CAJ | 학술논문

目的：通过对不同生育经历的健康志愿女性肛门括约肌肌电图进行分析，探讨分娩对女性肛门括约肌肌电图的影响。方法以招募方式招募有不同生育经历的女性健康志愿者28名，按照不同生育经历分成剖宫产组7名及经阴道分娩组21名，其中经阴道分娩组按照分娩次数进一步分为1次者12名、2次者6名、3次者3名；同期招募未生育女性9名作为对照组。所有受试者均进行双侧肛门括约肌肌电图检查，以运动单位电位时限、波幅、面积、平均转折及平均相数为参数，分析分娩因素对肛门括约肌肌电图的影响。结果剖宫产组与未生育组相比，肛门括约肌肌电图运动单位电位各参数差异均没有统计学意义；经阴道分娩组肛门括约肌肌电图运动单位电位平均时限大于未生育组（10.5 ms与8.9 ms，t＝-3.025，P＝0.005），并且平均时限（10.5 ms与9.0 ms，t＝-2.506， P＝0.019）、平均相数（4.0与3.6，t＝-2.707，P＝0.012）大于剖宫产组；随着经阴道分娩次数增加，肛门括约肌肌电图运动单位电位各参数有逐渐增加趋势，但是只有平均转折达差异有统计学意义。有经阴道分娩经历女性较无阴道分娩经历女性除运动单位电位时限增宽，平均相数增加外，双侧运动单位电位平均时限更倾向于不对称。结论分娩是肛门括约肌肌电图的影响因素，分娩的影响主要来源于经阴道分娩过程而非怀孕本身，且损伤主要发生于第1次经阴道分娩时，双侧不对称，以一侧为主，可能与分娩过程中的局部机械损伤及压迫引起的血供障碍有关。
목적：통과대불동생육경력적건강지원녀성항문괄약기기전도진행분석，탐토분면대녀성항문괄약기기전도적영향。방법이초모방식초모유불동생육경력적녀성건강지원자28명，안조불동생육경력분성부궁산조7명급경음도분면조21명，기중경음도분면조안조분면차수진일보분위1차자12명、2차자6명、3차자3명；동기초모미생육녀성9명작위대조조。소유수시자균진행쌍측항문괄약기기전도검사，이운동단위전위시한、파폭、면적、평균전절급평균상수위삼수，분석분면인소대항문괄약기기전도적영향。결과부궁산조여미생육조상비，항문괄약기기전도운동단위전위각삼수차이균몰유통계학의의；경음도분면조항문괄약기기전도운동단위전위평균시한대우미생육조（10.5 ms여8.9 ms，t＝-3.025，P＝0.005），병차평균시한（10.5 ms여9.0 ms，t＝-2.506， P＝0.019）、평균상수（4.0여3.6，t＝-2.707，P＝0.012）대우부궁산조；수착경음도분면차수증가，항문괄약기기전도운동단위전위각삼수유축점증가추세，단시지유평균전절체차이유통계학의의。유경음도분면경력녀성교무음도분면경력녀성제운동단위전위시한증관，평균상수증가외，쌍측운동단위전위평균시한경경향우불대칭。결론분면시항문괄약기기전도적영향인소，분면적영향주요래원우경음도분면과정이비부잉본신，차손상주요발생우제1차경음도분면시，쌍측불대칭，이일측위주，가능여분면과정중적국부궤계손상급압박인기적혈공장애유관。
Objective To explore the impact of childbirth on women external anal sphincter electromyography by analysis of motor unit potentials parameters of external anal sphincter electromyography of healthy women volunteers with different childbirth experiences.Methods Twenty-eight healthy volunteers with different childbirth experiences were recruited in this study.Among them , 7 had a history of cesarean and 21 had experienced 1-3 uncomplicated vaginal deliveries ( 12 women had experienced 1, 6 had experienced 2, and 3 had experienced 3).Another 9 nulliparous healthy volunteers were recruited as control group.Among all subjects who completed the examination , parameters of motor unit potentials ( duration, amplitude, area, mean number of turns and mean phases ) of bilateral external anal sphincter were obtained for statistical analysis.Results There were no significant differences in any of the parameters of motor unit potentials between the nulliparous group and the cesarean group , while parameters of durations (10.5 ms vs 9.0 ms, t=-2.506, P=0.019) and mean phases (4.0 vs 3.6, t =-2.707, P=0.012) of vaginal delivery group were significantly higher than that of cesarean group and parameter of durations ( 10.5 ms vs 8.9 ms, t =-3.025, P =0.005 ) of vaginal delivery group was significantly higher than that of the nulliparous group;With increasing numbers of vaginal deliveries , only the parameter of mean turns showed statistically significant differences , although there was a slight trend of larger and more complex motor unit potentials.Compared with subjects without vaginal delivery experience ( including nulliparous group and the cesarean group ) , the parameters of durations and mean phases of subjects with vaginal delivery experience were statistically higher; Nevertheless , parameter of bilateral duration of the motor unit potential preferred asymmetric.Conclusions Childbirth experience has an explicit impact on the parameters of the external anal sphincter motor unit potentials , which is considered to be strongly correlated with the vaginal delivery process rather than the pregnancy procession itself.In addition , the impact is mostly from the first vaginal delivery experience.The characters of asymmetry of motor unit potential parameters imply the possibility of mechanical damage and decrease blood perfusion of tissues during delivery procession.