产后腹直肌分离高频超声特征及其与分娩方式的相关性研究

叶秀琴; 潘群艳

doi:10.16766/j.cnki.issn.1674-4152.002909

产后腹直肌分离高频超声特征及其与分娩方式的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.002909

叶秀琴^1, ,,
潘群艳²

1.
诸暨市妇幼保健院超声科，浙江绍兴 311800
2.
宁波市北仑区人民医院超声科，浙江宁波 315800

基金项目:

浙江省医药卫生科技计划项目 2019ZH009

详细信息

通讯作者:
叶秀琴, E-mail: 673828150@qq.com

中图分类号: R445.1 R715.3
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- 文章访问数: 278
- HTML全文浏览量: 97
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2022-11-03
- 网络出版日期: 2023-04-19

High frequency ultrasound characteristics of postpartum rectus abdominis separation after delivery and its correlation with delivery mode

YE Xiuqin^{1
, ,},
PAN Qunyan²

1.
Department of Ultrasound, Zhuji Maternal and Child Health Hospital, Shaoxing, Zhejiang 311800, China

摘要

摘要: 目的不同分娩方式女性腹直肌超声特征可能存在差异，本研究观察分析分娩方式对女性产后早期腹直肌超声特征的影响。方法以2020年8月—2022年10月于诸暨市妇幼保健院进行产后检查的200例女性为研究对象，均行腹直肌高频超声检查，统计研究对象腹直肌分离(DRA)发生率，比较不同分娩方式、不同位置、不同状态下DRA发生率、腹直肌厚度及腹直肌间距(IRD)差异，观察DRA与非DRA女性腹中线超声特征和腹直肌回声特征。结果产后6~8周，经阴道分娩组女性DRA总体发生率(62.12%，82/132)显著低于剖宫产组(82.35%，56/68)，P＜0.05，且脐上缘、脐下缘及脐上3 cm处DRA发生率均显著低于剖宫产组(均P＜0.05)。经阴道分娩组女性平卧、屈曲和直立状态下腹直肌厚度[(0.79±0.11)cm，(1.13±0.18)cm，(0.71±0.09)cm]均显著高于剖宫产组[(0.68±0.10)cm，(0.98±0.16)cm，(0.64±0.08)cm]，均P＜0.05，且平卧、屈曲和直立状态下不同位置IRD数值均显著小于剖宫产组(均P＜0.05)。DRA与非DRA女性腹中线超声特征和腹直肌回声特征比较差异均有统计学意义(均P＜0.05)。结论剖宫产女性产后早期DRA发生率较经阴道分娩女性更高，腹直肌厚度更小，IRD更大。DRA女性腹中线多表现增宽超声特征，腹直肌回声多表现增强特征。
- 高频超声 /
- 产后 /
- 腹直肌分离 /
- 腹直肌间距 /
- 腹直肌厚度 /
- 超声特征
Abstract: Objective The ultrasonic characteristics of the rectus abdominis in women with different delivery methods may be different, however, the clinical experience is not rich. Therefore, this study aims to observe the influence of delivery methods on the ultrasonic characteristics of the rectus abdominis in women in the early postpartum period. Methods A total of 200 women who underwent postpartum examinations at Zhuji Maternal and Child Health Hospital from August 2020 to October 2022 were taken as the study subjects. All of them underwent high-frequency ultrasound examination of the rectus abdominis. The incidence of diastasis recti abdominis (DRA) in the study subjects was statistically analyzed. The incidence of DRA, the thickness of the rectus abdominis and the difference of inter-recti distance (IRD) values in different delivery modes, different locations and different conditions were compared. The ultrasound characteristics of the midline abdominis and the echo characteristics of the rectus abdominis in DRA women and non-DRA women were observed. Results Between 6 and 8 weeks postpartum, the overall incidence of DRA in the vaginal delivery group (62.12%, 82/132) was significantly lower than that in the cesarean delivery group (82.35%, 56/68), P < 0.05, and the incidence of DRA in the upper, lower and 3 cm above umbilicus was significantly lower than that in the cesarean group (all P < 0.05). The thickness of rectus abdominis muscle [(0.79±0.11) cm, (1.13±0.18) cm, (0.71±0.09) cm] in the supine, flexed and upright positions of women in the vaginal delivery group were significantly higher than in the cesarean delivery group [(0.68±0.10) cm, (0.98±0.16) cm, (0.64±0.08) cm], all P < 0.05, and the IRD values at different positions in the supine, flexed and upright positions were significantly lower than those in the cesarean delivery group (all P < 0.05). There were statistically significant differences between DRA and non-DRA women in mid-abdominal ultrasound characteristics and rectus abdominis echo characteristics (all P < 0.05). Conclusion The incidence of DRA in the early postpartum period is higher in women who have had a cesarean section than in women who have had a vaginal delivery. The rectus abdominis is thinner, and the IRD is larger. In women with DRA, the midline of the abdomen is wider, and the echo of the rectus abdominis is more enhanced.
- High frequency ultrasound /
- Postpartum /
- Diastasis recti abdominis /
- The distance between rectus abdominis /
- Thickness of rectus abdominis muscle /
- Ultrasonic characteristics

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表 1 不同分娩方式女性产后6~8周不同状态、不同位置IRD数值比较[M(P₂₅, P₇₅), mm]

Table 1. Comparison of IRD values in different states and positions in women with different delivery modes at 6-8 weeks postpartum[M(P₂₅, P₇₅), mm]

组别	例数	平卧状态
组别	例数	脐上缘	脐下缘	脐上3 cm	脐下3 cm
经阴道分娩组	132	24.67(21.38，32.94)	22.81(18.92，30.14)	20.57(16.39，27.28)	9.28(5.74，12.94)
剖宫产组	68	32.95(28.41，39.06)	30.17(25.78，36.82)	27.32(21.38，32.94)	16.69(9.03，21.82)
Z值		4.281	4.059	3.646	3.925
P值		＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	屈曲状态
组别	例数	脐上缘	脐下缘	脐上3 cm	脐下3 cm
经阴道分娩组	132	20.98(15.52，26.76)	19.21(16.44，24.18)	18.09(15.63，22.56)	6.72(4.05，9.98)
剖宫产组	68	26.75(17.84，33.85)	25.09(17.27，32.05)	23.24(18.59，27.42)	10.35(6.82，15.42)
Z值		4.476	4.132	3.856	3.617
P值		＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	直立状态
组别	例数	脐上缘	脐下缘	脐上3 cm	脐下3 cm
经阴道分娩组	132	31.24(22.93，38.05)	29.61(21.49，37.28)	23.86(18.57，30.85)	1.21(0.00，5.62)
剖宫产组	68	38.03(31.51，44.32)	36.85(30.68，42.91)	30.92(23.01，37.65)	6.93(0.00，14.51)
Z值		3.951	3.824	3.618	3.746
P值		＜0.001	＜0.001	＜0.001	＜0.001

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表 2 DRA与非DRA女性产后6~8周高频超声信号特征比较[例(%)]

Table 2. Comparison of high-frequency ultrasound signal characteristics between DRA and non-DRA women at 6-8 weeks postpartum [cases (%)]

组别	例数	腹中线超声特征		腹直肌回声特征
组别	例数	腹中线增宽	腹中线连续性中断	高低不等	窄带样中强	纤维样略强
DRA	138	118(85.51)	20(14.49)	18(13.04)	56(40.58)	64(46.38)
非DRA	62	17(27.42)	45(72.58)	37(59.68)	13(20.97)	12(19.35)
χ²值		65.800		46.821
P值		＜0.001		＜0.001

下载: 导出CSV

参考文献(19)

