产后压力性尿失禁的危险因素及盆底功能锻炼的改善效果分析

Analysis of the risk factors of postpartum stress urinary incontinence and the clinical effectiveness of pelvic floor functional exercise for postpartum stress urinary incontinence

目的:探讨产后压力性尿失禁(SUI)的危险因素及盆底功能锻炼的改善效果。方法:回顾性分析88例产后SUI产妇(失禁组)和同期分娩未发生SUI的80例健康产妇(对照组)临床资料。比较其年龄、孕龄、孕次、流产次数、体重指数(BMI)、经产情况、胎数、分娩方式、孕前或孕期合并尿失禁情况、吸烟情况、产后增加腹压、新生儿体重、产后盆底功能锻炼情况、孕期运动量、孕期泌尿系感染情况、新生儿喂养方式、母乳喂养时间等因素差异,经非条件logistic多元逐步回归分析影响产妇产后SUI的独立危险因素。按照实际治疗情况将88例失禁组产妇分为盆底功能锻炼组(38例)和未接受盆底功能锻炼组(50例),比较两组产妇治疗前后尿动力学指标,即最大尿道压(MUP)、最大尿流率(Qmax)、尿流时间(VT)等。结果:两组产妇年龄、孕龄、孕次、BMI、吸烟情况、孕期泌尿系感染情况、新生儿喂养方式、母乳喂养时间等一般资料比较均无统计学差异(P>0.05)。多元逐步回归分析显示,阴道分娩、孕前或孕期合并尿失禁、产后未予以盆底功能锻炼及新生儿体重≥4000g是影响产妇产后SUI发生的独立危险因素(P<0.05)。治疗后6、12个月时,失禁组中锻炼组产妇Qmax、MUP水平均较治疗前明显提高,且高于同期非锻炼组产妇(P<0.05);VT水平则较治疗前明显降低,且低于同期非锻炼组产妇(P均<0.05)。结论:阴道分娩、产后未行盆底功能锻炼、巨大儿及孕前或孕期合并尿失禁均同产后SUI的发生关系密切,建议产妇产后尽早接受盆底功能锻炼,以促进排尿功能恢复。

Objective：To investigate the risk factors of postpartum stress urinary incontinence （SUI） and the clinical effectiveness of pelvic floor functional exercise for improvement of SUI.Methods：The clinical data of 80 women with postpartum SUI （SUI group） and 88 healthy women （control group） were analyzed retrospectively.Age,gestational age,gravidity,the number of abortion,body mass index （BMI）,parity,embryo number,mode of delivery,urinary incontinence before or during pregnancy,smoking,postpartum increased abdominal pressure,neonatal weight,post partum pelvic floor functional exercise,exercise during pregnancy,urinary tract infection during pregnancy,neonatal feeding pattern,breastfeeding time and other factors of included women were compared between the two groups.The independent risk factors of maternal postpartum SUI were analyzed by non conditional Logistic multiple stepwise regression analysis.According to the actual treatment,88 women in SUI group were divided into the pelvic floor functional exercise group （group A,8 cases） and non pelvic floor functional exercise group （group B,50 cases）.The maternal urodynamic indexes [maximum urethral pressure （MUP）,maximum urinary flow rate （Qmax）,voiding time （VT）] were compared between the two groups before and after treatment.Results：Age,gestational age,gravidity,BMI,smoking,urinary tract infection during pregnancy,neonatal feeding pattern,breastfeeding time and other factors showed no significant difference between the two groups （P〉 0.05）.The non conditional Logistic multivariate regression analysis showed that vaginal delivery,urinary incontinence before or during pregnancy,no pelvic floor functional exercise and neonatal weight ≥ 4000g were the independent risk factors for postpartum SUI （P〈 0.05）.In 6 and 12 months after the treatment,Qmax and MUP levels of women in group A increased,and were significant higher than those of women in group B （P〈 0.05）,while VT level of women in group A was significant lower than that of women before treatment,and was also lower than that of women in group B at the same time （P〈 0.05）.Conclusion：Vaginal delivery,no postpartum pelvic floor functional exercise,macrosomia,and urinary incontinence before or during pregnancy are closely associated with postpartum SUI.It is recommended that women receive postpartum pelvic floor functional exercise as soon as delivery to promote the recovery of urinary function.