探讨盆底肌训练(PFMT)时机，对高龄(分娩年龄≥35岁)初产妇产后盆底肌张力及性功能的影响。

选择于上海市第一妇婴保健院产前检查，确诊预产期为2022年1月至12月的233例高龄、初产、单胎妊娠孕妇为研究对象。采用前瞻性研究方法，将受试者随机分为产前训练组(n＝78，孕龄25孕周开始PFMT直至分娩结束，时间>3个月)，产后训练组(n＝79，产后第7天开始PFMT，时间>3个月)和对照组(n＝76，给予常规围产期健康教育，未接受PFMT)。采用χ²检验、单因素方差分析(总体比较)和LSD-t检验(两两比较)等，对3组孕产妇产后42 d、产后3个月、产后6个月的盆底肌Ⅰ、Ⅱ类肌纤维肌力，盆腔脏器脱垂(POP)及压力性尿失禁(SUI)发生率、女性性功能指数(FSFI)量表评分、住院时间和孕产妇满意率等进行比较。本研究经本院伦理委员会审核通过(审批文号：20200308)。所有孕产妇及家属知情同意，并签署临床研究知情同意书。

①产前训练组、产后训练组孕产妇产后42 d、产后3个月、产后6个月时，盆底肌Ⅰ、Ⅱ类肌纤维肌力改良牛津评分(MOS)，均分别高于对照组，并且产前训练组高于产后训练组，差异均有统计学意义(P<0.05)。3组孕产妇5个时间点(孕龄25孕周、产前7 d、产后42 d、产后3个月、产后6个月)的盆底肌Ⅰ、Ⅱ类肌纤维肌力MOS评分比较，均存在组间效应、时间效应及交互效应(Ⅰ类：F_组间＝21.34、F_时间＝110.15、F_{组间×时间}＝4.45，均为P<0.001；Ⅱ类：F_组间＝15.49、P<0.001，F_时间＝54.92、P<0.001，F_{组间×时间}＝2.58、P＝0.007)。②3组孕产妇产后42 d、3个月、6个月POP发生率，以及产后6个月SUI发生率比较，差异均无统计学意义(P>0.05)；3组孕产妇产后42 d、3个月SUI发生率比较，差异均有统计学意义(P<0.05)。其中，产后训练组产后42 d SUI发生率高于产前训练组，并且差异有统计学意义(P<0.01)。③3组孕产妇FSFI量表各纬度评分及总分比较，差异均有统计学意义(P<0.05)。其中，产前训练组FSFI量表各纬度评分及总分均高于产后训练组，产前、产后训练组这些指标均分别高于对照组，并且差异均有统计学意义(P<0.05)。④产前训练组、产后训练组孕产妇住院时间，均分别短于对照组，而患者满意率，则均分别高于对照组，并且差异均有统计学意义(P<0.05)。

产前PFMT对于预防产后盆底功能障碍性疾病(PFD)效果，较产后PFMT更佳，并且获得较高患者满意率，值得临床推广。

To explore the effect of pelvic floor muscle training (PFMT) timing on pelvic floor muscle tension and sexual function in elderly (delivery age≥35 years old) primiparous women after delivery.

A total of 233 elderly, primiparous, and single pregnancy pregnant women with a confirmed due date of delivery from January to December 2022 due to prenatal examination in Shanghai First Maternity and Infant Hospital were selected as the research subjects. Using a prospective research method, participants were randomly divided into prenatal training group (n=78, starting PFMT at 25 weeks of pregnancy until delivery, duration>3 months), postpartum training group (n=79, starting PFMT at 7 days postpartum, duration>3 months), and control group (n=76, receiving routine perinatal health education but not receiving PFMT). Chi-square test, one-way ANOVA (overall comparison) and LSD-t test (pairwise comparison) were used to compare the pelvic floor muscle fiber strength for type Ⅰ and Ⅱ, incidence of pelvic organ prolapse (POP) and stress urinary incontinence (SUI), female sexual function index (FSFI) score, length of hospital stay, and maternal satisfaction rate among three groups of pregnant and puerperant at 42 days postpartum, 3 months postpartum, and 6 months postpartum. This study has been reviewed and approved by the Ethics Committee of our hospital (Approval No. 20200308). All pregnant and puerperant and their families have informed consent and signed the clinical study informed consent forms.

① At 42 d, 3 months and 6 months after delivery, the modified Oxford scores (MOS) of pelvic floor muscle fiber strength for type Ⅰ and Ⅱ were all showed that the prenatal and postpartum training groups were higher than control group, respectively, also the prenatal training group was higher than the postpartum training group, and the differences were statistically significant (P<0.05). Comparison of pelvic floor muscle fiber strength MOS scores of type Ⅰ and type Ⅱ among three groups of pregnant and puerperant at five time points (gestational age of 25 weeks, 7 days before delivery, 42 days after delivery, 3 months after delivery, and 6 months after delivery) showed intergroup effects, time effects, and interaction effects (type Ⅰ: F_intergroup=21.34, F_time=110.15, F_{intergroup×time}=4.45, all with P<0.001; type Ⅱ: F_intergroup=15.49, P<0.001; F_time=54.92, P<0.001; F_{intergroup×time}=2.58, P=0.007). ②There were no significant differences in the incidence of POP at 42 days, 3 months, and 6 months after delivery and SUI at 6 months after delivery among three groups of pregnant and puerperant (P>0.05). There were significant differences in the incidence of SUI at 42 days and 3 months after delivery among three groups of pregnant and puerperant (P<0.05), and the incidence of SUI at 42 days after delivery in postpartum training group was higher than that in prenatal training group, and the difference was statistically significant (P<0.01). ③There were significant differences in each dimension scores and total scores of FSFI among three groups of pregnant and puerperant (P<0.05). Among them, each dimension scores and total scores of FSFI in prenatal training group were higher than those in postpartum training group, and these indicators in prenatal and postpartum training groups were higher than those in control group, respectively, and the differences were statistically significant (P<0.05). ④The hospitalization time of prenatal training group and postpartum training group were shorter than those of control group, respectively, while the patient satisfaction rate were higher than those of control group, respectively, and the differences were statistically significant (P<0.05).

Prenatal PFMT is more effective in preventing postpartum pelvic floor dysfunction (PFD) compared to postpartum PFMT, and has a higher patient satisfaction rate. Prenatal PFMT is worthy of clinical promotion.