中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2010年
2期
104-108
,共5页
产褥期疾病%尿失禁,压力性%接生,产科%危险因素
產褥期疾病%尿失禁,壓力性%接生,產科%危險因素
산욕기질병%뇨실금,압력성%접생,산과%위험인소
Puerperal disorders%Urinary incontinence,stress%Delivery,obstetric%Risk factors
目的 探讨不同分娩方式对孕产妇发生尿失禁的影响和阴道分娩后发生产后压力性尿失禁(SUI)的相关因素.方法 选择2008年1-12月在首都医科大学附属北京妇产医院行产前检查并于分娩后6～8周复查的孕产妇788例.根据分娩方式不同分为剖宫产组212例、阴道顺产组534例、产钳助产组42例,将阴道顺产组和产钳助产组孕产妇合计后统计尿失禁发生情况.采用问卷调查方式了解各组孕产妇分娩方式及其与分娩有关的产科因素对产后SUI发生的影响.并使用盆底肌电图检测各组孕产妇盆底肌强度,了解产后SUI发生与盆底肌肉强度的关系.结果 (1)尿失禁发生率:孕期尿失禁总的发生率为15.4%(121/788),其中阴道顺产组为15.9%(85/534),产钳助产组为11.9%(5/42),剖宫产组为14.6%(31/212),3组比较,差异无统计学意义(P>0.05).产后6～8周SUI总的发生率为17.1%(135/788),其中阴道顺产组为19.1%(102/534),产钳助产组为26.2%(11/42),剖宫产组为10.4%(22/212).阴道顺产组产后SUI发生率明显低于产钳助产组,两组比较,差异有统计学意义(P<0.01);剖宫产组产后SUI发生率明显低于阴道顺产组,两组比较,差异有统计学意义(P<0.01).(2)不同产科因素对产后SUI的影响:阴道顺产组和产钳助产组孕产妇共发生尿失禁113例,未发生尿失禁463例,将尿失禁发生与否两类孕产妇的一般情况和产科因素进行单因素分析和logistic多元回归分析,了解其对产后SUI的影响.结果显示,分娩方式、新生儿出生体质量、孕期发生尿失禁是产后SUI的主要影响因素.剖宫产术可使产后SUI发病率降低(P<0.01),新生儿出生体质量增加、孕期发生尿失禁可使产后SUI的发生风险加大.对阴道分娩组和产钳助产组孕产妇分析发现,新生儿出生体质量增加、产钳助产、孕期发生尿失禁与产后SUI发病率升高有关(P均<0.01);而与分娩镇痛、产程时间、会阴侧切、产后哺乳、产后出血量、分娩孕周、引产与否、孕前体质量等无明显相关(P均>0.05).(3)盆底肌电图检测结果:剖宫产组孕产妇盆底肌活力值为(19.7±9.9)μv,做功值为(84.5±37.2)μv,峰值为(25.5±12.5)μv,均高于阴道顺产组和产钳助产组[两组均值为:活力值(14.8±8.4)μv、做功值(78.8±28.2)μv、峰值(19.7±11.8)μv].两者比较,差异有统计学意义(P均<0.01).阴道顺产组和产钳助产组中尿失禁孕产妇盆底肌放松值[均值为(1.7±1.8)μv]较非尿失禁孕产妇[均值为(3.0±3.9)μv]低,两者比较,差异有统计学意义(P<0.01).尿失禁孕产妇放松值与活力值(r/a)比值为0.2±0.2,非尿失禁孕产妇r/a比值为0.3±0.5,差异有统计学意义(P<0.01).阴道顺产组和产钳助产组孕产妇r/a比值为0.2±3.5,虽高于剖宫产组(0.2±0.2),但差异无统计学意义(P>0.05).结论 产钳助产及阴道顺产产妇的产后SUI发生率高于剖宫产.孕期发生尿失禁、产钳助产、新生儿出生体质量增加是产后SUI发生的高危因素.
