盆底超声参数及盆底肌电生理参数与女性产后尿失禁患者病情严重程度的相关性研究

Correlation study between pelvic floor ultrasound parameters,pelvic floor electrophysiological parameters and severity of postpartum stress urinary incontinence in women

目的探究盆底超声参数及盆底肌电生理参数与女性产后尿失禁患者病情严重程度的相关性。方法回顾性将2018年1月至2023年3月在兰州市第一人民医院就诊的215例产后42 d的产妇纳入本次研究,其中压力性尿失禁(SUI)产妇65例,纳入研究组,150例无SUI产妇纳入对照组。研究组产妇根据病情严重程度又分为轻度组(n=25)、中度组(n=22)和重度组(n=18),产妇均接受盆底超声及盆底肌电生理检查,比较各组的盆底超声参数[膀胱尿道后角(PUA)、尿道倾斜角(UTA)、膀胱位置(BDP)、膀胱颈的位置(BNP)、膀胱颈移动度(BND)、尿道旋转角(URA)、肛提肌裂孔面积]及肌电生理参数(前基线平台期平均值、前基线平台期高张情况、Ⅱ类肌纤维收缩期电位平均值、Ⅱ类肌纤维收缩期时间、Ⅱ类肌纤维收缩期分级、后基线平台期平均值、后基线平台期高张情况、Ⅰ类肌纤维收缩期电位平均值、Ⅰ类肌纤维收缩期时间、Ⅰ类肌纤维收缩期分级)。结果研究组静息状态下的PUA、UTA、肌裂孔面积分别为(121.91±15.25)°、(22.89±7.61)°、(16.67±4.05)cm^(2),均显著高于对照组[(77.46±7.57)°、(18.63±6.39)°和(14.35±3.31)cm^(2)],差异均有统计学意义(P<0.05);2组静息状态下的BDP和BNP比较,差异均无统计学意义(P>0.05);研究组最大Valsalva动作状态下的PUA、UTA、URA、肌裂孔面积分别为(168.38±15.99)°、(36.19±10.27)°、(50.06±14.39)°和(18.84±4.10)cm^(2),均显著高于对照组[(85.10±10.37)°、(16.94±5.08)°、(33.50±9.48)°和(14.59±3.75)cm^(2)],最大Valsalva动作状态下的BDP、BNP和BND分别为(2.21±1.03)、(2.40±1.05)和(25.97±6.52)mm,均显著低于对照组[(11.40±5.02)、(11.22±4.41)和(14.50±3.49)mm],差异均有统计学意义(P<0.05)。2组的前基线平台期电位均值、前基线平台期分级、后基线平台期电位均值、后基线平台期分级、Ⅰ类肌纤维收缩期电位均值、Ⅰ类肌纤维收缩期时间和Ⅰ类肌纤维收缩期分级比较,差异均无统计学意义(P>0.05);研究组的Ⅱ类肌纤维收缩期电位均值、收缩期时间、收缩期分级分别为(24.61±3.67)μV、(0.43±0.14)s、(1.70±0.36)级,均显著低于对照组[(30.27±4.21)μV、(0.51±0.13)s、(2.23±0.38)级],差异均有统计学意义(P<0.05)。重度组静息状态和最大Valsalva动作状态的PUA、UTA、肌裂孔面积及Valsalva动作状态的URA、BDP均显著高于中度组,而中度组的上述指标高于轻度组;重度组Valsalva动作状态的BDP、BNP均显著低于中度组,中度组的BDP、BNP均显著低于轻度组,差异均有统计学意义(P<0.05);重度组的Ⅱ类肌纤维收缩期电位均值、收缩期时间、收缩期分级显著低于中度组,而中度组的上述指标显著低于轻度组,差异均有统计学意义(P<0.05)。结论盆底超声检查及肌电生理检查可用于评估SUI患者盆底结构的变化,且相关检查参数与SUI严重程度有一定相关性。

