初产妇产后盆底功能相关性尿动力障碍现状及其预警因素分析  

Analysis of the current situation of 120 cases of postpartum pelvic floor function-related urodynamic disorders in primiparous women in Tangshan area and its early warning factors

作　　者：唐艳荣[1] 甘玲[2] 赵竞 王燕云[1] TANG Yanrong;GAN Ling;ZHAO Jing;WANG Yanyun(Tangshan City Maternal and Child Health Care Hospital obstetrics and Gynecology department,Tangshan,Hebei 063000,China;Critical Care Medicine Department of Tangshan Workers'Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]唐山市妇幼保健院妇产科,河北唐山063000 [2]唐山工人医院重症医学科,河北唐山063000

出　　处：《中国妇幼健康研究》2023年第7期45-50,共6页Chinese Journal of Woman and Child Health Research

基　　金：2022年河北省医学科学研究课题计划(20221760)。

摘　　要：目的 分析唐山地区初产妇产后盆底功能相关性尿动力障碍现状及其预警因素,进而指导临床有针对性地干预和管理。方法 选取2021年9月至2022年6月唐山市妇幼保健院收治的120例初产妇,根据产后是否出现盆底功能相关性尿动力障碍分为障碍组和正常组,采用尿流动力学仪检测两组产后6周的尿动力学,比较两组社会人口学资料和临床特征,通过Logistic回归分析盆底功能相关性尿动力障碍的预警因素,采用R语言绘制盆底功能相关性尿动力障碍的列线图预测模型。结果 障碍组最大尿流率、腹压漏尿点压小于正常组(t值分别为9.930、3.773,P<0.05),障碍组孕期体质量指数增加值、顺产、阴道撕裂2度、产后子宫脱垂、产后阴道壁脱垂的比例均高于正常组(t值分别为6.100、24.951、31.434、6.340、5.681,P<0.05),产后盆底肌康复比例小于正常组(χ^(2)=15.422,P<0.05)。多因素分析发现,孕期体质量指数增加值(OR=15.064,95%CI:2.625~86.442)、顺产(OR=11.672,95%CI:1.007~135.29)、阴道撕裂2度(OR=14.169,95%CI:1.846~108.75)、产后子宫脱垂(OR=12.063,95%CI:2.177~66.840)、产后阴道壁脱垂(OR=11.992,95%CI:1.935~74.316)是盆底功能相关性尿动力障碍的危险因素;产后盆底肌康复(OR=0.622,95%CI:0.399~0.971)是盆底功能相关性尿动力障碍的保护因素;各预警因素预测风险能力指数(C-index)为0.941,预测能力较高。采用受试者工作特征曲线(ROC)评价列线图预测效能显示,其曲线下面积(AUC)为0.941(95%CI:0.902~0.981),敏感度为94.23%,特异度为86.76%,外部验证显示列线图预测的发生率与实际发生率具有较高的一致性,其校准度为0.883。结论 基于孕期体质量指数增加值、顺产、阴道撕裂2度、产后盆底肌康复、产后子宫脱垂、产后阴道壁脱垂构建的列线图可用于盆底功能相关性尿动力障碍的预测,以帮助临床医师早期制定干预措施。Objective To analyze the current status of postpartum pelvic floor function-related urodynamic disorders in 120 primiparous women in Tangshan area,and to analyze their early warning factors,and then to guide clinical targeted intervention and management.Methods Selected from September 2021 to June 2022,Tangshan maternal and child health care hospital 120 cases,according to postpartum pelvic floor function related urinary dysfunction is divided into groups,no group,using uroflowmeter to detect two groups 6 weeks postpartum urodynamics,compare the two groups of sociodemographic data and clinical characteristics,by Logistic regression analysis of pelvic floor function related urinary dysfunction warning factors,using the R language nomogram prediction model.Results The maximum urinary flow rate and abdominal pressure leakage point pressure were less in the impaired group than in the normal group(t=9.930,3.773),and the proportions of increased body mass index during pregnancy,normal delivery,vaginal tearing degree 2,postpartum uterine prolapse and postpartum vaginal wall prolapse were higher than in the normal group(t=6.100,24.951,31.434,6.340,5.681),and the proportion of postpartum pelvic floor muscle rehabilitation was less than in the normal group(χ^(2)=15.422)(P<0.05);A multifactorial analysis found that increased body mass index during pregnancy(OR=15.064,95%CI:2.625 to 86.442),normal delivery(OR=11.672,95%CI:1.007 to 135.29),vaginal tearing 2nd degree(OR=14.169,95%CI:1.846 to 108.75),postpartum uterine prolapse(OR=12.063,95%CI:2.177 to 66.840),and postpartum vaginal wall prolapse(OR=11.992,95%CI:1.935 to 74.316)were risk factors for pelvic floor function-related urodynamic disorders(p<0.05);postpartum pelvic floor muscle rehabilitation(OR=0.622,95%CI:0.399 to 0.971)was a protective factor for pelvic floor protective factor for function-related urodynamic disorders(P<0.05);Evaluation of the predictive efficacy of the columnar graph using the subject operating characteristic(ROC)curve showed an area under the cu

关 键 词：初产妇 盆底功能 尿动力障碍 阴道撕裂 子宫脱垂 

分 类 号：R173[医药卫生—妇幼卫生保健]