经会阴三维超声检查初产妇肛提肌损伤及其危险因素相关性研究

Levator ani muscle injury detected by 3-dimensional transperineal ultrasound in primiparous women and its correlation with risk factors

目的探讨经会阴三维超声评估初产妇肛提肌损伤的危险因素。方法选取2013年2月至2014年6月在新疆医科大学第五附属医院就诊的81例初产妇进行观察研究。使用经会阴三维超声观察81例经阴道分娩的初产妇产后6-8周的肛提肌,对所有可能导致初产妇肛提肌损伤的危险因素进行回顾性分析,其中包括受试者的新生儿头围（HC）、出生体质量、第二产程时长、母体年龄、婴儿性别、会阴侧切及器械分娩。对以上所有的可能因素进行研究,应用Logistic多元回归的统计学方法分析产后肛提肌损伤发生的独立危险因素。结果通过经会阴三维超声观察81例初产妇的肛提肌,其中13例（16.05%）初产妇肛提肌损伤。单因素分析影响肛提肌损伤的因素有：较大的胎儿头围,较长的第二产程时长,较大体质量,会阴侧切,器械分娩。多因素Logistic回归分析结果显示：胎儿头围OR=5.72（95%CI：1.68-19.47）,第二产程时长OR=4.93（95%CI：1.65-14.68）,胎儿体质量OR=1.90（95%CI：1.09-3.29）,器械分娩OR=1.36（95%CI：1.05-2.51）,会阴侧切OR=1.41（95%CI：1.16-5.47）,以上均为独立危险因素。结论胎儿性别、母体年龄不是初产妇肛提肌损伤的独立危险因素,较大的头围和较长的第二产程是初产妇肛提肌损伤的主要危险因素。

Objective To evaluate the risk factors of lavatory ani muscle（LAM）injury among primiparas by using 3-dimensional transperineal ultrasound.Methods A total of 81 primiparous women in the Fifth Affiliated Hospital of Xinjiang Medical University from February 2013 to June 2014 were selected for conducting observation.The 3-dimensional transperineal ultrasound examination was performed for observing LAM in 6-8weeks after delivery.The whole risk factors possibly causing the LAM injury in primiparous women were retrospectively analyzed,including the neonatal heal circumference（HC）,birthweight,second stage duration of labor,maternal age,neonatal sex,instrumental delivery and episiotomy.The above possible factors were included in this study.The Logistic multiple regression statistical method was adopted to analyze the independent risk factors for the occurrence of postoperative LAM injury.Results Among 81 cases,LAM injury was observed in 13cases（16.05%）.The single factor analysis showed that the factors causing LAM injury were larger HC,longer second stage duration of labor,larger body weight,episiotomy and instrumental delivery.The multi-factor Logistic regression analysis results showed that fetal HC[OR=5.72,95% confidence interval（CI）：1.68-19.47],second stage duration（OR=4.93,95% CI：1.65-14.68）,fetal weight（OR=1.90,95%CI：1.09-3.29）,instrumental delivery（OR=1.36,95%CI：1.05-2.51）,episiotomy（OR=1.41,95%CI：1.16-5.47）were the risk factors for LAM injury.Conclusion The fetal sex and maternal age are not the independent risk factors of LAM injury.larger HC and longer second stage duration of labor are the main risk factors of LAM injury in primiparous women.