产后尿潴留高危因素及盆底康复技术对其疗效的分析

Analysis of risk factors of postpartum urinary retentionand the effect of application of pelvic floor rehabilitation techniques on the postpartum urinary retention

目的:研究产后尿潴留(PUR)发生的高危因素,并探讨盆底康复技术治疗PUR的效果。方法:随机选取2012年4月至9月在大连市妇幼保健院(妇产医院)经阴分娩的393例产妇,其中发生PUR并给予开放式导尿治疗的产妇193例(病例组),未发生PUR的产妇200例(正常组),收集并比较两组患者的临床资料。根据入组标准,最终纳入186例PUR患者,根据治疗方法分为低频脉冲电治疗组(实验组,86例)和常规物理治疗组(对照组,100例),比较两组患者的顽固性PUR发生率、膀胱残余尿量、住院天数、住院费用等。结果:单因素分析显示,无痛分娩、产钳助产术、胎头吸引术、手转胎头、第一产程时间、第二产程时间是PUR发生的相关危险因素。Logistic逐步回归分析显示,PUR的独立危险因素按风险度大小依次为产钳助产术、胎头吸引术、无痛分娩、手转胎头及年龄。撤除导尿管后,实验组的残余尿量、顽固性PUR人数、住院天数均显著少于对照组(P≤0.05)。结论:无痛分娩、产钳助产术、胎头吸引术、手转胎头、第一产程时间、第二产程时间显著增加PUR的风险。年龄、手转胎头、无痛分娩、产钳助产术、胎头吸引术是PUR的独立危险因素。低频脉冲电对PUR有显著的治疗作用。

Objective：To summarize the high risk factors of postpartum urinary reten- tion （ PUR）, and to explore the treatment effect of the PUR after applying pelvic floor rehabilita- tion technology. Method：393 cases of the maternal vaginal delivery were selected from Apr. 2012 to Sep. 2012. Among these, 193 cases who occurred postpartum urinary retention and giv- en open-catheterization treatment was case group. 200 case of maternal not occurred postpartum urinary retention was normal group. In the case group, 86 cases treated with a low-frequency pulse electric was experimental group, and 100 cases treated with conventional physical therapy was control group. The incidence of refractory urinary retention, post-void residual volume, the number of days in hospital, hospitalization costs of the two groups were analzed. Results： Univa- riate analysis showed that the factors related to the occurrence of urinary retention include pain- less childbirth, midwifery forceps, vacuum extraction, turning fetal head, the first stage of labor time, second stage of labor time（P~〈0.05）. Logistic regression analysis showed that descending order of OR of urinary retention was ： midwifery forceps, vacuum extraction, painless childbirth, turning fetal head and age. Residual urine volume, the number of refractory urinary retention, the number of days in hospital of the experimental group after the withdrawal catheterization ob- viously less than that of the control group（ P~〈0.05 ）. Conclusion：Painless childbirth, midwife- ry forceps, vacuum extraction, turning fetal head, the first stage of labor, the second stage of la- bor time clearly increase the risk of postpartum urinary retention. Age, painless childbirth, mid- wifery forceps, vacuum extraction are independent risk factors of PUR. Low-frequency pulse e- lectric therapy has a significant role in the treatment of PUR.