[1]	王琳, 徐俊, 牛蕾蕾, 等. 初产妇产后6~8周腹直肌分离与尿失禁、盆腔器官脱垂的关系[J]. 实用妇产科杂志, 2020, 36(12): 953-955. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202012023.htm WANG L, XU J, NIU L L, et al. The relationship between rectus abdominis muscle separation and urinary incontinence, pelvic organ prolapse in primipara at 6-8 weeks after delivery[J]. Journal of Practical Obstetrics and Gynecology, 2020, 36(12): 953-955. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202012023.htm
[2]	KESHWANI N, MATHUR S, MCLEAN L. The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial[J]. Physiother Theory Pract, 2021, 37(9): 1018-1033. doi: 10.1080/09593985.2019.1675207
[3]	LAFRAMBOISE F C, SCHLAFF R A, BARUTH M. Postpartum exercise intervention targeting diastasis recti abdominis[J]. Int J Exerc Sci, 2021, 14(3): 400-409.
[4]	刘菲菲, 石岩, 李殿城, 等. 基于高频超声的正常未育女性腹直肌间距测量及其相关因素分析[J]. 临床超声医学杂志, 2021, 23(5): 390-392. doi: 10.3969/j.issn.1008-6978.2021.05.021 LIU F F, SHI Y, LI D C, et al. Measurement of inter-rectus distance in normal nulliparous women based on high frequency ultrasound and analysis of its correlated factors[J]. Journal of Clinical Ultrasound in Medicine, 2021, 23(5): 390-392. doi: 10.3969/j.issn.1008-6978.2021.05.021
[5]	郑新烈, 陈潇宇, 涂素华, 等. 产后女性腹直肌分离危险因素的Meta分析[J]. 全科护理, 2022, 20(27): 3754-3758. https://www.cnki.com.cn/Article/CJFDTOTAL-JTHS202227003.htm ZHENG X L, CHEN X Y, TU S H, et al. Meta-analysis of risk factors for diastasis recti abdominis in postpartum women[J]. Chinese General Practice Nursing, 2022, 20(27): 3754-3758. https://www.cnki.com.cn/Article/CJFDTOTAL-JTHS202227003.htm
[6]	付鹏, 江凌, 崔立刚. 高频超声在产后女性腹直肌分离评估中的应用价值[J]. 中华医学超声杂志(电子版), 2021, 18(1): 79-83. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHCD202101016.htm FU P, JIANG L, CUI L G, et al. Value of high frequency ultrasound in evaluation of diastasis recti abdominis in postpartum women[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(1): 79-83. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHCD202101016.htm
[7]	古广荣, 罗丽芳, 朱艳芳, 等. 超声诊断产后腹直肌分离的临床价值[J]. 现代医用影像学, 2021, 30(6): 1029-1031, 1038. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYY202106010.htm GU G R, LUO L F, ZHU Y F, et al. Clinical value of ultrasonography in the diagnosis of postpartum rectus separation[J]. Modern Medical Imagelogy, 2021, 30(6): 1029-1031, 1038. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYY202106010.htm
[8]	陈刚, 吴清. 高频超声对产妇腹直肌和耻骨联合分离的预测价值[J]. 贵州医科大学学报, 2022, 47(2): 229-233, 248. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYB202202016.htm CHEN G, WU Q. Predicting value of high frequency ultra-sonograph for postpartum diastasis of rectus abdominis and pubis[J]. Journal of Guizhou Medical University, 2022, 47(2): 229-233, 248. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYB202202016.htm
[9]	GLUPPE S B, ENGH M E, BO K. Immediate effect of abdominal and pelvic floor muscle exercises on interrecti distance in women with diastasis recti abdominis who were parous[J]. Phys Ther, 2020, 100(8): 1372-1383.
[10]	GLUPPE S B, ENGH M E, BØ K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis[J]. Braz J Phys Ther, 2021, 25(6): 664-675.
[11]	BARBATO G, ROLLO S, MAGGIONI C, et al. Laparoscopic diastasis recti abdominis and midline hernia repair[J]. Minerva Surg, 2021, 76(2): 187-191.
