产后压力性尿失禁发生的影响因素研究

Risk factors for stress urinary incontinence after delivery

目的探讨产后压力性尿失禁(SUI)发生的影响因素。方法回顾性分析2016年12月至2017年12月于北京大学人民医院产科定期产前检查住院分娩,并于产后6～14周复查的1 027例产妇的临床资料,其中SUI组303例,无SUI者724例,统计分析妊娠及产后SUI发生率及其影响因素。结果①1 027例产妇SUI的发生率为29.50%(303/1 027);②SUI高危因素分析显示,不同分娩方式对产后SUI的发生产生不同影响(χ2=31.757,P <0.001),阴道分娩者相对于选择性剖宫产者发生产后SUI的风险增加(OR=3.001,95%CI:1.964～4.585),阴道分娩转剖宫产者产后SUI的发生率与选择性剖宫产者比较,差异无统计学意义(P> 0.05)。产妇的母亲有SUI者相对于无家族史者发生SUI的风险增加(OR=15.563,95%CI:5.769～41.982)。第二产程时间、会阴裂伤、产钳助产、会阴侧切、手取胎盘、无痛分娩对产后SUI无明显影响(P>0.05);③经阴道分娩组中,SUI者的平均年龄、产前体质指数较无SUI者升高(P <0.05),母亲有SUI的产妇相对于无家族史者发生SUI的风险增加(OR=15.251,95%CI:4.511～51.560)。经产妇相对于初产妇发生SUI的风险增加(OR=1.498,95%CI:1.051～2.136)。结论经阴道分娩、母亲患SUI、肥胖及高龄是产后SUI的高危因素;第二产程时间、会阴裂伤、产钳助产、会阴侧切、手取胎盘、无痛分娩等产科因素对SUI的发生未产生明显影响。

Objective To investigate the affecting factors of stress urinary incontinence after delivery.Methods A retrospective survey and women who did regular examination and gave birth in Peking University People’s Hospital and had an annual pelvic floor examination at 6~14 weeks after delivery during December 2016 to December2017 were interviewed.Of the 1 027 cases,303 were incontinent and 724 were non-incontinent.To analyze the incidence of SUI in postpartum and its influencing factors.Results ① The incidence of SUI in 1027 parturient women was 29.50%(303/1 027);② Analysis of the risk factors of SUI showed that different modes of childbirth had different effects on the occurrence of SUI in postpartum(χ2=31.757,P < 0.001).Comparing with selective cesarean section,vaginal delivery patients have an increased risk of SUI(OR=3.001,95%CI:1.964~4.585).There was no statistically signif icant difference in the incidence of SUI between those with selective cesarean section and those with cesarean section to which vaginal delivery was transferred(P >0.05).Maternal mothers with SUI had an increased risk of SUI compared with those without a family history of SUI(OR=15.563,95%CI:5.769~41.982).Delivery time of second stage of labor,perineal laceration,forceps delivery,episiotomy,manual removal of placenta,and painless labor had no signif icant effect on SUI(P >0.05).③ In the transvaginal delivery group,the mean age and prenatal BMI of SUI patients were higher than those without SUI(P <0.05).Maternal mothers with SUI had an increased risk of SUI compared with those without a family history of SUI(OR=15.251,95%CI:4.511~51.560).Compared with primipara,multipara had an increased risk of SUI(OR=1.498,95%ci:1.051~2.136).Conclusion Transvaginal delivery,the mother suffered from SUI,obesity and advanced age are the risk factors of SUI in postpartum.Obstetric factors such as delivery time of second stage of labor,perineal laceration,forceps delivery,episiotomy,manual removal of placenta,and painless labor had no signif icant effect on the occurrence of SUI.