孕产妇体重指数、新生儿体重与盆底功能障碍性疾病的相关性

Relationship between maternal body mass,neonatal weight and pelvic floor dysfunction

目的分析影响盆底功能障碍性疾病的因素,比较孕产妇孕前、产前不同水平体重指数(BMI)及新生儿体重对盆底功能的影响。方法收集2019年7月~2020年1月中国医科大学附属盛京医院行盆底产后功能检查的210例足月产后产妇的临床资料进行分析,统计盆底状况、肌力、脱垂和压力尿失禁情况。对产后跟踪3次复查的100例患者进行多因素分析,评估其产后3、6个月的盆底肌力恢复情况。结果产前BMI、增重、胎儿体重、出生方式对盆底肌有显著影响;胎次、年龄对盆底肌的影响不显著,差异无统计学意义(P>0.05);分别以动态压力、Ⅰ类肌力、Ⅱ类肌为因变量,单因素分析显著性<0.1的因素作为自变量进行多因素回归分析,结果显示,出生方式对动态压力有显著影响,新生儿体重对Ⅰ类肌肌力有负向影响,产前BMI对Ⅰ、Ⅱ类肌肌力有显著负向影响(P<0.05)。单因素分析中,对各组盆底肌功能比较发现,出生方式对漏尿的影响差异有统计学意义(χ^(2)=1.997,P=0.048)。以漏尿为因变量,单因素分析显著性<0.1的因素(孕前BMI,产前BMI、出生方式)作为自变量进行回归分析,结果显示出生方式(β=0.151,P=0.029)的回归模型显著;单因素分析结果中,增重、胎儿体重和出生方式对盆底肌功能的影响差异有统计学意义,电刺激治疗有显著正相影响(P<0.05)。以产后3个月复查病例的动态压力、Ⅰ类肌肌力为因变量,单因素分析显著性<0.1的因素作为自变量进行多因素回归分析,结果显示,出生方式、治疗分别对产后3个月的动态压力、Ⅰ类肌肌力有显著影响,差异有统计学意义(P<0.05);以产后6个月复查病例的动态压力、Ⅰ类肌肌力、Ⅱ类肌肌力为因变量,单因素分析显著性<0.1的因素作为自变量进行多因素回归分析,结果显示,新生儿体重、产前BMI对盆底肌肌力有显著负向影响,治疗能有效提高快慢肌纤维肌力。结论产前BMI、孕期增重、新生儿体重和出生方式对盆底功能性障碍疾病有显著影响。

Objective To analyze the influencing factors of pelvic floor dysfunction,and to compare the influence of different levels of body mass index(BMI)of maternal pre-pregnancy,antenatal and neonatal weight on pelvic floor function.Methods The clinical data of 210 full-term postpartum women who underwent pelvic floor function examination in Shengjing Hospital Affiliated to China Medical University from July 2019 to January 2020 were collected and analyzed.Pelvic floor condition,muscle strength,prolapse and stress urinary incontinence were recorded.Multivariate analysis was performed on 100 patients who were followed up for 3 times after delivery,and their pelvic floor muscle strength was assessed at 3 and 6 months postpartum.Results Prenatal BMI,weight gain,fetal weight and birth mode had significant influence on pelvic floor muscle,there were no significant influence in the influence of birth mode and age on pelvic floor muscle(P>0.05).Dynamic pressure,typeⅠmuscle strength and typeⅡmuscle strength were used as dependent variables,and the factors with significance less than 0.1 in univariate analysis were used as independent variables for multivariate regression analysis,the results showed that birth mode had a significant impact on dynamic stress,neonatal weight had a negative impact on typeⅠmuscle strength,and prenatal BMI had a significant negative impact on typeⅠandⅡmuscle strength(P<0.05).In univariate analysis,the comparison of pelvic floor muscle function in each group showed that the influence of birth style on urinary leakage was statistically significant(χ^(2)=1.997,P=0.048).With urinary leakage as the dependent variable,univariate analysis showed that the factors with significance<0.1(pre pregnancy BMI,prenatal BMI,birth style)were used as independent variables for regression analysis,the results showed that the birth mode was not the same(β=0.151,P=0.029).In univariate analysis,the influence of weight gain,fetal weight and birth mode on pelvic floor muscle function were statistically significant,and electrical stimulation therapy had a significant positive effect(P<0.05).The dynamic pressure and typeⅠmuscle strength of the patients who were reexamined 3 months after delivery were taken as dependent variables,and the factors with significance less than 0.1 in univariate analysis were taken as independent variables for multivariate regression analysis,the results showed that birth mode and treatment had significant effects on dynamic pressure and typeⅠmuscle strength at 3 months postpartum(P<0.05).The dynamic pressure,classⅠmuscle strength and classⅡmuscle strength of the patients who were reexamined 6 months after delivery were taken as dependent variables,and the factors with significance less than 0.1 in univariate analysis were taken as independent variables for multivariate regression analysis,the results showed that neonatal weight and prenatal BMI had significant negative influence on pelvic floor muscle strength,and treatment could effectively improve the fast and slow muscle fiber strength.Conclusion Prenatal BMI,weight gain during pregnancy,neonatal weight and birth mode have significant influence on pelvic floor dysfunction.