[12]	蔡留芸, 邓芯茹, 陆彦旭, 等. 超声评估初产妇产后6周腹直肌分离情况及影响因素[J]. 中国医学影像学杂志, 2021, 29(11): 1134-1138. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYZ202111020.htm CAI L Y, DENG X R, LU Y X, et al. Diastasis recti abdominis in primipara women at 6 weeks after childbirth measured by ultrasound and risk factors[J]. Chinese Journal of Medical Imaging, 2021, 29(11): 1134-1138. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYZ202111020.htm
[13]	胡宇意, 李秀美, 刘燕青, 等. 超声检查在产后女性腹直肌分离及康复治疗效果评估中的应用分析[J]. 中国医学装备, 2022, 19(9): 75-79. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZB202209017.htm HU Y Y, LI X M, LIU Y Q, et al. Exploration on the application of ultrasound in the assessment of postpartum DRA and on the analysis of the effect of rehabilitation and treatment[J]. China Medical Equipment, 2022, 19(9): 75-79. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZB202209017.htm
[14]	胡秀红, 李景珊, 李旺英. 产后早期女性腹直肌分离的多位点高频超声特征与不同分娩方式的相关性分析[J]. 实用医技杂志, 2021, 28(11): 1310-1312. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYJ202111013.htm HU X H, LI J S, LI W Y. Correlation between the characteristics of high-frequency ultrasound at multiple sites of rectus abdominis muscle separation and different delivery modes in early postpartum women[J]. Journal of Practical Medical Techniques, 2021, 28(11): 1310-1312. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYJ202111013.htm
[15]	单华英, 徐亚芬, 陆艳, 等. 盆底超声在女性压力性尿失禁中的应用及初产妇产后盆底肌肉训练的疗效评估[J]. 中华全科医学, 2019, 17(9): 1557-1560. doi: 10.16766/j.cnki.issn.1674-4152.000997 SHAN H Y, XU Y F, LU Y, et al. Application of pelvic floor ultrasound in female stress incontinence and evaluation of efficacy of postpartum pelvic floor muscle training[J]. Chinese Journal of General Practice, 2019, 17(9): 1557-1560. doi: 10.16766/j.cnki.issn.1674-4152.000997
[16]	CAVALLI M, AIOLFI A, BRUNI P G, et al. Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation[J]. Hernia, 2021, 25(4): 883-890.
[17]	李玲, 崔金晖, 欧阳丽萍, 等. 产后腹直肌分离的相关危险因素分析[J]. 中山大学学报(医学科学版), 2021, 42(5): 790-795. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSYK202105021.htm LI L, CUI J H, OUYANG L P, et al. Risk factors analysis of diastasis recti abdominis during postpartum[J]. Journal of Sun Yat-sen University (Medical Sciences), 2021, 42(5): 790-795. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSYK202105021.htm
[18]	张红芸, 李小永, 鲁红, 等. 产后腹直肌分离高频超声特征及其与分娩方式的关系[J]. 中华超声影像学杂志, 2020, 29(11): 982-986. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202303028.htm ZHANG H Y, LI X Y, LU H, et al. The high frequency ultrasonographic features of rectus diastasis and their relationships with the modes of delivery in postpartum women[J]. Chinese Journal of Ultrasonography, 2020, 29(11): 982-986. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202303028.htm
[19]	江庆, 顾军, 冯冠男, 等. 产后42~60 d腹直肌间距的超声参考值范围[J]. 中华医学超声杂志(电子版), 2021, 18(11): 1067-1072. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHCD202111010.htm JIANG Q, GU J, FENG G N, et al. Reference range of inter-recti distance measured by ultrasonography at 42-60 days postpartum[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(11): 1067-1072. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHCD202111010.htm