不同分娩方式对产后尿失禁及盆底肌肉功能的影响
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摘要
目的探讨不同分娩方式对产后尿失禁及盆底肌肉功能的影响。方法选择2017年3月-2017年9于青岛市妇女儿童医院分娩的顺产、剖宫产及助产产妇各100例。每位纳入研究的孕产妇分别于孕21周及产后6周测定盆底肌功能,并记录相应产科基本资料。比较不同分娩方式产妇产前、产后盆底肌功能及其改变,分析其与尿失禁之间的关系,并分析影响尿失禁发生的因素。筛选可以在临床上检测的指标建立ROC曲线,评价其对产后尿失禁的预测能力。结果在产前各项指标无明显差异的条件下(P>0.05),经阴道分娩者产后阴道静息压力(VRP)为(28.9±5.4) cmH_2O,盆底肌(PFM)力量为(17.6±15.3) cmH_2O,PFM耐力为(112.9±85.9) cmH_2O,均较产前显著降低,且低于剖宫产者[(40.1±9.6)cmH_2O、(32.4±14.2) cmH_2O、(226.2±138.5) cmH_2O)],差异均具有统计学意义(P<0.05)。产前及产后PFM力量及耐力是尿失禁发生的独立危险因素,其中产后PFM耐力相对危险度较高;筛选出PFM力量及耐力建立ROC曲线,发现产前PFM耐力预测产后尿失禁的ROC曲线下面积(AUC)为0.896,其敏感性为97.80%,特异性为59.80%。结论与剖宫产相比,经阴道分娩者盆底肌功能受较大影响,且其尿失禁发生率更高,而PFM力量及耐力的改变可显著影响尿失禁的发生,对产后尿失禁有一定的预测效能。
Objective To investigate the effects of different modes of delivery on postpartum urinary incontinence and pelvic floor muscle function. Methods According to natural delivery, cesarean section and midwife-giving, 300 cases who gave birth in Qingdao women and children′s hospital from March 2017 to September 2017 were enrolled, and 100 cases in each group respectively. The pelvic floor muscle function were analyzed at 21 weeks of gestation and 6 weeks postpartum, and recorded the corresponding obstetric data. To compare the prenatal and postpartum pelvic floor muscle function and its changes in different delivery methods, analyze the relationship between it and urinary incontinence, and analyze the factors affecting the occurrence of urinary incontinence. Screening for indicators that can be clinically tested establishes ROC curves and evaluates their ability to predict postpartum urinary incontinence. Results With the same condition of prenatal status(P>0.05), postpartum vaginal resting pressure(VRP)(28.9±5.4 cmH_2O), pelvic floor muscle(PFM) strength(17.6±15.3 cmH_2O) and endurance(112.9±85.9 cmH_2O) were lower than that in pregestation, and cesarean section [(40.1±9.6) cmH_2O,(32.4±14.2) cmH_2O,(226.2±138.5) cmH_2O], the differences were statistically significant(P<0.05); prenatal and postpartum PFM strength and endurance were independent risk factors for urinary incontinence, and the relative risk of postpartum PFM endurance was higher; PFM strength and endurance were screened to establish ROC curve, and prenatal PFM endurance is predicted to be postpartum. The area of the ROC curve for urinary incontinence is(AUC) of 0.896 with a sensitivity of 97.80% and a specificity of 59.80%. Conclusion Compared with cesarean section, there was a greater effection on the pelvic floor muscle through the process of vaginal delivery, and the incidence of urinary incontinence was higher. The change of PFM strength and endurance can significantly affect the occurrence of urinary incontinence, postpartum urinary incontinence.
Objective To investigate the effects of different modes of delivery on postpartum urinary incontinence and pelvic floor muscle function. Methods According to natural delivery, cesarean section and midwife-giving, 300 cases who gave birth in Qingdao women and children′s hospital from March 2017 to September 2017 were enrolled, and 100 cases in each group respectively. The pelvic floor muscle function were analyzed at 21 weeks of gestation and 6 weeks postpartum, and recorded the corresponding obstetric data. To compare the prenatal and postpartum pelvic floor muscle function and its changes in different delivery methods, analyze the relationship between it and urinary incontinence, and analyze the factors affecting the occurrence of urinary incontinence. Screening for indicators that can be clinically tested establishes ROC curves and evaluates their ability to predict postpartum urinary incontinence. Results With the same condition of prenatal status(P>0.05), postpartum vaginal resting pressure(VRP)(28.9±5.4 cmH_2O), pelvic floor muscle(PFM) strength(17.6±15.3 cmH_2O) and endurance(112.9±85.9 cmH_2O) were lower than that in pregestation, and cesarean section [(40.1±9.6) cmH_2O,(32.4±14.2) cmH_2O,(226.2±138.5) cmH_2O], the differences were statistically significant(P<0.05); prenatal and postpartum PFM strength and endurance were independent risk factors for urinary incontinence, and the relative risk of postpartum PFM endurance was higher; PFM strength and endurance were screened to establish ROC curve, and prenatal PFM endurance is predicted to be postpartum. The area of the ROC curve for urinary incontinence is(AUC) of 0.896 with a sensitivity of 97.80% and a specificity of 59.80%. Conclusion Compared with cesarean section, there was a greater effection on the pelvic floor muscle through the process of vaginal delivery, and the incidence of urinary incontinence was higher. The change of PFM strength and endurance can significantly affect the occurrence of urinary incontinence, postpartum urinary incontinence.
