成都地区产后早期尿失禁的危险因素分析

A Study on the Risk Factors for Early Postpartum Urinary Incontinence in Chengdu

目的分析成都地区产妇产后早期尿失禁的发病情况,寻找其高危因素,为临床诊治提供参考。方法收集2014年1月至2018年1月在四川大学华西第二医院分娩并于分娩后6周复查的产妇9 918例,采用问卷调查方式,分析产妇产后6周尿失禁的患病率;采用χ^2检验及多因素logistic回归分析影响其患病率的危险因素。结果实际有效调查9 550例产妇。成都地区产妇产后6周尿失禁的患病率为15.53%(1 483/9 550),其中以压力性尿失禁(73.03%,1 083/1 483)最常见。单因素分析显示:年龄、盆腔手术史、产前体质量指数(body mass index, BMI)、妊娠期尿失禁、新生儿体质量、产次、分娩方式、会阴侧切、会阴撕裂及第二产程时长均与产后6周尿失禁的发生有关(P<0.05)。多因素logistic回归分析显示,相对于阴道分娩(顺产),剖宫产可降低尿失禁的发生概率[比值比(odds ratio,OR)=0.373,P<0.001];年龄≥35岁(OR=1.803,P=0.001)、有盆腔手术史(OR=1.260,P=0.003)、产前肥胖(BMI≥28 kg/m^2)(OR=1.694,P=0.025)、妊娠期有尿失禁(OR=2.605,P<0.001)、分娩新生儿体质量≥4 kg(OR=2.307,P=0.040)、经产(OR=1.284,P=0.023)及有会阴撕裂(OR=1.372,P=0.035)是产后6周尿失禁发生的独立危险因素。结论产后6周尿失禁在成都地区产妇中并不少见,以压力性尿失禁为主。顺产、高龄产妇、经产妇、盆腔手术史、产前肥胖、妊娠期尿失禁、新生儿体质量大及会阴撕裂是产后6周尿失禁的危险因素。

Objective To investigate the incidence of early postpartum urinary incontinence in parturients from Chengdu, and to find out the high-risk factors for reference for clinical diagnosis and treatment. Methods A total of 9 918 parturient women who gave delivery at the West China Second University Hospital of Sichuan University from January 2014 to January 2018 were enrolled and reviewed 6 weeks after delivery. The prevalence of urinary incontinence at 6 weeks postpartum was investigated by questionnaire. χ~2 test and multivariate logistic regression analysis were used to analyze the risk factors affecting the prevalence. Results 9 550 parturient women were actually investigated. The prevalence of urinary incontinence was 15.53%(1 483/9 550) at 6 weeks postpartum in Chengdu, among which stress urinary incontinence was the most common(73.03%,1 083/1 483). Univariate analysis showed that age, pelvic surgery history, prenatal body mass index(BMI), urinary incontinence during pregnancy, neonatal body mass, the number of parturition, delivery mode, lateral perineal incision, perineal laceration and prolonged second stage of labor were all correlated with the occurrence of urinary incontinence at 6 weeks postpartum(P<0.05). Multivariate logistic regression analysis showed that cesarean section can reduce the risk of urinary incontinence compared with vaginal delivery [odds ratio(OR)=0.373,P<0.001]. Age≥35 yr.(OR=1.803,P=0.001), pelvic surgery history(OR=1.260,P=0.003), BMI≥28 kg/m^2 during pregnancy(OR=1.694,P=0.025), urinary incontinence during pregnancy(OR=2.605,P<0.001), neonatal body mass ≥4 kg(OR=2.307,P=0.040),multipara(OR=1.284,P=0.023) and perineal laceration(OR=1.372,P=0.035)were independent risk factors for urinary incontinence at 6 weeks postpartum. Conclusion Urinary incontinence at 6 weeks postpartum is not rare in Chengdu, and stress urinary incontinence is more frequent. Eutocia, elderly parturient, multipara, pelvic surgery history, prenatal obesity, urinary incontinence during pregnancy, large neonatal body mass and perineal laceration are the main risk factors for urinary incontinence at 6 weeks postpartum.