会阴裂伤初产妇产后12个月内肛门失禁状况分析

Study on Anal Incontinence of Primiparous Women with Perineal Laceration within 12 Months Postpartum

目的探讨会阴裂伤对初产妇产后12个月肛门失禁(AI)的影响。方法采用前瞻性研究的方法,收集2015年4月—2020年12月住院分娩的初产妇804例,在产后12个月对其进行随访调查。根据AI发病状况分为AI组和非AI组,对比分析2组女性的一般资料和肛管压力。采用logistic回归分析探讨影响女性AI发病的相关因素;采用受试者工作特征(ROC)曲线分析探讨对应的影响因素对初产妇AI发病的预测效能。结果妊娠期间AI、会阴裂伤、肛门外括约肌(EAS)单纯损伤、肛门内括约肌(IAS)单纯损伤、EAS和IAS复合损伤、肛管平均静息压低、肛管最大收缩压低、真空辅助阴道分娩、肥胖等9个因素是初产妇AI的危险因素。9个因素联合预测初产妇AI发病的效能:曲线下面积(AUC)为0.896,95%CI为0.837~0.947,灵敏度为0.905,特异度为0.894。结论会阴裂伤是女性产后12个月AI发病的独立危险因素,裂伤程度与AI程度密切关联,其趋势显著。会阴裂伤程度等9个因素联合预测初产妇AI发病的效能很高。

Objective To explore the influence of perineal laceration on anal incontinence(AI)of primiparous women 12 months after delivery.Methods Using the method of prospective research,804 cases of primiparous women who gave birth in hospitals from April 2015 to December 2020 were collected,and a follow-up survey was conducted 12 months after delivery.According to the incidence of AI,participants were divided into AI group and non-AI group,and the general data and anal canal pressure of individuals in the two groups were compared and analyzed.Logistic regression analysis was used to explore the related factors affecting the incidence of AI in women.ROC analysis was used to explore the predictive efficacy of the corresponding influencing factors on the incidence of AI in primiparous women.Results During pregnancy,anal incontinence,perineum laceration,simple injury of external anal sphincter(EAS),simple injury of internal anal sphincter(IAS),combined injury of EAS and IAS,low average resting pressure of anal canal,and low maximum contraction pressure of anal canal,vacuum-assisted vaginal delivery,obesity were the nine risk factors of AI in primiparous women.The combined prediction of nine factors,including perineal laceration degree,was highly effective in predicting the onset of AI in primiparous women with AUC of 0.896,95%CI of 0.837 to 0.947,a sensitivity of 0.905 and a specificity of 0.894.Conclusion Perineal laceration was an independent risk factor for the onset of AI 12 months after delivery.The degree of perineal laceration was closely related to the degree of AI in women,and its trend was significant.