健康产妇早期盆底功能障碍危险因素的logistic回归分析

Logistic regression analysis of risk factors of early pelvic floor dysfunction in healthy maternal women

目的:探讨影响健康产妇早期盆底功能障碍的危险因素。方法:采用Glazer方案对2018年1月至2019年7月在重庆市妇幼保健院就诊的产后6~8周健康产妇进行盆底功能评估,对可能的影响因素进行单因素及多因素logistic回归分析。结果:与剖宫产相比,阴道分娩(包括非阴道助产及阴道助产)在前、后静息阶段肌肉过度活跃风险明显降低(P=0.000),但阴道分娩时快肌肌力、慢肌肌力与耐力受损风险明显增加(P=0.000);与婴儿出生体质量≥4000 g相比,婴儿体质量<4000 g的产妇快肌受损风险明显降低(P=0.004);与分娩时会阴肌肉损伤的产妇相比,会阴肌肉无损伤产妇快肌受损风险明显降低(OR=0.815,95%CI=0.683~0.973)。结论:剖宫产或阴道分娩均可能引起产后早期盆底功能障碍,剖宫产对盆底肌无明显保护作用;婴儿出生体质量及分娩时会阴肌肉有无损伤是导致早期盆底功能障碍的独立影响因素。

Objective:To explore the risk factors of early pelvic floor dysfunction(PFD)in healthy maternal women.Methods:Glazer protocol was used to evaluate the pelvic floor function of the healthy puerpera who came to Chongqing Health Center for Women and Children from January 2018 to July 2019,and logistic regression analysis of single factor and multi factor was conducted to analyze the possible risk factors.Results:Compared with cesarean section,the risks of pelvic floor overactivity in vaginal delivery(with or without aspirator or forceps)were significantly lower in the pre and post rest stage(P=0.000),but the risks of fast muscle strength,slow muscle strength and endurance damage were significantly increased in vaginal delivery(P=0.000);compared with women with fetal birth weight≥4000 g,the risk of fast muscle damage in women with infant birth weight less than 4000 g was significantly lower(P=0.004);compared with women with perineum muscle damage in childbirth,the risk of fast muscle damage in women without perineum muscle damage was significantly lower(OR=0.815,95%CI=0.683-0.973).Conclusion:Cesarean section or vaginal delivery may cause early postpartum pelvic floor dysfunction,and cesarean section has no obvious protective effect on pelvic floor muscle.Infant overweight and perineum muscle damage during delivery are also independent factors leading to early pelvic floor dysfunction.