Účinnost fyzioterapie na úlevu od bolesti a funkční zotavení po císařském řezu

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Autoři: Svitlana Ostafiichuk ¹ ; Nataliia Drohomyretska ¹ ; Olena Kusa ¹ ; Oksana Zhukuliak ¹ ; Olha Neiko ¹ ; Taras Kotyk ²
Působiště autorů: Department of Obstetrics and Gynecology, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine ¹; Department of Human Anatomy, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine ²
Vyšlo v časopise: Ceska Gynekol 2025; 90(3): 204-211
Kategorie: Původní práce
doi: https://doi.org/10.48095/cccg2025204

Souhrn

Úvod: Počty císařských řezů (CS – cesarean section) celosvětově rostou, přičemž související poporodní komplikace jsou výrazně vyšší ve srovnání s vaginálním porodem. Řešení těchto komplikací pomocí optimalizovaného managementu a cílené fyzioterapie je klíčové pro zlepšení mateřských výsledků a kvality života. Cíl: Cílem této studie bylo zhodnotit účinnost fyzioterapie na úlevu od bolesti a obnovení funkční aktivity žen po CS. Materiál a metody: Do studie bylo zapojeno 91 pacientek, které byly přijaty do porodnické nemocnice pro elektivní CS. Kontrolní skupině (47 žen) byl poskytnut standardní předoperační a pooperační dohled. Intervenční skupina (44 pacientů) kromě standardní péče absolvovala fyzioterapii, která zahrnovala předoperační péči (fyzioterapeutický výcvik, edukační výcvik) a pooperační cvičení (dechové, oběhové a pánevní cvičení spolu s masáží pojiva). Výsledky po CS byly analyzovány po dobu 3 dnů. Výsledky: Nižší intenzita pooperačních bolestí a snazší chůze od 1. dne, nižší obtížnost při provádění funkčních činností 2. den (snazší otočení na lůžku a přechod do sedu), rychlejší obnova střevní motility v důsledku průchodu flatusu za 3,5 hod a defekace na 10 hod, snížená potřeba analgetik navíc 4,21krát (OR = 0,24; 95% CI 0,10–0,58; p = 0,02) a bylo zjištěno významné snížení doby trvání hospitalizace (OR = 0,24; 95% CI 0,09–0,57; p = 0,02). Závěr: Studie prokázala účinnost navrženého fyzioterapeutického programu v časném období po CS ve smyslu snížení bolesti a zlepšení obnovy funkční aktivity organizmu.

Klíčová slova:

císařský řez – fyzioterapie – porodnická rehabilitace – fyzioterapeutická edukace – syndrom pooperační bolesti

Zdroje

1. Sung S, Mahdy H. Cesarean Section. In: StatPearls. Treasure Island (FL): StatPearls Publishing 2024. [online]. Available from: https: //www.ncbi.nlm.nih.gov/books/NBK546707/.

2. OECD. Caesarean sections. Health at a Glance 2019. Paris: OECD Publishing 2019. doi: 10.1787/fa1f7281-en.

3. Ministry of Health of Ukraine. Order of the Ministry of Health of Ukraine dated 05.01.2022 No. 8 ”On approval of the Unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care ”Caesarean section””. 2023 [online]. Available from: https: //moz.gov.ua/uk/decrees/nakaz-moz-ukraini-vid-05012022-8-pro-zatverdzhennja-unifikovanogo-klinichnogo-protokolu-pervinnoi-vtorinnoi-specializovanoi-ta-tretinnoi-visokospecializovanoi-medichnoi-dopomogi-kesariv-roztin.

4. Vashchenko VL. Modern approaches to caesarean section at the third level of perinatal care. Actual Problems of the Modern Medicine: Bulletin of Ukrainian Medical Stomatological Academy 2023; 23 (2.1): 3–8. doi: 10.31718/2077-1096.23.2.1.3.

5. Dahlquist K, Stuart A, Källén K. Planned cesarean section vs planned vaginal delivery among women without formal medical indication for planned cesarean section: a retrospective cohort study of maternal short‐term complications. Acta Obstet Gynecol Scand 2022; 101 (9): 1026–1032. doi: 10.1111/aogs. 14408.

