中山大学附属第三医院产科,广东 广州 510630
李玲,硕士,主治医师,研究方向:围产医学,E-mail:gzyxyliling@163.com
收稿:2021-05-18,
纸质出版:2021-09-20
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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(05):790-795.
LI Ling,CUI Jin-hui,OUYANG Li-ping,et al.Risk Factors Analysis of Diastasis Recti Abdominis during Postpartum[J].Journal of Sun Yat-sen University(Medical Sciences),2021,42(05):790-795.
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(05):790-795. DOI: 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2021.0519.
LI Ling,CUI Jin-hui,OUYANG Li-ping,et al.Risk Factors Analysis of Diastasis Recti Abdominis during Postpartum[J].Journal of Sun Yat-sen University(Medical Sciences),2021,42(05):790-795. DOI: 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2021.0519.
目的
2
探讨产后腹直肌分离的相关危险因素。
方法
2
回顾性分析2019年6月至2020年10月在中山大学附属第三医院岭南医院产检并分娩,且产后3个月内使用高频超声探头测量腹直肌的孕妇共2 394例,根据腹直肌是否分离,分为非DRA组321例和DRA组2 073例。收集两组孕期的一般临床特点和分娩结局,包括:年龄、身高、产次、体质量指数、是否合并糖尿病、分娩孕周、分娩方式和新生儿出生体质量等。对比分析两组之间的临床特点差异,通过Logistic回归分析方法分析DRA发生的危险因素。
结果
2
①产后3个月内DRA以脐部分离为主,发生率为86.6%。其中轻度DRA发生率32.1%,中度DRA发生率48.2%,重度DRA发生率6.3%。②与非DRA组相比较,DRA组的产妇年龄、孕前BMI、分娩前BMI和新生儿出生体质量更大(
P
<
0.001),DRA组中多产和剖宫产的比例更高(48.2%
vs.
26.8%和41.3%
vs.
19.6%,
P
<
0.001)。③高龄、多产和剖宫产均为产后DRA发生的独立危险因素[OR=4.137,95%CI为(2.655,6.448);OR=2.892,95%CI为(2.198,3.805)和OR=3.217,95%CI为(2.379,4.350),
P
<
0.05]。
结论
2
高龄、多产和剖宫产均为产妇产后DRA发生的独立危险因素。
Objective
2
To explore the risk factors of diastasis recti abdominis(DRA) during postpartum.
Methods
2
Retrospective analysis was performed on 2 394 deliveries who received regular prenatal tests and delivered in the Third Affiliated Hospital of Sun Yat-sen University during June 2019 to October 2020. The inter-rectus distance were measured by high-frequency ultrasound during 3 months postpartum. According to the width of inter-rectus distance, 321 cases in non-DRA group and 2 073 cases in DRA group were included. The clinical characteristics and delivery outcomes of the subjects were collected, including age, height, parity, body mass index(BMI), diabetes mellitus or not, gestational age at delivery, delivery modes and neonatal birth weight. The differences of clinical characteristics between the two groups were compared, and the risk factors of DRA were explored by Logistic analysis.
Results
2
DRA mainly occurred at umbilicus, the incidence of DRA after postpartum 3 months was 86.6%, the incidence of mild DRA was 32.1%,moderate DRA was 48.2% and severe DRA was 6.3%. Compared with non-DRA group, the average age,pre-pregnancy BMI, BMI at delivery and the neonatal birth weight were bigger in DRA group (
P
<
0.001), the proportion of multiple parturitions and cesarean section were higher in DRA group(48.2%
vs
. 26.8% and 41.3%
vs
. 19.6%,
P
<
0.001). Elderly women, multiple parturitions and cesarean section were all independent risk factors of DRA after postpartum. [OR=4.137,95%CI (2.655, 6.448);OR=2.892,95%CI (2.198, 3.805) and OR=3.217,95%CI (2.379, 4.350),all
P
<
0.05].
Conclusion
2
Elderly maternal, multiple parturitions and cesarean section were independent risk factors of DRA during postpartum.
Sperstad JB , Tennfjord MK , Hilde G , et al . Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain [J]. Br J Sports Med , 2016 , 50 ( 17 ): 1092 - 1096 .
Fernandes DMP , Pascoal AG , Carita A I , et al . Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain [J]. Man Ther , 2015 , 20 ( 1 ): 200 - 205 .
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 .
Zhang HY , Li XY , Lu H , et al . The high frequency ultrasonographic features of rectus diastasis and their relationships with the modes of delivery in postpartum women [J]. Chin J Ultrasonog , 2020 , 29 ( 11 ): 982 - 986 .
Wu L , Gu Y , Gu Y , et al . Diastasis recti abdominis in adult women based on abdominal computed tomography imaging: Prevalence, risk factors and its impact on life [J]. J Clin Nurs , 2021 , 30 ( 3-4 ): 518 - 527 .
