广西6市妇女产后盆底功能障碍性疾病调查及盆底肌力异常危险因素分析

Survey on pelvic floor dysfunction and risk factors analysis of pelvic floor muscle strength abnormalities among postpartum women from six cities in Guangxi

目的了解广西地区产后盆底功能障碍性疾病(PDF)发生情况及其危险因素。方法随机抽取广西南宁、柳州、梧州、钦州、百色、桂林市妇幼保健院住院产妇1 574例进行产后盆底功能筛查,分析产后盆底肌力下降的影响因素。结果 1 574例产妇中,检出尿失禁427例(27. 13%),盆腔脏器脱垂(POP) 716例(45. 49%);检出盆底Ⅰ类、Ⅱ类纤维肌力异常分别为970例(61. 63%)和907例(57. 62%),Ⅰ类、Ⅱ类纤维疲劳度异常分别为1 297例(82. 40%)和1 023例(64. 99%),阴道动态压异常1 247例(79. 22%)。单因素分析结果显示:壮族女性、文化程度低、阴道分娩、足月分娩2次及以上、会阴撕裂、盆腔痛与盆底纤维肌力异常有关(均P <0. 05)。多因素Logistic回归分析显示:文化程度高是产后盆底肌力的保护因素,阴道分娩方式、分娩次数多、盆腔痛是产后盆底纤维肌力下降的独立危险因素(P <0. 05)。结论广西地区妇女产后PDF常见。阴道分娩方式、分娩次数多、盆腔痛是妇女产后盆底肌力异常的主要危险因素,提示减少产次,提高围生期保健意识,或可预防或减少PDF的发生。

Objective To investigate the prevalence of postpartum pelvic floor dysfunction(PDF)and its risk factors in Guangxi.Methods A screening of postpartum pelvic floor function was conducted among 1 574 hospitalized puerperae randomly selected from the maternal and child health hospitals of Nanning City,Liuzhou City,Wuzhou City,Qinzhou City,Baise City and Guilin City in Guangxi.The factors influencing the decline of postpartum pelvic floor muscle strength were analyzed.Results Among the 1 574 puerperae,urinary incontinence occurred in 427 cases(27.13%),pelvic organ prolapse(POP)in 716 cases(45.49%);typeⅠand typeⅡmuscle fiber strength abnormalities in 970 cases(61.63%)and 907 cases(57.62%)respectively,typeⅠand typeⅡfiber fatigue abnormalities in 1 297 cases(82.40%)and 1 023 cases(64.99%)respectively,and vaginal dynamic pressure abnormalities in 1 247 cases(79.22%).The results of univariate analysis showed that the females with Zhuang nationality,poor education level,vaginal delivery,full-term childbirth for the second time or above,perineal tear and pelvic pain correlated with pelvic floor fiber strength abnormalities(all P<0.05).The results of multivariate Logistic regression analysis showed that high education level was a protective factor of pelvic floor muscle strength after delivery,and vaginal delivery approach,frequent delivery and pelvic pain were independent risk factors for the decline of postpartum pelvic floor fiber muscle strength(P<0.05).Conclusion PDF is common in Guangxi postpartum women.Vaginal delivery approach,frequent delivery and pelvic pain are the major risk factors for pelvic floor muscle strength abnormalities in postpartum women,which indicates that reducing delivery frequency and improving the awareness of perinatal healthcare might contribute to preventing or reducing the incidence rate of PDF.