基于肌电评估的不同分娩方式对产后盆底功能影响的纵向研究

A Longitudinal Study on the Effects of Different Modes of Delivery on Postpartum Pelvic Floor Function Based on Electromyographic Assessment

摘要: 目的：比较自然分娩与剖宫产产妇产后6周、12周、24周的盆底肌电功能，探讨不同分娩方式对盆底肌收缩功能的影响及其恢复规律，为产后盆底康复提供循证依据。方法：采用前瞻性纵向研究设计，选取自然分娩与剖宫产初产妇各85例。分别于产后6周、12周、24周采用盆底肌电生物反馈仪测定快肌收缩期、慢肌收缩期及综合肌收缩期肌电值。比较两组各时间点肌电指标的差异及阶段性变化。结果：产后6周和12周，自然分娩组快肌收缩期肌电值均显著低于剖宫产组(P < 0.0001)，产后24周两组差异无统计学意义(P = 0.0872)。慢肌收缩期与综合肌收缩期在各时间点自然分娩组均显著低于剖宫产组(P < 0.0001)。阶段性变化显示，自然分娩组各指标提升幅度均较大，尤其在慢肌收缩期后期提升更为明显；剖宫产组起点较高但恢复速度较慢。结论：自然分娩对产后早期盆底肌功能损伤更为严重，但恢复速度较快，快肌功能在产后24周时与剖宫产组趋于一致，慢肌功能恢复缓慢，两组仍存在显著差距。剖宫产并非盆底功能的完全保护因素。临床应根据分娩方式制定个体化、分阶段的盆底康复方案。

Abstract: Objective: This paper aims to compare the electromyographic function of the pelvic floor muscles at 6, 12, and 24 weeks postpartum between women who underwent vaginal delivery and those who underwent cesarean section, and to explore the effects of different delivery modes on pelvic floor muscle contraction function and their recovery patterns, so as to provide evidence-based support for postpartum pelvic floor rehabilitation. Methods: A prospective longitudinal study was conducted, enrolling 85 primiparous women in the vaginal delivery group and 85 in the cesarean section group. Electromyographic values of fast-twitch muscle contraction, slow-twitch muscle contraction, and comprehensive muscle contraction were measured using a pelvic floor electromyographic biofeedback instrument at 6, 12, and 24 weeks postpartum. Differences in electromyographic parameters and stage-specific changes were compared between the two groups. Results: At 6 and 12 weeks postpartum, the fast-twitch muscle contraction values in the vaginal delivery group were significantly lower than those in the cesarean section group (P < 0.0001), while no significant difference was observed at 24 weeks (P = 0.0872). The slow-twitch muscle contraction and comprehensive muscle contraction values in the vaginal delivery group were significantly lower than those in the cesarean section group at all time points (P < 0.0001). Stage-specific analysis showed that the vaginal delivery group exhibited greater improvements across all parameters, particularly in slow-twitch muscle contraction during the later stage, whereas the cesarean section group had higher baseline values but slower recovery. Conclusion: Vaginal delivery causes more severe impairment of pelvic floor muscle function in the early postpartum period, but recovery occurs more rapidly. Fast-twitch muscle function becomes comparable between the two groups by 24 weeks postpartum, while slow-twitch muscle function recovers slowly and remains significantly different. Cesarean section does not serve as a complete protective factor for pelvic floor function. Individualized, stage-specific pelvic floor rehabilitation strategies should be developed based on the mode of delivery.