目的 探討不同分娩方式對孕產婦髮生尿失禁的影響和陰道分娩後髮生產後壓力性尿失禁(SUI)的相關因素.方法 選擇2008年1-12月在首都醫科大學附屬北京婦產醫院行產前檢查併于分娩後6～8週複查的孕產婦788例.根據分娩方式不同分為剖宮產組212例、陰道順產組534例、產鉗助產組42例,將陰道順產組和產鉗助產組孕產婦閤計後統計尿失禁髮生情況.採用問捲調查方式瞭解各組孕產婦分娩方式及其與分娩有關的產科因素對產後SUI髮生的影響.併使用盆底肌電圖檢測各組孕產婦盆底肌彊度,瞭解產後SUI髮生與盆底肌肉彊度的關繫.結果 (1)尿失禁髮生率:孕期尿失禁總的髮生率為15.4%(121/788),其中陰道順產組為15.9%(85/534),產鉗助產組為11.9%(5/42),剖宮產組為14.6%(31/212),3組比較,差異無統計學意義(P>0.05).產後6～8週SUI總的髮生率為17.1%(135/788),其中陰道順產組為19.1%(102/534),產鉗助產組為26.2%(11/42),剖宮產組為10.4%(22/212).陰道順產組產後SUI髮生率明顯低于產鉗助產組,兩組比較,差異有統計學意義(P<0.01);剖宮產組產後SUI髮生率明顯低于陰道順產組,兩組比較,差異有統計學意義(P<0.01).(2)不同產科因素對產後SUI的影響:陰道順產組和產鉗助產組孕產婦共髮生尿失禁113例,未髮生尿失禁463例,將尿失禁髮生與否兩類孕產婦的一般情況和產科因素進行單因素分析和logistic多元迴歸分析,瞭解其對產後SUI的影響.結果顯示,分娩方式、新生兒齣生體質量、孕期髮生尿失禁是產後SUI的主要影響因素.剖宮產術可使產後SUI髮病率降低(P<0.01),新生兒齣生體質量增加、孕期髮生尿失禁可使產後SUI的髮生風險加大.對陰道分娩組和產鉗助產組孕產婦分析髮現,新生兒齣生體質量增加、產鉗助產、孕期髮生尿失禁與產後SUI髮病率升高有關(P均<0.01);而與分娩鎮痛、產程時間、會陰側切、產後哺乳、產後齣血量、分娩孕週、引產與否、孕前體質量等無明顯相關(P均>0.05).(3)盆底肌電圖檢測結果:剖宮產組孕產婦盆底肌活力值為(19.7±9.9)μv,做功值為(84.5±37.2)μv,峰值為(25.5±12.5)μv,均高于陰道順產組和產鉗助產組[兩組均值為:活力值(14.8±8.4)μv、做功值(78.8±28.2)μv、峰值(19.7±11.8)μv].兩者比較,差異有統計學意義(P均<0.01).陰道順產組和產鉗助產組中尿失禁孕產婦盆底肌放鬆值[均值為(1.7±1.8)μv]較非尿失禁孕產婦[均值為(3.0±3.9)μv]低,兩者比較,差異有統計學意義(P<0.01).尿失禁孕產婦放鬆值與活力值(r/a)比值為0.2±0.2,非尿失禁孕產婦r/a比值為0.3±0.5,差異有統計學意義(P<0.01).陰道順產組和產鉗助產組孕產婦r/a比值為0.2±3.5,雖高于剖宮產組(0.2±0.2),但差異無統計學意義(P>0.05).結論 產鉗助產及陰道順產產婦的產後SUI髮生率高于剖宮產.孕期髮生尿失禁、產鉗助產、新生兒齣生體質量增加是產後SUI髮生的高危因素.
목적 탐토불동분면방식대잉산부발생뇨실금적영향화음도분면후발생산후압력성뇨실금(SUI)적상관인소.방법 선택2008년1-12월재수도의과대학부속북경부산의원행산전검사병우분면후6～8주복사적잉산부788례.근거분면방식불동분위부궁산조212례、음도순산조534례、산겸조산조42례,장음도순산조화산겸조산조잉산부합계후통계뇨실금발생정황.채용문권조사방식료해각조잉산부분면방식급기여분면유관적산과인소대산후SUI발생적영향.병사용분저기전도검측각조잉산부분저기강도,료해산후SUI발생여분저기육강도적관계.결과 (1)뇨실금발생솔:잉기뇨실금총적발생솔위15.4%(121/788),기중음도순산조위15.9%(85/534),산겸조산조위11.9%(5/42),부궁산조위14.6%(31/212),3조비교,차이무통계학의의(P>0.05).산후6～8주SUI총적발생솔위17.1%(135/788),기중음도순산조위19.1%(102/534),산겸조산조위26.2%(11/42),부궁산조위10.4%(22/212).음도순산조산후SUI발생솔명현저우산겸조산조,량조비교,차이유통계학의의(P<0.01);부궁산조산후SUI발생솔명현저우음도순산조,량조비교,차이유통계학의의(P<0.01).(2)불동산과인소대산후SUI적영향:음도순산조화산겸조산조잉산부공발생뇨실금113례,미발생뇨실금463례,장뇨실금발생여부량류잉산부적일반정황화산과인소진행단인소분석화logistic다원회귀분석,료해기대산후SUI적영향.결과현시,분면방식、신생인출생체질량、잉기발생뇨실금시산후SUI적주요영향인소.부궁산술가사산후SUI발병솔강저(P<0.01),신생인출생체질량증가、잉기발생뇨실금가사산후SUI적발생풍험가대.대음도분면조화산겸조산조잉산부분석발현,신생인출생체질량증가、산겸조산、잉기발생뇨실금여산후SUI발병솔승고유관(P균<0.01);이여분면진통、산정시간、회음측절、산후포유、산후출혈량、분면잉주、인산여부、잉전체질량등무명현상관(P균>0.05).(3)분저기전도검측결과:부궁산조잉산부분저기활력치위(19.7±9.9)μv,주공치위(84.5±37.2)μv,봉치위(25.5±12.5)μv,균고우음도순산조화산겸조산조[량조균치위:활력치(14.8±8.4)μv、주공치(78.8±28.2)μv、봉치(19.7±11.8)μv].량자비교,차이유통계학의의(P균<0.01).음도순산조화산겸조산조중뇨실금잉산부분저기방송치[균치위(1.7±1.8)μv]교비뇨실금잉산부[균치위(3.0±3.9)μv]저,량자비교,차이유통계학의의(P<0.01).뇨실금잉산부방송치여활력치(r/a)비치위0.2±0.2,비뇨실금잉산부r/a비치위0.3±0.5,차이유통계학의의(P<0.01).음도순산조화산겸조산조잉산부r/a비치위0.2±3.5,수고우부궁산조(0.2±0.2),단차이무통계학의의(P>0.05).결론 산겸조산급음도순산산부적산후SUI발생솔고우부궁산.잉기발생뇨실금、산겸조산、신생인출생체질량증가시산후SUI발생적고위인소.
