘处IRD均显著小于对照组（P＜0.05）；试验组EPDS评分显著下降（P＜0.01），且改善明显优于对照组（P＜0.05）。试验组57例产妇完成满意度调研问卷，约八成对PRMT过程满意并表示PRMT提升了其再生育意愿。 结论：PRMT对产妇产后体重滞留、体态变化、体脂分布、盆底功能损伤、腹直肌分离及心理抑郁情绪具良好改善作用，有助提升女性接受再生育意愿。

Abstract:

      Abstract Objective： To explore the role of the multidimensional therapy in postpartum rehabilitation. Method：150 patients meeting the inclusion criteria were randomly divided into the control group and the experimental group. The control group received routine postpartum rehabilitation education and guidance， while the experimental group received the postpartum rehabilitation multidimensional therapy（PRMT） on this basis. The postpartum weight retention， posture change， body fat distribution， pelvic floor muscle surface voltage， inter-recti distance（IRD） and the scores of incontinence quality of life questionnaire （I-QOL）， pelvic floor impact questionnaire short form （PFIQ-7） and Edinburgh postnatal depression scale （EPDS） were respectively measured to observe the effect of intervention. Satisfaction with the PRMT was investigated by self-made questionnaire before and after intervention，. Result：The body weight（BW）， waist circumference（WC）， body mass index （BMI） and waist-hip ratio （WHR） of the experimental group were significantly reduced after 40 days intervention（P＜0.01）， and the BMI， WC and WHR were significantly lower than those in the control group（P＜0.01）； the percentage body fat （PBF）， body fat mass（BFM）， visceral fat area （VFA） and fat mass index（FMI） were significantly reduced（P＜0.01） in the experimental group， PBF， BFM and FMI were significantly lower than those in the control group（P＜0.05）； the pelvic floor type Ⅰ and type Ⅱ muscle fiber voltage， assessment total score， I-QOL score were significantly increased（P＜0.01） and PFIQ-7 score were significantly decreased（P＜0.01） in the experimental group， and the pelvic floor type Ⅰ and type Ⅱ muscle fiber voltage， assessment total score and I-QOL score were significantly higher than those in control group（P＜0.05）. The IRD of parturients in the resting and flexion state of experimental groups was significantly reduced， with significant difference compared with before intervention （P<0.05 or P<0.01）. In addition， the IRD of the upper umbilical margin and the lower umbilical margin at resting state and the lower umbilical margin at flexion state were significantly lower than those in the control group （P<0.05）. After intervention， the EPDS in the experimental group were significantly decreased （P<0.01）， and the improvement were significantly better than the control group （P<0.05）. The 57 parturients in the experimental group completed the satisfaction questionnaire， about 80% of them were satisfied with the PRMT process and considered that the PRMT improved their willingness to have a second or third child. Conclusion： PRMT was effective in improving the postpartum weight retention， posture change， body fat distribution， pelvic floor function injury，diastasis recti abdominis（DRA） and postpartum psychological depression.