阴道分娩97例初产妇产后尿潴留危险因素临床分析

Clinical Analysis of Risk Factors for Postpartum Urinary Retention in 97 Primiparas Through Vaginal Delivery

目的:探讨经阴道分娩产后尿潴留(postpartum urinary retention,PUR)的危险因素,为降低PUR发生率、减少产后并发症提供理论依据。方法:选择天津医科大学宝坻临床学院(我院)2016年1—12月经阴道分娩PUR患者97例为观察组[A组,其中分娩镇痛者83例(A1组),无分娩镇痛者14例(A2组)],随机选择同期经阴道分娩无尿潴留者88例为对照组[B组,其中分娩镇痛者59例(B1组),无分娩镇痛者29例(B2组)]。记录2组患者一般信息、妊娠期合并症及妊娠期并发症、产时情况、产后出血情况及新生儿体质量,进行回顾性分析。结果:2组产妇妊娠期合并症及并发症、孕次、胎膜早破、枕左前(LOA)胎位、第三产程时间和新生儿体质量比较,差异无统计学意义(均P>0.05)。孕周、分娩镇痛、产钳助娩、侧切、第一产程时间、第二产程时间和产后出血比较,差异有统计学意义(均P<0.05)。发生PUR的危险因素有孕周增大(OR=1.619,95%CI:1.121～2.339)、产钳助娩(OR=4.981,95%CI:2.184～11.361)、产后出血(OR=3.429,95%CI:1.024～11.488)和侧切(OR=2.419,95%CI:1.058～5.531)。PUR危险因素的ROC曲线分析:年龄最佳临界值为26.50岁,孕周最佳临界值为40.36周,新生儿体质量最佳临界值为3 372.50 g,分娩镇痛第一产程最佳临界值为402.50 min,分娩镇痛第二产程最佳临界值为61.50 min,无分娩镇痛第一产程最佳临界值为230.00 min,无分娩镇痛第二产程最佳临界值为34.50 min。结论:对孕周、分娩镇痛、产钳助娩、侧切、第一产程时间、第二产程时间、产后出血诸因素适当干预,可减少PUR的发生。

Objective:To explore the risk factors of postpartum urinary retention after vaginal delivery,to provide theoretical basis for reducing the incidence of postpartum urinary retention and reducing postpartum complications.Methods:Using the method of retrospective analysis,97 cases of postpartum urinary retention in vaginal delivery from January 2016 to December of Baodi Clinical College of Tianjin Medical University were selected as the observation group(A group,with labor analgesia group was A1 group,and without labor analgesia group was A2 group),and 88 cases of non urinary retention in the same period were randomly selected as the control group(B group,the labor analgesia for the B1 group,no analgesia for the B2 group).Record the general information of 2 groups of patients,pregnancy complications,complications during pregnancy,the situation during childbirth,postpartum hemorrhage and neonatal body mass,retrospective analysis was performed.Results:There were no significant differences in pregnancy complications,complications during pregnancy,pregnancy times,premature rupture of membranes,left anterior occipital position,third stage of labor and neonatal body mass between the two groups(all P>0.05).There were significant differences in pregnant weeks,labor analgesia,forceps delivery,episiotomy,first stage of labor,second stage of labor and postpartum hemorrhage(P<0.05).Logistic stepwise regression analysis showed that the risk factors of PUR were pregnant weeks(OR=1.619,95%CI:1.121-2.339),forceps delivery(OR=4.981,95%CI:2.184-11.361),postpartum hemorrhage(OR=3.429,95%CI:1.024-11.488),episiotomy(OR=2.419,95%CI:1.058-5.531).Analysis of the risk factors of postpartum urinary retention by ROC curve,the best critical age was 26.50,the best critical value of the gestational week is 40.36 weeks,the best critical value of newborn weight was 3 372.50 g,the best critical value for the first labor process of labor analgesia was 402.50 min,the second birth process time of labor analgesia was 61.50 min,the best critical value for the first labor process of no labor analgesia was 230.00 min,the second birth process time of no labor analgesia was 34.50 min.Conclusions:The occurrence of postpartum urinary retention can be reduced by proper intervention on factors such as pregnant weeks,labor analgesia,forceps delivery,episiotomy,first stage of labor,second stage of labor and postpartum hemorrhage.