Objective To evaluate the effect of cesarean section (CS) and vaginal delivery (VD) on postpartum stress urinary incontinence (SUI) and pelvic floor muscles strength and to find out the correlated obstetric factors and preventions for postpartum SUI. Methods Totally, 788 women, who visited the antenatal clinics, delivered and had the follow-up at 6-8 weeks after delivery in Beijing Obstetrics and Gynecology Hospital in the year of 2008, were enrolled in this study and were divided into 3 groups: CS group (n=212); normal vaginal delivery (NVD) group (n=534) and forceps delivery (FD) group(n=42). Women in the NVD and FD group were merged into one VD group and then divided into SUI and non-SUI group. Information of delivery mode and the correlated obstetric factors were obtained through questionnaires and medical records. Femiscan pelvic floor muscle examine system was applied to measure the pelvic floor muscle strength to understand the relationship between postpartum SUI and pelvic floor muscle strength. Results (1) Incidence of SUI: The overall proportion of women who complained of urinary incontinence (UI) during pregnancy was 15.4% (121/788), and it was 15.9% (85/534), 11.9%(5/ 42) and 14.6% (31/212) in the NVD, FD and CS group, respectively(P>0.05). The overall incidence of postpartum SUI was 17. 1% (135/788), and it was 19.1% (102/534), 26.2% (11/42) and 10.4% (22/212) in the NVD, FD and CS group, respectively, with significant difference between the NVD and FD group, and between the CS and NVD group (all P < 0.01). (2) The associated obstetric factors of postpartum SUI: Among the VD group, 113 women were in the postpartum SUI group and 463 in the non-SUI group. Univariate analysis and logistic multivariate analysis showed that delivery mode, neonatal birth weight and UI during pregnancy were risk factors of postpartum SUI. CS decreased and higher neonatal birth weight and UI during pregnancy increased the risk of postpartum SUI. In the VD group, neonatal birth weight, forceps delivery and UI during pregnancy increased the incidence of postpartum SUI(P<0.01), but no correlation was found with labor analgesia, duration of labor, episiotomy, breast feeding, volume of postpartum bleeding, gestational weeks at delivery, induction and pre-pregnant BMI, etc (all P>0.05).(3) Pelvic floor electromyogram: Pelvic floor muscles strength in the CS group was significantly higher than that of the VD group [activity value: (19. 7±9.9) μv vs (14. 8±8.4) μv; work value: (84. 5±37.2) μv vs (78. 8±28.2) μv; peak value: (25.5±12. 5) μv vs (19. 7±11.8) μv, all P<0.01]. Among women in the VD group, the relaxation value and the ratio of relaxation value over activity value (r/a) in the postpartum SUI group were significantly lower than those in the non-SUI group [relaxation value: (1.7±1.8) μv vs (3.0±3.9) μv; r/a ratio: 0. 2±0. 2 vs 0. 3±0. 5, all P <0.01]. The r/a ratio in the VD group showed no difference compared to that in the CS group (0. 2±3.5 vs 0. 2±0. 2, P>0.05).Conclusion Women experienced vaginal delivery, either NVD or FD, have a higher incidence of postpartum SUI than those delivered through CS. UI during pregnancy, forceps delivery and neonatal birth weight are risk factors of postpartum SUI.
