腹直肌分离度、盆底肌力及盆底sEMG参数与初产妇产后压力性尿失禁的关系

Relationship between rectus abdominis separation,pelvic floor muscle strength,and pelvic floor sEMG parameters with postpartum stress urinary incontinence in primiparas

目的分析腹直肌分离度、盆底肌力及盆底表面肌电图(s EMG)参数与初产妇产后压力性尿失禁(SUI)的关系,探讨初产妇产后发生SUI的影响因素,以及腹直肌分离度、盆底肌力及s EMG参数对初产妇产后发生SUI的预测价值。方法选取2022年2月—2023年2月在上海市第一妇婴保健院住院分娩的116例初产妇,根据SUI发生情况分为SUI组(35例)和非SUI组(81例),比较2组产妇腹直肌分离度、盆底肌力及s EMG参数;采用逐步Logistic回归分析初产妇产后SUI发生的影响因素;绘制受试者工作特征(ROC)曲线分析腹直肌分离度、盆底肌力及s EMG参数对产后SUI的预测价值。结果2组产妇年龄、孕周、孕前身体质量指数(BMI)、孕期增体质量、新生儿体质量、有无阴道手术助产比例比较,差异均无统计学意义(P>0.05);SUI组产妇顺产比例高于非SUI组,差异有统计学意义(P<0.05)。SUI组产妇腹直肌分离度大于非SUI组,盆底肌力小于非SUI组,s EMG快速收缩阶段最大值、紧张收缩阶段平均值、紧张收缩阶段变异性、耐力收缩阶段平均值、耐力收缩阶段变异性均小于非SUI组,差异均有统计学意义(P<0.05)。逐步Logistic回归分析结果显示,顺产、腹直肌分离度、盆底肌力、s EMG紧张收缩阶段变异性、耐力收缩阶段平均值均是初产妇产后发生SUI的影响因素(P<0.05)。ROC曲线分析结果显示,腹直肌分离度、盆底肌力、耐力收缩阶段平均值及三者联合检测预测初产妇产后发生SUI的ROC曲线下面积(AUC)分别为0.838、0.874、0.870、0.957(均P<0.05)。结论产后发生SUI的初产妇存在腹直肌分离、盆底肌力及s EMG参数下降,检测腹直肌分离度、盆底肌力及s EMG参数对初产妇产后SUI有一定预测价值。

Objective This study aimed to analyze the relationship between rectus abdominis separation,pelvic floor muscle strength,and pelvic floor surface electromyography(sEMG)parameters with postpartum stress urinary incontinence(SUI)in primiparas.It explores the influencing factors of postpartum SUI and evaluates the predictive value of rectus abdominis separation,pelvic floor muscle strength,and sEMG parameters for postpartum SUI in primiparas.Methods A total of 116 primiparas who delivered at Shanghai First Maternity and Infant Hospital from February 2022 to February 2023 were selected for the study.According to the occurrence of SUI,they were allocated to an SUI group(n=35)and a non-SUI group(n=81).The rectus abdominis separation,pelvic floor muscle strength,and sEMG parameters were compared between the two groups.Stepwise logistic regression was used to analyze the influencing factors for postpartum SUI in primiparas.The receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of rectus abdominis separation,pelvic floor muscle strength,and sEMG parameters for postpartum SUI.Results No statistically significant differences were noted in age,gestational weeks,pre-pregnancy body mass index(BMI),gestational weight gain,neonatal weight,and the proportion of vaginal surgical delivery between the two groups(P>0.05).The proportion of natural deliveries in the SUI group was significantly higher than in the non-SUI group(P<0.05).The SUI group had greater rectus abdominis separation,lower pelvic floor muscle strength,lower maximum value during the fast contraction phase,lower average value during the tense contraction phase,lower variability during the tense contraction phase,lower average value during the endurance contraction phase,and lower variability during the endurance contraction phase of sEMG parameters compared to the non-SUI group,all with statistical significance(P<0.05).Stepwise logistic regression analysis showed that natural delivery,rectus abdominis separation,pelvic floor muscle strength,variability during the tense contraction phase of sEMG,and aver-age value during the endurance contraction phase were influencing factors of postpartum SUI in primiparas(P<0.05).ROC curve analysis indicated that the areas under the ROC curve(AUC)for rectus abdominis separation,pelvic floor mus-cle strength,and average value during the endurance contraction phase,as well as their combined detection,in predicting postpartum SUI in primiparas were 0.838,0.874,0.870,and 0.957,respectively(P<0.05).Conclusion Primiparas with postpartum SUI exhibit rectus abdominis separation,reduced pelvic floor muscle strength,and decreased sEMG pa-rameters.Monitoring rectus abdominis separation,pelvic floor muscle strength,and sEMG parameters has certain predic-tive value for postpartum SUI in primiparas.