高频超声在妇女产前和产后腹直肌变化中的应用研究.docx

高频超声在妇女产前和产后腹直肌变化中的应用研究李莉1邓燕梅1丘青2李杨2余咏宜21.深圳市罗湖医院集团妇幼保健院超声科2,深圳市罗湖医院集团妇幼保健院妇女保健科【摘要】目的：通过高频超声测量妇女产前和产后腹直肌的形态变化，探讨高频超声在腹直肌检查中的应用价值，为临床的产后康复治疗提供直观、可靠的影像学依据。方法：选取我院从2019年7月2020年7月期间产检并纳入排除标准的孕产妇150例，分别从孕12周、孕23周、孕30周、孕37周、产后3天、产后42天、测量左右腹直肌厚度及腹直肌内间距（IRD）,观察其产前和产后的变化规律。分析每个时间段左右腹直肌的厚度及腹直肌内间距（IRD）是否具有统计学差异。并在产后42天，根据目前临床共识的诊断标准：腹直肌内间距>2cm即为异常分为腹直肌分离组与无分离组，分析两组受检者在同一时间段的腹直肌厚度、IRD的差异以及在同一部位的腹直肌厚度、IRD的差异，最后分析腹直肌分离组中腹直肌厚度及内间距与腹直肌分离（DRA）的相关性。结果：腹直肌分离组孕产妇的孕期增重、剖腹产率及胎儿体重均明显大于腹直肌无分离组（p<0.05）;腹白线沿线脐上5cm与腹白线脐下3cm腹直肌超声测量结果显示，无分离组产后42天腹直肌厚度明显厚于分离组（p<0.05）,孕30周、孕37周、产后3天、产后42天各时间段分离组的腹宜肌分离宽度均明显大于无分离组（p<0.05）;腹白线脐边线腹直肌超声测量结果显示，产后42天腹直肌分离组的腹直肌厚度明显薄于腹直肌无分高组（p<0.05）:孕30周、孕37周、产后3天、产后42天各时间段分离组的腹直肌分离宽度明显大于无分离组（p<0.05）；结论：利用高频超声检查手段对腹直肌分离进行辅助观察，能准确地分辨出腹宜肌的结构差异和变化，准确地测量两侧腹直肌间距数值，观察腹直肌分离情况，对发现产后发生DRA具有指导性作用，为临床产后康复治疗提供更多的影像学依据，利于为患者进行早期干预及制定康复计划，帮助产后腹直肌恢复，降低DRA的发生率。【关键词】经腹部高频超声；产后腹直肌分离；孕产妇Applicationofhigh-frequencyultrasoundinthechangesofwomen,srectusabdominisbeforeandafterchildbirth1.ILi1DENGYan-mei1QIUQing2LIYang2YUYong-yu21、DepartmentofUltrasoundImaging,MaternalandChildHealthHospitalofShenzhenLuohuHospitalGroup2、Women,sHealthDepartment,MaternalandChildHealthHospitalofShenzhenLuohuHospitalGroupAbstractObjectivejThemorphologicalchangesoftherectusabdominisinwomenbeforeandafterdeliveryweremeasuredbyhigh-frequencyultrasound,andtheapplicationvalueofhigh-frequencyultrasoundintheexaminationoftherectusabdominiswasexploredtoprovideanintuitiveandreliableimagingbasisforclinicalpostpartumds:150casesofpregnantandlying-inwomenwereselectedfromourhospitalfromJuly2019toJuly2020andincludedintheexclusioncriteria,including12weeksofgestation,23weeksofgestation,30weeksofgestation,37weeksofgestation,3daysofpostpartum,and42daysofpostpartum.,Measurethethicknessoftheleftandrightrectusabdominisandtheinternaldistance(IRD)oftherectusabdoministoobservethechangesbeforeandafterdelivery.Analyzewhetherthethicknessoftheleftandrightrectusabdominisandtheinternaldistance(IRD)oftherectusabdominisarestatisticallydifferentineachtimeperiod.Andat42dayspostpartum,accordingtothecurrentclinicalconsensusdiagnosticcriteria:thedistancebetweentherectusabdominismusclesisgreaterthan2cm,whichisabnormal,andtheyaredividedintotherectusabdominisseparationgroupandthenon-separationgroup.Thetwogroupsofsubjectswereanalyzedfortherectusabdominisatthesametimeperiod.Thedifferenceinthickness,IRD,thethicknessoftherectusabdominisatthesamesite,thedifferenceinIRD,andfinallythecorrelationbetweenthethicknessandinternaldistanceoftherectusabdominisintherectusabdominisseparationgroupandtheseparationoftherectusabdominis(DRA)wereanalyzed.Results:Theweightgainduringpregnancy,therateofcaesareansectionandtheweightofthefetusintherectusabdominisseparationgroupweresignificantlygreaterthanthoseoftherectusabdominisgroupwithoutseparation(p<0,05);therectusabdomenwas5cmabovetheumbilicusalongthewhitelineand3cmbelowthewhiteline.Muscleultrasoundmeasurementresultsshowedthatthethicknessoftherectusabdominisinthenon-separatedgroup42dayspostpartumwassignificantlythickerthanthatoftheseparationgroup(p<0.05),andtherectusabdomenoftheseparatedgroupwas30weeksgestation,37weeksgestation,3dayspostpartum,and42dayspostpartum.Thewidthofmuscleseparationwassignificantlygreaterthanthatofthenon-separatedgroup（p<0,05）;theultrasoundmeasurementresultsoftherectusabdominisattheumbilicallineofthewhitelineshowedthatthethicknessoftherectusabdominisintherectusabdominisseparationgroupwassignificantlythinnerthantherectusabdominisgroupat42dayspostpartum（P<0.05）;Theseparationwidthoftherectusabdominisintheseparationgroupat30weeksofgestation,37weeksofgestation,3dayspostpartum,and42dayspostpartumwassignificantlygreaterthanthatofthenon-separationgroup（p<0.05）;Conclusion:Theauxiliaryobservationoftherectusabdominisseparationbymeansofhigh-frequencyultrasoundcanaccuratelydistinguishthestructuraldifferencesandchangesoftherectusabdominis,accuratelymeasurethedistancebetweentherectusabdominisonbothsides,andobservetheseparationoftherectusabdominis.ItisfoundthattheoccurrenceofDRAafterchildbirthhasaguidingrole,whichprovidesmoreimagingbasisforclinicalpostpartumrehabilitationtreatment,isconducivetoearlyinterventionanddevelopmentofrehabilitationplansforpatients,helpstherectusabdominisrecoveryafterchildbirth,andreducestheincidenceofDRA.（Keywordstransabdominalhigh-frequencyultrasound;postpartumrectusabdominisseparation;pregnantandlying-inwomen腹直肌分离（diastasisrectiabdominis,DRA）是指因后天因素使两侧的腹直肌沿肌肉长轴分离,在腹白线处向腹壁左右两侧分开,超过正常宽度,指两侧腹直肌内侧缘距离>2cm,妊娠期因激素水平变化及增大的子宫影响，使腹壁肌肉、结缔组织弹性改变和机械性的压力增大，继而发生腹直肌分离，出现腹壁松弛、膨隆，引起产后的腰背部及盆腔疼痛等症状u21有研究表明女性孕期腹直肌的发生率为30QIO0%,产后发生率为35%60%。本研究拟通过高频超声测量产前和产后腹直肌厚度及腹直肌内间距,来评估妇女整个孕期及产后腹直肌的变化情况，为临床产后康复制定合理的治疗方案提供更多的信息。1资料与方法1.1一般资料本组研究对象选取我院从2019年7月2020年7月期间产检产妇，根据研究目的要求，并纳入排除标准的孕产妇150例。患者纳入标准：（1）年龄2136岁的符合婚育妇女；（2）既往无生育史的初产妇；（3）无妊娠高血压疾病、妊娠期糖尿病等合并症；（4）单胎妊娠;（5）要求在本院分娩，自愿配合妊娠期、产后3天、产后42天腹直肌检测。排除标准：（1）既往有腹部手术史；（2）既往有腹壁疝、脐尿屡等疾病史；（3）既往有DRA诊断史；（4）腹部脂肪过厚、因其他原因而不能配合妊娠期腹直肌检测。（5）既往有慢性咳嗽、慢性便秘史。研究经医院伦理委员会审核批准，所有研究对象均签署相关知情同意书。1.2方法