留置尿管治疗产后尿潴留发生二次置管的危险因素分析

Risk factors of repeat catheterization in indwelling catheter for postpartum urinary retention

目的探讨留置尿管治疗产后尿潴留(postpartum urinary retention,PUR)拔除尿管后需要再次置管治疗的高危因素。方法选取2017年7月至2019年6月在上海交通大学医学院附属国际和平妇幼保健院阴道分娩后发生PUR的初产妇633例。按照留置导尿管治疗后拔除尿管是否需要二次置管分为两组:二次置管组(51例),治愈582例为对照组。采用单因素和多因素Logistic回归分析各种产科因素与PUR需要二次留置导尿管治疗的相关性。结果在633例阴道分娩后发生PUR的初产妇中,二次置管发生率为8.1%(51/633);二次置管组分娩镇痛率、产后宫腔操作率及产钳助产率均高于对照组,差异有统计学意义(P<0.05);两组产妇年龄、孕前体质量指数(body mass index,BMI)、孕期体质量增加量、产时BMI、第二产程时长、总产程时长、新生儿出生体质量、第一次导尿量、留置尿管时长、是否有会阴裂伤和是否行会阴侧切比较,差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,行镇痛分娩、行产钳助产、行产后宫腔操作的产妇发生PUR二次置管率升高,差异均有统计学意义(P<0.05)。结论留置尿管治疗PUR需要再次置管发生率与分娩镇痛、产钳助产及产后宫腔操作有关。

Objective To investigate risk factors of repeat catheterization for postpartum urinary retention(PUR).Methods 633 primiparous women with PUR after vaginal delivery were recruited from July 2017 to June 2019 in International Peace Maternity and Child Health Hospital.Divided them into two groups according to whether repeat catheterization after removal catheter:51 women who developed repeat catheterization treatment were set as study group,582 women who recovered after one indwelling catheter were set as control group.Univariate and multivariate Logistic regression were used to analyze the correlation between various obstetric factors and the need for secondary indwelling catheterization for PUR.Results Of the 633 participants,8.1%(51/633)had developed repeat catheterization treatment.There were significant differences at epidural analgesia,postpartum intrauterine operation and forceps delivery between the two groups(P<0.05).There were no significant differences at maternal age,BMI before pregnancy,increased body weight during pregnancy,BMI during delivery,duration of the second stage of labor,total length of labor,birth weight of the newborn,volume of first catheterization,length of indwelling catheter,presence of perineal laceration,and presence of perineum between the two groups(P>0.05).Multivariate Logistic regression analysis showed that there was an increase in the rate of PUR and repeat catheterization in women undergoing analgesic delivery,assisted delivery with forceps,and postpartum intrauterine operation(P<0.05).Conclusion Women with epidural analgesia,forceps delivery or intrauterine operation were more prone to develop repeat catheterization in the treatment of PUR.