6. Mascarello KC, Horta BL, Silveira MF. Maternal complications and cesarean section without indication: systematic review and meta-analysis. Rev Saude Publica 2017; 51: 105. doi: 10.11606/S1518-8787.2017051000389.

7. Duran S, Vural G. Problems experienced by the mothers in post-cesarean period: a narrative review. Iran J Public Health 2023; 52 (10): 2036–2041. doi: 10.18502/ijph.v52i10. 13841.

8. Hailu S, Mekonen S, Shiferaw A. Prevention and management of postoperative nausea and vomiting after cesarean section: a systematic literature review. Ann Med Surg (Lond) 2022; 75: 103433. doi: 10.1016/j.amsu.2022.103433.

9. Çelik AS, Çelik EC. Do delivery method and anesthesia type at delivery affect postnatal comfort levels? J Acad Res Nurs 2020; 6 (1): 97–108. doi: 10.5222/jaren.2020.46704.

10. Sonderman KA, Citron I, Meara JG. National surgical, obstetric, and anesthesia planning in the context of global surgery. JAMA Surg 2018; 153 (10): 959–960. doi: 10.1001/jama surg.2018.2440.

11. Syed H, Slayman T, DuChene Thoma K. ACOG committee opinion no. 804: physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol 2021; 137 (2): 375–376. doi: 10.1097/AOG.0000000000004266.

12. Campos MD, Buglia S, Colombo CS et al. Position statement on exercise during pregnancy and the post-partum period – 2021. Arq Brasi Cardiol 2021; 117 (1): 160–180. doi: 10.36660/abc.20210408.

13. Weerasinghe K, Rishard M, Brabaharan S et al. Physiotherapy training and education prior to elective Caesarean section and its impact on post-natal quality of life: a secondary analysis of a randomized controlled trial. BMC Res Notes 2023; 16 (1): 270. doi: 10.1186/s13104-023-06550-5.

14. Chaudhary A, Shukla S, Sairker D et al. An observational study on effect of breathing exercise on quality of recovery among postoperative patients. J Res Appl Basic Med Sci 2023; 9 (4): 254–262. doi: 10.61186/rabms.9.4.254.

15. Karagoz О, Sayilan AA. The effection pain and anxiety of a breathing exercise applied following laparoscopic cholecystectomy: a randomized controlled study. Brain Behav Immun Integrative 2023; 2: 100008. doi: 10.1016/j.bbii.2023.100008.

16. Mahlovanyy AV, Hrynovets VS, Kuninets OB et al. Bases of physical rehabilitation in medicine. Lviv: Liga-Press 2019.

17. Akalpler O, Okumuş H. Gum chewing and bowel function after Caesarean section under spinal anesthesia. Pak J Med Sci 2018; 34 (5): 1242–1247. doi: 10.12669/pjms.345. 15772.

18. Sninate S, Bellamlih H, Allioui S et al. Ogilvie syndrome following caesarean section: a case report. Galician Med J 2021; 28 (2): E202126. doi: 10.21802/gmj.2021.2.6.

19. Holey LA, Dixon J. Connective tissue manipulation: a review of theory and clinical evidence. J Bodyw Mov Ther 2014; 18 (1): 112–118. doi: 10.1016/j.jbmt.2013.08.003.

20. Özgül S, Nalan Çinar G, Gürşen C et al. The effects of connective tissue manipulation in primary dysmenorrhea: a randomized placebo-controlled study. Reprod Sci 2023; 30 (1): 181–191. doi: 10.1007/s43032-022-00964-5.

21. Güney E, Uçar T. Effects of deep tissue massage on pain and comfort after cesarean: a randomized controlled trial. Complement Ther Clin Pract 2021; 43: 101320. doi: 10.1016/j.ctcp.2021.101320.

22. Ain QU, Waqar F, Bashir A. Ease in pain and functional activities following caesarean delivery by post Natal exercises (pilot study). JIIMC 2018; 13: 32–35.

23. Gamal AM, Soliman GehanH, Elhomosy SM. Effectiveness of post-operative nursing intervention on functional activities in the early post cesarean period. Int J Nur Edu Research 2019; 7 (1): 63–70. doi: 10.5958/2454-2660.2019.00 013.9.