Benjamin DR , Frawley H C , Shields N , et al . Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review [J]. Physiotherapy , 2019 , 105 ( 1 ): 24 - 34 .
Keshwani N , Mathur S , Mclean L . Relationship between interrectus distance and symptom severity in women with diastasis recti abdominis in the early postpartum period [J]. Phys Ther , 2018 , 98 ( 3 ): 182 - 190 .
Doubkova L , Andel R , Palascakova-Springrova I , et al . Diastasis of rectus abdominis muscles in low back pain patients [J]. J Back Musculoskelet Rehabil , 2018 , 31 ( 1 ): 107 - 112 .
Reinpold W , Kockerling F , Bittner R , et al . Classification of rectus diastasis-a proposal by the german hernia society (DHG) and the International Endohernia Society (IEHS) [J]. Front Surg , 2019 , 6 : 1 .
Ranney B . Diastasis recti and umbilical hernia causes, recognition and repair [J]. S D J Med , 1990 , 43 ( 10 ): 5 - 8 .
Theodorsen NM , Strand LI , Bo K . Effect of pelvic floor and transversus abdominis muscle contraction on inter-rectus distance in postpartum women: a cross-sectional experimental study [J]. Physiotherapy , 2019 , 105 ( 3 ): 315 - 320 .
Bo K , Hilde G , Tennfjord MK , et al . Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: Prospective cohort study [J]. Neurourol Urodyn , 2017 , 36 ( 3 ): 716 - 721 .
van de Water AT , Benjamin DR . Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): A systematic review of their measurement properties and meta-analytic reliability generalisation [J]. Man Ther , 2016 , 21 : 41 - 53 .
Fei H , Liu Y , Li M , et al . The relationship of severity in diastasis recti abdominis and pelvic floor dysfunction: a retrospective cohort study [J]. BMC Womens Health , 2021 , 21 ( 1 ): 68 .
Benjamin DR , van de Water AT , Peiris CL . Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review [J]. Physiotherapy , 2014 , 100 ( 1 ): 1 - 8 .
Gluppe SL , Hilde G , Tennfjord MK , et al . Effect of a postpartum training program on the prevalence of diastasis recti abdominis in postpartum primiparous women: A randomized controlled trial [J]. Phys Ther , 2018 , 98 ( 4 ): 260 - 268 .
Emanuelsson P , Gunnarsson U , Dahlstrand U , et al . Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: A randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures [J]. Surgery , 2016 , 160 ( 5 ): 1367 - 1375 .
Kamel DM , Yousif AM . Neuromuscular electrical stimulation and strength recovery of postnatal diastasis recti abdominis muscles [J]. Ann Rehabil Med , 2017 , 41 ( 3 ): 465 - 474 .
Thabet AA , Alshehri MA . Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial [J]. J Musculoskelet Neuronal Interact , 2019 , 19 ( 1 ): 62 - 68 .
Gluppe SB , Engh ME , 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 .
Carlstedt A , Bringman S , Egberth M , et al . Management of diastasis of the rectus abdominis muscles: Recommendations for Swedish National Guidelines [J]. Scand J Surg , 2020 : 230936600 .
Olsson A , Kiwanuka O , Wilhelmsson S , et al . Cohort study of the effect of surgical repair of symptomatic diastasis recti abdominis on abdominal trunk function and quality of life [J]. BJS Open , 2019 , 3 ( 6 ): 750 - 758 .
Liaw LJ , Hsu MJ , Liao CF , et al . The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study [J]. J Orthop Sports Phys Ther , 2011 , 41 ( 6 ): 435 - 443 .
Wang Q , Yu X , Chen G , et al . Does diastasis recti abdominis weaken pelvic floor function? A cross-sectional study [J]. Int Urogynecol J , 2020 , 31 ( 2 ): 277 - 283 .
Ormsbee MJ , Prado CM , Ilich JZ , et al . Osteosarcopenic obesity: the role of bone, muscle, and fat on health [J]. J Cachexia Sarcopenia Muscle , 2014 , 5 ( 3 ): 183 - 192 .
罗琳 , 杨金鹏 , 王松涛 , 等 . 肥胖性肌肉萎缩的分子机制研究进展 [J]. 中国康复理论与实践 , 2017 , 23 ( 5 ): 553 - 557 .
Luo L , Yang JP , Wang ST , et al . Advances in the molecular mechanism of obesity induced muscular atrophy [J]. Chin J Rehabilitation Theory and practice , 2017 , 23 ( 5 ): 553 - 557 .
Choi ES , Cho SH , Kim JH . Relationship between rectus abdominis muscle thickness and metabolic syndrome in middle-aged men [J]. PLoS One , 2017 , 12 ( 9 ): e185040 .
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