初产妇与经产妇分娩后一周内尿动力学表现分析

Urodynamic study on primipara and bipara after parturition

目的探讨初产妇与经产妇分娩后1周内的尿动力学表现。方法按照国际尿控协会推荐的方法对36例初产妇志愿者(初产妇组)和12例经产妇志愿者(经产妇组)分娩后1周内(产后2～7 d)的尿动力学变化进行检查。14例因上尿路疾病而下尿路功能正常的已婚未育妇女作为对照组。结果初产妇组与经产妇组妇女分娩后功能性膀胱容量(FBV)分别为(310±154)、(243±141)ml,正常尿意膀胱压测定容量(NDCC)分别为(215±90)、(225±115)ml,均低于对照组的(437±193)ml 和(338±120)ml,分别比较,差异均有统计学意义(P<0.05);但初产妇组与经产妇组间FBV 和 NDCC 比较,差异无统计学意义(P>0.05)。初产妇组与经产妇组妇女最大静态尿道压(MUP)和最大尿道闭合压(MCUP)也均显著高于对照组,差异有统计学意义(P<0.05);但初产妇组MUP 和 MCUP 与经产妇组比较,差异无统计学意义(P>0.05)。功能尿道长度(FUL)初产妇组妇女为(31±6)mm,经产妇组妇女为(27±5)mm,对照组妇女为(30±3)mm,初产妇、经产妇组分别与对照组比较,差异均无统计学意义(P>0.05),但初产妇组 FUL 显著长于经产妇组,差异有统计学意义(P<0.05)。初产妇组、经产妇组及对照组的 Abrams-Griffiths(AG)值分别为-35±28、-26±26和-11±17,两产妇组分别与对照组比较,差异有统计学意义(P<0.05);初产妇组、经产妇组及对照组尿道阻力因子(URA)分别为(8±4)、(9±3)和(11±3)cm H_2O(1 am H_2O=0.098 kPa),3组比较,差异均无统计学意义(P>0.05)。初产妇组和经产妇组腹压漏尿点压(VLPP)测定各有1例漏尿发生,VLPP 分别为50 cm H_2O和67 cm H_2O。结论初产妇和经产妇分娩后1周内均表现为膀胱容量减少,尿道静态阻力增加,但膀胱排空能力正常。

Objective To investigate the bladder function in primipara and bipara within 1 week after delivery using urodynamic study. Methods Investigations on urodynamic changes were performed in 36 primipara volunteers and 12 bipara volunteers according to the recommendations of the International Continence Society （ICS）. Fourteen women with upper urinary tract diseases but having normal lower urinary tract function, who had not experienced parturation were included as controls. Results Functional bladder volume （FBV） of primipara and bipara after delivery and normal desire cytometric capacity （NDCC） were respectively lower than those of control group （437±193 ）ml and （338±120 ） ml, however FBV and NDCC between primipara and bipara （310 ±154）, （215±90） ml vs （243±141） , （225±115） ml were not significantly different. The static Pure. max and Pure. clos. max of primipara and bipara were respectively higher than those of control group （ 87±7 ） cm H2O （ 1 cm H2O= 0. 098 kPa ） and （ 78±8 ） cm H2O（ P 〈 0. 05 ） , but there were no significant differences in Pure. max and Pure. closure, max between primipara and bipara （116±28） cm H2O and （97±25） cm H20 vs （120±31） cm H2O and （106±37） cm H2O. There were significant differences in functional urethral length between primipara（ 31± 6 ） mm and bipara （27±5 ） ram. Abrams-Griffiths number （ AG ） and urethral resistance factor （ URA ） of primipara and bipara also showed no significant differences from control group （ 11 ±3 ） cm H2O. Each group had one case with leakage on valsalva action, and valsalva leak point pressure （VLPP） was respectively 50 cm H2O and67 cm H2O. Conclusions It is suggested that bladders of primipara and bipara shortly after delivery are sensitive and static urethral pressure parameters are increased, but voiding ability is still normal. There are no significant differences in urodynamic parameters between primipara and bipara.