24. Weerasinghe K, Rishard M, Brabaharan S et al. Effectiveness of face-to-face physiotherapy training and education for women who are undergoing elective caesarean section: a randomized controlled trial. Arch Physiother 2022; 12 (1): 4. doi: 10.1186/s40945-021- 00128-9.

25. Ali Shaimaa M, Hassan Shadia AK, Ghani Rania MA. Effect of early post-cesarean section exercises on early resumption of women’s functional activities. Egypt Nurs J 2020; 17 (2): 135–145. doi: 10.4103/enj. enj_36_20.

26. Pelvic, obstetric and gynecological physiotherapy. Exercise and advice after pregnancy. Manual. UK: POGP 2022. [online]. Available from: https: //thepogp.co.uk/resources/113/exercise_and_advice_after_pregnancy/.

27. Vancouver Island Health Authority Service. Breathing & Leg Exercises Before and After Surgery. Patient information. 2018 [online]. Available from: https: //www.islandhealth.ca/sites/default/files/2018-04/breathing-and-leg-exercises-for-surgery.pdf.

28. Advice and exercises following Caesarean Section. Physiotherapy. Eaglestone: Milton Keynes University Hospital NHS Foundation Trust Standing Way. 2023 [online]. Available from: https: //www.mkuh.nhs.uk/wp-content/uploads/2021/01/Advice-and-exercises-following-a-caesarean-section-patient-information-leaflet-Jun-2023-1.pdf.

29. Gürsen C, Kerem Günel M, Kaya S et al. Effect of connective tissue manipulation on symptoms and quality of life in patients with chronic constipation: a randomized controlled trial. J Manipulative Physiol Ther 2015; 38 (5): 335–343. doi: 10.1016/j.jmpt.2015.06.003.

30. Myles PS, Myles DB, Galagher W et al. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth 2017; 118 (3): 424–429. doi: 10.1093/bja/aew466.

31. Ceballos-Rivera M, González-González Y, Alonso-Calvete A et al. Physiotherapy in the sequelae of cesarean childbirth. A systematic review. Rev Esp Salud Publica 2023; 97: e202301002.

32. Ma X, Yue ZQ, Gong ZQ et al. The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Front Psychol 2017; 8: 874. doi: 10.3389/fpsyg.2017. 00874.

33. Oyarzabal EA, Seuferling B, Babbar S et al. Mind-body techniques in pregnancy and post-partum. Clin Obstet Gynecol 2021; 64 (3): 683–703. doi: 10.1097/GRF.00000000000 00641.

34. Unsgaard-Tøndel M, Vasseljen O, Woodhouse A et al. Exercises for women with persistent pelvic and low back pain after pregnancy. Glob J Health Sci 2016; 8 (9): 54311. doi: 10.5539/gjhs.v8n9p107.

35. Uz C. COVID-19 through the eyes of a physiatrist: back pain can be a symptom and may predict pneumonia in COVID-19. Galician Med J 2022; 29 (4): E202241. doi: 10.21802/gmj. 2022.4.1.

36. Rao L, Liu X, Yu L et al. Effect of nursing intervention to guide early postoperative activities on rapid rehabilitation of patients undergoing abdominal surgery: a protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100 (12): e24776. doi: 10.1097/MD.0000000000024776.

37. Çıtak Karakaya İ, Yüksel İ, Akbayrak T et al. Effects of physiotherapy on pain and functional activities after cesarean delivery. Arch Gynecol Obstet 2011; 285 (3): 621–627. doi: 10.1007/s00404-011-2037-0.

38. Xue LL, Zhang JZ, Shen HX et al. The application of rapid rehabilitation model of multidisciplinary cooperation in cesarean section and the evaluation of health economics. Zhonghua Yi Xue Za Zhi 2019; 99 (42): 3335–3339. doi: 10.3760/cma.j.issn.0376-2491.2019.42.012.

ORCID of authors

S. Ostafiichuk 0000-0001-8301-814X

N. Drohomyretska 0000-0002-7371-2450

O. Kusa 0000-0002-8881-3756

O. Zhukuliak 0000-0002-8060-006X

O. Neiko 0000-0003-2408-2664

T. Kotyk 0000-0002-3585-2356

Submitted/Doručeno: 17. 12. 2024

Accepted/Přijato: 7. 3. 2025

Taras Kotyk, MD

Department of Human Anatomy

Ivano-Frankivsk National Medical University