盆底超声在产后早期压力性尿失禁筛查中的应用价值  

Application value of pelvic floor ultrasound in screening early postpartum stress urinary incontinence

作　　者：黄慧琨 王慧香[1] 韦克暖[1] 潘琦文[1] 黄纯愉 刘海蓉 韦芳玲[1] 苏青妹 Huang Huikun;Wang Huixiang;Wei Kenuan;Pan Qiwen;Huang Chunyu;Liu Hairong;Wei Fangling;Su Qinmei(Department of Ultrasonic Diagnosis,The People's Hospital of Hechi,Hechi 547000,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]河池市人民医院超声诊断科,河池547000

出　　处：《中国基层医药》2022年第4期554-558,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：广西壮族自治区河池市科学研究与技术开发计划项目(河科B1717-08)。

摘　　要：目的探讨盆底超声在产后早期压力性尿失禁(SUI)筛查中的应用价值。方法选择河池市人民医院2018年1月至2019年6月收治的产后女性220例作为研究对象,根据产后42 d内是否发生SUI分为有SUI组(52例)和无SUI组(168例),比较分析两组盆底超声参数及临床资料,探讨各参数对产后SUI的影响,构建ROC曲线并计算超声参数的曲线下面积,采用logistic回归分析影响产后SUI的危险因素。结果(1)有SUI组患者的产次(≥2次)、分娩方式(阴道分娩)及新生儿体质量显著高于无SUI组(χ^(2)=4.13、3.30,t=4.43,均P<0.05);在静息状态时两组患者的膀胱颈位置、肛提肌裂孔面积差异均有统计学意义(t=2.29、3.09,均P<0.05);在Valsalva动作状态时两组患者的膀胱颈位置、肛提肌裂孔面积、尿道旋转角、膀胱颈活动度差异均有统计学意义(t=13.14、4.27、15.64、8.54,均P<0.05)。(2)静息状态时膀胱颈位置、肛提肌裂孔面积、Valsalva动作状态时膀胱颈位置、肛提肌裂孔面积、尿道旋转角、膀胱颈活动度的ROC曲线下面积分别为0.707、0.725、0.730、0.771、0.813、0.836,联合参数诊断SUI的ROC曲线下面积为0.849。(3)logistic回归分析结果显示产次(≥2次)、静息状态时膀胱颈位置(>27.286 mm)、肛提肌裂孔面积(>16.663 cm2)、Valsalva动作状态时膀胱颈位置(<-2.774 mm)、肛提肌裂孔面积(>21.915 cm2)、尿道旋转角(>80.445°)、膀胱颈活动度(>30.501°)为产后SUI的危险因素。结论盆底超声参数联合诊断产后SUI的价值较高,膀胱颈位置、肛提肌裂孔面积、尿道旋转角、膀胱颈活动度的异常改变与产后SUI的发生密切相关,可优先选用于产后妇女早期压力性尿失禁的筛查。Objective To investigate the application value of pelvic floor ultrasound in screening early postpartum stress urinary incontinence(SUI).Methods A total of 220 postpartum women,who were admitted by the Department of Gynecology and Obstetrics of The People's Hospital of Hechi from January 2018 to June 2019,were selected for this study.These women were divided into SUI(n=52)and no SUI(n=168)groups according to whether SUI occurred within 42 days after delivery.Pelvic floor ultrasound parameters and clinical data were compared between the two groups.The effects of each ultrasound parameter on postpartum SUI were assessed.The receiver operating characteristic(ROC)curve was plotted for each parameter.The area under the ROC was calculated.The risk factors for postpartum SUI were investigated using the logistic regression analysis.Results The number of deliveries(≥2 times),the proportion of women subjected to vaginal delivery,and neonatal weight in the SUI group were significantly higher than those in the no SUI group[χ^(2)=4.13,3.30,t=4.43,all P<0.05].There were significant differences in the bladder neck position and levator hiatus area in the resting state between the two groups(t=2.29,3.09,both P<0.05).There were significant differences in the bladder neck position,levator hiatus area,urethral rotation angle,and bladder neck mobility during the Valsalva movement between the two groups(t=13.14,4.27,15.64,8.54,all P<0.05).The areas under the ROC of bladder neck position and levator hiatus area in the resting state and the areas under the ROC of bladder neck position,levator hiatus area,urethral rotation angle,and bladder neck mobility during the Valsalva movement were 0.707,0.725,0.730,0.771,0.813,and 0.836,respectively.The area under the ROC of parameters used in combination was 0.849.Logistic regression analysis results revealed that the number of deliveries(≥2 times),bladder neck position(>27.286 mm)and levator ani hiatus area in resting state(>16.663 cm2),and bladder neck position(<-2.774 mm),levator hiatus a

关 键 词：产后期 女性 超声检查 尿失禁 压力性 骨盆底 功能障碍 危险因素 早期诊断 

分 类 号：R711.59[医药卫生—妇产科学] R445.1[医药卫生—临床医学]