初產婦懷孕期間及產後骨盆底肌肉運動之介入成效

Effect of pelvic muscle exercise in primiparas during pregnancy and postpartum

曾紀萌(Chi-Meng Tseng)

指導教授 ： 李淑杏

中山醫學大學/護理學院/護理研究所/碩士(2006年)

https://doi.org/10.6834/CSMU.2006.00067

摘要

本研究目的在探討懷孕期間及產後，骨盆底肌肉運動衛教措施對初產婦下泌尿道症狀及骨盆底肌肉張力之介入成效。採準實驗性研究法，研究對象為中部某醫學中心婦產科門診、產房之初產婦，收案期間於民國95年1月至95年5月間，個案分實驗與控制兩組，組別分派以星期為區段交替收案，總計收案數103人。研究個案於產前32週時，填答本研究下泌尿道症狀之問卷並接受會陰壓力器測量其陰道內肌肉收縮之壓力，實驗組個案予以護理衛教介入有關促進骨盆底肌肉張力知識，並藉由會陰壓力器輔助教導其骨盆底肌肉運動，其後於第38週及產後6週亦如前再次測量，其間研究者對實驗組個案每週以電話追蹤其執行情況。控制組以常規照顧模式，分別於32、38週及產後6週予問卷填答及測量其骨盆底肌肉收縮之壓力。資料收集經編碼，以SPSS套裝軟體進行統計分析，資料呈現採百分比、平均數、標準差、t檢定、配對t檢定及McNemar檢定。
結果顯示：初產婦於懷孕32週時，其下泌尿道症狀盛行率前三項分別為夜尿(91.3%)、下腹酸痛(66.0%)、下腹部下墜感(62.1%)，後三項分別為大便失禁(0.0%)、尿床(1.0%)、漏尿(5.8%)，而尿失禁為38.8%，下泌尿道症狀之盛行率會隨著懷孕週數增加而上升，產後隨之下降。骨盆底肌肉運動介入後，以階段來看實驗組比控制組在懷孕38週至產後6週其陰道壓力之改變情形，達顯著差異。
而實驗組比控制組在懷孕38週至產後6週其下泌尿道症狀發生次數之改變情形，並未達顯著差異。
本實驗能提供以實證基礎之護理介入措施提升照護品質，可提供護理人員臨床照護依據。

關鍵字

下泌尿道症狀 ； 初產婦 ； 骨盆底肌肉張力 ； 骨盆底肌肉運動

並列摘要

The aim of the research is to identify the effect of pelvic muscle exercise program in primiparas during pregnancy and postpartum .This Random control trial collected a total of 103 primiparous women from a medical center hospital OPD. DR from January,5, 2006 to May,30, 2006. Sample women were divided into study group and control group. After completing informed, all of both groups will be asked to answer the questionnaire about symptoms of lower urinary tract and tested vaginal pressure by peritron. In addition the women of study group were instructed the pelvic muscle excise program in OPD and asked to perform the experienced exercise for 60-180 times per day after go home. The control group received routine care. Both group women received internal vaginal pressure and pelvic muscle strength measurement at the 32th weeks、38th weeks of pregnancy and 6 weeks after delivery, respectively. Data will be collected coded and processed with SPSS 13.0 statistical package software. Statistical analysis include mean ±SD、percentage distribution、t-test、paired t-test and McNemar test. The results show that primiparas women at 32 weeks, the first three item rank of the prevalence of lower urinary tract symptoms were : nocturia(91.3%)、soreness(66.0%)、abdominal pressure(62.1%) and the last three item rank were fecal incontinence(0.0%)、noctural enuresis(1.0%)、unconscious incontinence(5.8%) , but urine incontinence was (38.8%). The prevalence of lower urinary tract symptoms increased with gestational weeks and decreased postpartum.
After intervention, there was significant difference in vaginal pressure during postpartum between experimental and control groups. The differences in frequency of lower urinary tract symptoms didn’t reach statistically significant between experimental and control groups. The results of this study provided nursing staff with evidence based nursing intervention which could be of help in promotion of the quality of nursing care.

並列關鍵字

lower urinary tract symptoms ； primiparas ； pelvic floor muscle exercise ； pelvic floor muscle strength

參考文獻

陳淑月、林隆堯、林淑姿、陳進典(2000)．婦女尿失禁骨盆底肌肉收縮運動遵從行為及其相關因素．醫學教育，4(4)，484-493。

鄒頡龍(2000)．骨盆底肌肉運動．中華泌尿醫學，12(1)，9-14。

蔡小滿、蔡維明(2005)．骨盆底運動訓練原理及技巧．慈濟醫學，17(1)，43-48。

Prevalence of lower urinary tract symptoms during pregnancy in Taiwan. Journal of Formosal Medical Association, 104(3), 185 – 189.

陳怡靜、陳進典(2002)．急迫性尿失禁之物理治療．台灣泌尿醫學誌，13(3)，97-101。