经阴道分娩初产妇产后早期盆底电生理异常影响因素分析及预测模型研究  

Analysis of the influencing factors and predictive models of early electrophysiological abnormalities of pelvic floor in primiparas after vaginal delivery

作　　者：张萍 卢琼芳[2] ZHANG Ping;LU Qiong-fang(Nursing School of Guangxi University of Chinese Medicine, Nanning 530200, China;Department of Obstetrics, People′s Hospital of Guigang City, Guigang 537100, China)

机构地区：[1]广西中医药大学护理学院,广西南宁530200 [2]广西贵港市人民医院产科,广西贵港537100

出　　处：《河北医科大学学报》2021年第5期559-567,共9页Journal of Hebei Medical University

基　　金：贵港市科学研究与技术开发项目[贵科攻190837(社自)]。

摘　　要：目的探索阴道分娩初产妇产后盆底电生理异常状况、影响因素及预测模型。方法回顾性分析在广西贵港市人民医院定期产检、分娩并在产后6~8周到医院进行盆底功能康复检查的阴道分娩初产妇妊娠和分娩相关资料,对产妇的资料及产后早期盆底检测结果进行统计分析,查找盆底电生理异常的影响因素和预测模型。结果664例阴道分娩初产妇中Ⅰ类肌肌力异常70.03%,Ⅱ类肌肌力异常69.27%,Ⅰ类肌疲劳69.73%,Ⅱ类肌疲劳31.02%,阴道动态压力有92.02%异常。产妇年龄、身高、会阴侧切、会阴撕裂伤、晚期增重、第二产程时长和新生儿体重、身长、性别与经阴道分娩初产妇产后早期盆底肌电生理异常有关,其中,产妇身高越高、新生儿身长越长、在第二产程不超过3 h的情况下第二产程时间越长均是保护因素。孕期体重增加对盆底肌电生理的影响明显,将孕期增重与盆底电生理检测结果绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)可以预测部分产妇产后早期盆底电生理异常,在孕早期25≤体重指数<30的孕妇,Ⅰ类肌肌力异常与晚期增重的ROC曲线下面积(area under curve,AUC)为0.725(P=0.044,95%CI:0.523~0.927),最佳晚期增重值为4.75 kg。结论经阴道分娩初产妇产后早期盆底肌电生理异常发生率较高,影响因素较多,孕期体重增加可以预测部分产妇产后早期电生理异常。Objective To explore the influencing factors and predictive models of electrophysiological abnormalities of pelvic floor in primiparas after vaginal delivery.Methods A retrospective analysis was performed on pregnancy and childbirth related data of primiparas who underwent regular antenatal examination,delivery and regular examination for rehabilitation of pelvic floor function at 6-8 weeks after vaginal delivery at People′s Hospital of Guigang City.The data of the parturient and the results of early postpartum pelvic floor detection were statistically analyzed,to ascertain the influencing factors and prediction models of electrophysiological abnormalities of the pelvic floor.Results Among the 664 primiparous women with vaginal delivery,there was an abnormal rate of typeⅠmuscle fiver strength(70.03%)and of typeⅡmuscle fiber strength(69.27%),as well as typeⅠandⅡpelvic floor muscle fiber fatigue(69.73%and 31.02%respectively),and abnormal vaginal dynamic pressure(92.02%).Maternal age,height,perineal lateral incision,perineal laceration,weight gain in the third trimester,duration of the second stage of labor,and newborn′s weight,newborn′s length,and gender were related to early electrophysiological abnormalities of pelvic floor of the primiparas after vaginal delivery.The greater maternal height,newborn′s length,and the second stage of labor of less than 3 h were protective factors.Weight gain during pregnancy had a significant impact on the electrophysiology of the pelvic floor.A receiver operating characteristic curve(ROC)of the weight gain during pregnancy and electrophysiological test results of pelvic floor was delineated to predict early electrophysiological abnormalities of pelvic floor in some parturients after delivery.In the early pregnancy,the area under ROC(AUC)of pregnant women with 25≤BMI<30,abnormality of typeⅠmuscle fiber strength and weight gain in the third trimester of pregnancy was 0.725(P=0.044,95%CI:0.523-0.927),and the optimal weight gain was 4.75 kg during third trimester.C

关 键 词：分娩 产道 骨盆底 电生理学 影响因素分析 

分 类 号：R337.5[医药卫生—人体生理学]