产后盆底功能障碍康复治疗效果的影响因素及列线图预测模型建立  

Influencing factors of rehabilitation treatment effect in patients with postpartum pelvic floor dysfunction and establishment of nomogram prediction model

作　　者：吴志荣 朱玉平[2] 万丽娟 Wu Zhirong;Zhu Yuping;Wan Lijuan(Department of Obstetrics,Huai'an Hospital Affiliated to Xuzhou Medical University,Jiangsu,Huai'an 223000,China;Department of Obstetrics,Huai'an Maternal and Child Health Hospital,Jiangsu,Huai'an 223000,China)

机构地区：[1]徐州医科大学附属淮安医院产科,江苏淮安223000 [2]淮安市妇幼保健院产科,江苏淮安223000

出　　处：《发育医学电子杂志》2023年第3期187-193,共7页Journal of Developmental Medicine (Electronic Version)

基　　金：江苏省妇幼保健科研项目(F202029)。

摘　　要：目的探讨产后盆底功能障碍(postpartum pelvic floor dysfunction,PFD)患者康复治疗效果的影响因素,并构建预测PFD康复效果的列线图模型。方法选取2020年4月至2022年4月徐州医科大学附属淮安医院和淮安市妇幼保健院收治的384例PFD患者为研究对象,患者均行生物反馈电刺激治疗及Kegal训练。治疗后3个月判定患者康复效果并分为康复良好组(n=311)和康复不佳组(n=73)。通过多因素Logistic回归分析筛查出影响PFD患者康复效果的危险因素,利用R 3.6.1软件建立预测PFD康复效果的列线图模型。采用受试者操作特征(receiver operator characteristic,ROC)曲线对模型的预测效能予以评估,并进行H-L拟合优度检验。结果384例患者中,康复不佳73例(19.01%)。康复良好组和康复不佳组高龄孕妇比例、产前体质量指数(body mass index,BMI)、产次、新生儿出生体质量、盆底肌分级、压力性尿失禁(stress urinary incontinence,SUI)程度分级、Kegel训练依从性比较,差异均有统计学意义(P值均<0.05)。多因素Logistic回归分析结果显示,影响PFD康复效果的主要因素为产前BMI(OR=1.741,95%CI:1.284~2.360,P<0.001)、产次≥2次(OR=2.229,95%CI:1.412~7.385,P=0.005)、新生儿出生体质量(OR=2.688,95%CI:1.278~8.635,P<0.001)、盆底肌分级≤1级(1级:OR=2.223,95%CI:1.663~8.349,P=0.040;0级:OR=3.223,95%CI:1.056~9.840,P=0.001)、Kegel训练依从性差(OR=3.092,95%CI:1.726~9.699,P=0.001)。上述5项影响因素的列线图模型曲线下面积(area under the curve,AUC)为0.853(95%CI:0.794~0.912)。拟合优度H-L检验提示,该模型预测PFD患者康复效果的区分度和一致度均较高(χ^(2)=0.837,P=0.416)。结论基于产前BMI、产次≥2次、新生儿出生体质量、盆底肌分级≤1级、Kegel训练依从性等5项影响因素构建的列线图预测模型预测PFD患者康复治疗效果的效能较强。Objective To investigate the influencing factors of the rehabilitation treatment effect of postpartum pelvic floor dysfunction(PFD)patients,and to construct a nomogram model to predict the rehabilitation effect of PFD.Method From April 2020 to April 2022,384 patients with PFD who were admitted to Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Maternal and Child Health Hospital were selected as the research objects.All patients underwent biofeedback electrical stimulation therapy and Kegal training.After three months,the rehabilitation effect was determined and the patients were divided into good rehabilitation group(n=311)and poor rehabilitation group(n=73).The influencing factors of the rehabilitation effect of PFD patients were screened out through multivariate Logistic regression analysis,R 3.6.1 software was used to establish a line graph model to predict the rehabilitation effect of PFD.The predictive performance of the model was evaluated by the receiver operator characteristic(ROC),and the H-L goodness of fit test was performed.Result Among the 384 patients,the rate of poor recovery was 19.01%.There were differences in the proportion of elderly pregnant women,prenatal body mass index(BMI),number of deliveries,neonatal birth weight,pelvic floor muscle classification,stress urinary incontinence(SUI)degree classification,and Kegel training compliance between the two groups(all P<0.05).Multivariate Logistic regression analysis results show that the main factors affecting the rehabilitation effect of PFD were prenatal BMI(OR=1.741,95%CI:1.284-2.360,P<0.001),number of deliveries≥2(OR=2.229,95%CI:1.412-7.385,P<0.005),birth weight of newborns(OR=2.688,95%CI:1.278-8.635,P<0.001),pelvic floor muscle classification≤class 1(class 1:OR=2.223,95%CI:1.663-8.349,P=0.040;class 0:OR=3.223,95%CI:1.056-9.840,P=0.001),and poor Kegel training compliance(OR=3.092,95%CI:1.726-9.699,P=0.001);the above five influencing factors were introduced into R software to establish a nomogram model,the area under the

关 键 词：产后盆底功能障碍 康复效果 影响因素 列线图预测模型 压力性尿失禁 盆腔器官脱垂 受试者操作特征 

分 类 号：R714.46[医药卫生—妇产科学] R711.5[医药卫生—临床医学]