产前尿动力学改变及其对产后盆底功能障碍及尿失禁相关性研究

Study on the correlation of prenatal urodynamic changes with postpartum pelvic floor dysfunction and urinary incontinence

目的浅析产前尿动力学改变和产后出现盆底功能障碍性疾病(PFD)及尿失禁患者的相关性。方法选取2019年8月至2020年8月广东医科大学附属惠东医院收治的分娩后产妇200例,所有患者行产前尿动力学检测,根据产妇有无产后PFD及尿失禁进行分组比较,未出现PFD及尿失禁的产妇100例设为对照组,出现PFD及尿失禁的患者100例设为观察组;比较两组产前尿动力学相关指标的变化,分析产前尿动力学改变与PFD、尿失禁之间的相关性。结果产前,两组尿动力学相关检测指标、尿道压相关指标比较,差异无统计学意义(P>0.05);产后,观察组膀胱的初感容积较对照组更高,差异无统计学意义(P>0.05)。观察组最大膀胱的容量与最大尿流率均显著低于对照组,差异有统计学意义(P<0.05)。观察组功能性尿道长度(FUL)指标低于对照组,观察组最大尿道压(MUP)高于对照组,差异无统计学意义(P>0.05)。观察组腹压漏尿点压(ALPP)与最大尿道的关闭压(MUCP)指标皆明显高于对照组,差异有统计学意义(P<0.05)。经Person单因素分析,产前尿动力学改变与尿失禁、PFD发生均呈正相关(r=0.431、0.441,P<0.05)。结论产前尿动力学改变与尿失禁、PFD呈正相关,通过ALPP与MUCP指标能有效判断患者尿失禁的程度。

Objective To analyze the correlation of prenatal urodynamic changes with the development of postpartum pelvic floor dysfunction(PFD)and urinary incontinence.Methods A total of 200 postpartum women who were admitted to Affiliated Huidong Hospital of Guangdong Medical University from August 2019 to August 2020 and underwent prenatal urodynamic testing were selected as study subjects.They were grouped to conduct comparison according to the presence or absence of postpartum PFD and urinary incontinence,with 100 postpartum women not developing postpartum PFD and urinary incontinence included in the control group and 100 postpartum women developing postpartum PFD and urinary incontinence included in the observation group for further study.The changes in prenatal urodynamic indexes were compared between the two groups,and the correlation of prenatal urodynamic changes with postpartum PFD and urinary incontinence was analyzed.Results Before delivery,there were no statistically significant differences between the two groups in terms of urodynamics-related test indexes and urethral pressure-related indexes(P>0.05).After delivery,the initial sensory volume of bladder filling in the observation group was higher than that in the control group,with no statistically significant differences(P>0.05).The maximum bladder volume and maximum urinary flow rate of the observation group were significantly lower than those of the control group,with statistically significant differences(P<0.05).The index of functional urethral length(FUL)in the observation group was lower than that in the control group,and the maximal urethral pressure(MUP)in the observation group was higher than that in the control group,with no statistically significant differences(P>0.05).The abdominal leak point pressure(ALPP)and maximal urethral closure pressure(MUCP)in the observation group were significantly higher than those in the control group,with statistically significant differences(P<0.05).The Person’s univariate analysis showed that prenatal urodynamic changes were positively correlated with the development of postpartum urinary incontinence and PFD(r=0.431,0.441,P<0.05).Conclusion Prenatal urodynamic changes are positively correlated with postpartum urinary incontinence and PFD,and the degree of urinary incontinence in patients could be effectively determined by ALPP and MUCP indexes.