多种产科因素对产后压力性尿失禁的影响

Effect of different obstetrical factors on postnatal stress urinary incontinence

目的：探讨产科相关因素与产后压力性尿失禁的关系。方法采用国际尿控协会（ICS）推荐的国际尿失禁标准问卷进行填表调查，随机选取718例在河北联合大学附属医院及秦皇岛市妇幼保健院产科分娩的初产妇进行调查，了解其孕期情况，有673例进行了产后复查，分析其产后42 d 左右尿失禁的出现情况。结果（1）产后42 d 左右，673例中有41例（6.09%）发生了尿失禁；尿失禁与分娩方式、胎儿出生体质量、孕前体质量及体质量指数、缩肛运动有关（P 均＜0.05）；（2）发生尿失禁的概率：自然分娩组为7.76%（34/438），选择性剖宫产组为2.97%（7/235），后者明显小于前者（χ2=6.1，P＜0.05）；（3）自然分娩组新生儿出生体质量、孕前体质量和体质量指数与产后尿失禁的发生有关（t 值分别为4.316、2.093、2.654，P 均＜0.05）。结论（1）产后尿失禁较容易出现于阴道分娩；（2）孕前体质量轻的产妇及体质量指数增长少、体质量较低新生儿、产后行缩肛运动者，可减少产后压力性尿失禁的出现；（3）孕期及产后常发生轻度尿失禁，因此这段时间内对盆底肌肉进行加强训练，对预防及治疗产后尿失禁有明显效果。

Objective To investigate the relationship between relevant obstetrical factors and postnatal stress urinary incontinence. Methods Standard questionnaire on international urinary incontinence was applied, which was recommended by International Continence Society(ICS). Seven hundred and eighteen primiparas from the Obstetrical Department of Hebei United University Affiliated Hospital and Qinhuangdao Maternity and Child Care Hospital were randomly selected as our subject and fill out the survey. Six hundred and seventy-three primiparas were re-examined after delivery. Their postnatal situation of urinary incontinence after 42 days was recorded. Results ( 1 )Forty-one( 6. 09% ) primiparas of 673 primiparas were diagnosed with urinary incontinence after 42 days of their parturition. There were relationship between postnatal urinary incontinence with the mode of delivery,fetus body weight,progestational body weight and body mass index,and anal contraction movements(P < 0. 05).(2)The probability of the vaginal delivery group was 7. 76%(34 / 438), higher than that in primiparas with selective cesarean section group(2. 97%(7 / 235);χ2 = 6. 1;P < 0. 05).(3) The postnatal urinary incontinence in vaginal delivery group was closely related with fetus body weight, progestational body weight,body mass index( t = 4. 316,2. 093,2. 654;P < 0. 05). Conclusion (1)The postnatal urinary incontinence is more easily appeared in vaginal delivery.(2)Progestational primiparas with light body weight,fetus with less body weight,and anal contraction movements conducted in the postpartum period,can reduce the probability of postnatal urinary incontinence.(3)Mild urinary incontinence is more likely appeared during pregnancy and in the postpartum period. Therefore,more pelvic floor muscle exercise will have a better effect on preventing and curing postnatal urinary incontinence.