引文
[1] 朱兰.中国女性盆底肌肉锻炼的状况与未来[J].中国实用妇科与产科杂志,2017,33(1):19-20.
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[7] 孙俐,叶丽萍.产后压力性尿失禁初产妇住院期间心理情绪评分及心理护理需求指标调查[J].中国医药指南,2011,9(35):229-230.
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[9] FREEMAN A,MENEES S.Fecal incontinence and pelvic floor dysfunction in women:A review[J].Gastroenterol Clin North Am,2016,45(2):217-237.
[10] 胡孟彩,王锐,徐冬梅,等.不同分娩方式对产后早期盆底肌力影响的研究[J].中国妇幼保健,2009,24(7):884-885.
[11] 林忠,朱雪红,卢坤彬,等.选择性剖宫产和阴道顺产对初产妇产后早期盆底功能影响Meta分析[J].中国实用妇科与产科杂志,2016,32(6):558-563.
[12] 刘晖,叶真,陈树强,等.孕妇压力性尿失禁发生情况及影响因素分析[J].福建医科大学学报,2016,50(5):342-344.
[13] 曹士青,徐静.阴道顺产和剖宫产对妇女产后早期盆底功能影响的对比和康复方案研究[J].中国社区医师,2016,32(5):63-64.
[14] 余霞娟,罗丹,陈玲,等.既往分娩方式对孕期压力性尿失禁的影响分析[J].山东医药,2018,58(6):84-87.
[15] 赵玉娇,高光峰,崔璨,等.经阴道分娩后压力性尿失禁产妇盆底结构改变的MRI研究[J].国际医学放射学杂志,2018,41(1):17-21.
[16] BK,Hilde G,Tennfjord M K,et al.Does episiotomy influence vaginal resting pressure,pelvic floor muscle strength and endurance,and prevalence of urinary incontinence 6 weeks postpartum?[J].Neurourol Urodynam,2017,36(3):683-686.
[2] 孙智晶,朱兰,郎景和,等.盆底肌肉训练在盆底功能障碍性疾病防治中的作用[J].中华妇产科杂志,2017,52(2):138-140.
[3] KEPENEKCI I,KESKINKILIC B,AKINSU F,et al.Prevalence of pelvic floor disorders in the female population and the impact of age,mode of delivery,and parity[J].Dis Colon Rectum,2011,54(1):85-94.
[4] 张丽华,常晓红,范亚丽,等.综合护理方案对PFD患者的盆底肌肉功能恢复的影响[J].基因组学与应用生物学,2017(9):3572-3576.
[5] M?RKVED S,SALVESEN KA,B? K,et al.Pelvic floor muscle strength and thickness in continent and incontinent nulliparous pregnant women[J].Int Urogynecol J Pelvic Floor Dysfunct,2004,15(6):384-390.
[6] BO K,FRAWLEY HC,HAYLE BT,et al.An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction[J].Int Urogynecol J,2017,28(2):191-213.
[7] 孙俐,叶丽萍.产后压力性尿失禁初产妇住院期间心理情绪评分及心理护理需求指标调查[J].中国医药指南,2011,9(35):229-230.
[8] SIGURDARDOTTIR T,ARNASON A,B? K.Pelvic floor muscle function before and after first childbirth[J].Int Urogynecol J,2011,22(12):1497-1503.
[9] FREEMAN A,MENEES S.Fecal incontinence and pelvic floor dysfunction in women:A review[J].Gastroenterol Clin North Am,2016,45(2):217-237.
[10] 胡孟彩,王锐,徐冬梅,等.不同分娩方式对产后早期盆底肌力影响的研究[J].中国妇幼保健,2009,24(7):884-885.
[11] 林忠,朱雪红,卢坤彬,等.选择性剖宫产和阴道顺产对初产妇产后早期盆底功能影响Meta分析[J].中国实用妇科与产科杂志,2016,32(6):558-563.
[12] 刘晖,叶真,陈树强,等.孕妇压力性尿失禁发生情况及影响因素分析[J].福建医科大学学报,2016,50(5):342-344.
[13] 曹士青,徐静.阴道顺产和剖宫产对妇女产后早期盆底功能影响的对比和康复方案研究[J].中国社区医师,2016,32(5):63-64.
[14] 余霞娟,罗丹,陈玲,等.既往分娩方式对孕期压力性尿失禁的影响分析[J].山东医药,2018,58(6):84-87.
[15] 赵玉娇,高光峰,崔璨,等.经阴道分娩后压力性尿失禁产妇盆底结构改变的MRI研究[J].国际医学放射学杂志,2018,41(1):17-21.
[16] BK,Hilde G,Tennfjord M K,et al.Does episiotomy influence vaginal resting pressure,pelvic floor muscle strength and endurance,and prevalence of urinary incontinence 6 weeks postpartum?[J].Neurourol Urodynam,2017,36(3):683-686.