Objective To investigate the correlation between pelvic floor ultrasound parameters,pelvic floor electromyographic parameters,and the severity of postpartum stress urinary incontinence(SUI) in women.Methods A total of 215 postpartum women who visited The First People's Hospital of Lanzhou from January 2018 to March 2023 were included in this study.Of these,65 women with SUI were assigned to the study group,while 150 women without SUI were assigned to the control group.The study group was further divided into the mild group(n=25),the moderate group(n=22),and the severe group(n=18) based on the severity of their condition.All participants underwent pelvic floor ultrasound and electromyographic examinations,and the pelvic floor ultrasound parameters[posterior urethral angle(PUA),urethral tilt angle(UTA),bladder dome position(BDP),bladder neck position(BNP),bladder neck displacement(BND),urethral rotation angle(URA),and levator ani muscle hiatus area] and electromyographic parameters(terms of baseline plateau potential mean,baseline plateau grading,type Ⅱmuscle fiber contraction potential mean,type Ⅱ muscle fiber contraction time,and type Ⅱmuscle fiber contraction grading,post-baseline plateau potential mean,post-baseline plateau grading,type I muscle fiber contraction potential mean,type I muscle fiber contraction time,and type I muscle fiber contraction grading) among the groups were compared.Results In the study group,the resting angles of PUA,UTA,and levator hiatus area were(121.91±15.25)°,(22.89±7.61)°,and(16.67±4.05) cm^(2),which were significantly higher than those in the control group [(77.46±7.57)°,(18.63±6.39)°,and(14.35±3.31) cm^(2)],the differences were statistically significant(P<0.05).There were no statistically significant differences in the resting positions of the BDP and BNP between the two groups(P>0.05).The maximum Valsalva angles of PUA,UTA,URA,and hiatus area in the study group were(168.38±15.99)°,(36.19±10.27)°,(50.06±14.39)°,and(18.84±4.10) cm^(2),respectively,which were significantly higher than those in the control group [(85.10±10.37)°,(16.94±5.08)°,(33.50±9.48)°,and(14.59±3.75) cm^(2)],the differences were statistically significant(P<0.05).The maximum Valsalva BDP,BNP,and BND in the study group were(2.21±1.03),(2.40±1.05),and(25.97±6.52) mm,respectively,which were significantly lower than those in the control group [(11.40±5.02),(11.22±4.41),and(14.50±3.49) mm],the differences were statistically significant(P<0.05).There were no statistically significant differences in the electromyographic parameters between the two groups in terms of baseline plateau potential mean,baseline plateau grading,post-baseline plateau potential mean,post-baseline plateau grading,type I muscle fiber contraction potential mean,type I muscle fiber contraction time,and type I muscle fiber contraction grading(P>0.05).However,the mean potentials,contraction times,and contraction gradings of type Ⅱ muscle fibers in the study group were(24.61±3.67) μV,(0.43±0.14) s,(1.70±0.36) level,respectively,which were significantly lower than those in the control group [(30.27±4.21) μV,(0.51±0.13) s,(2.23±0.38) level],the differences were statistically significant(P<0.05).The resting and maximum Valsalva PUA,UTA,levator hiatus area,and Valsalva URA and BDP in the severe group were significantly higher than those in the moderate group,while those indexs in the moderate group were higher than those in the mild group;the Valsalva BDP and BNP in the severe group were significantly lower than those in the moderate group,and the above indicators in the moderate group were significantly lower than those in the mild group,the differences were statistically significant(P<0.05).The the mean potentials,contraction times,and contraction gradings of type Ⅱ muscle fibers in the severe group were significantly lower than those in the moderate group,while the above indicators in the moderate group were significantly lower than those in the mild group,the differences were statistically significant(P<0.05).Conclusion Pelvic floor ultrasound and electromyographic examinations can be used to evaluate changes in pelvic floor structures in women with SUI,and the related parameters are correlated with the severity of stress urinary incontinence.