产后压力性尿失禁发生风险预测因素的综合分析
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摘要
目的评估产后引起压力性尿失禁(stress urinary incontinence,SUI)的风险因素。方法方便抽样选取上海市某三级甲等医院产后6～8周复查时患有SUI的产妇126例,同法选择同期复查时无SUI的产妇150例作为对照组。通过病历资料及国际尿失禁咨询委员会尿失禁问卷表(International Consultation on Incontinence questionnaire short-form,ICIQ-SF)收集数据并进行分析。结果产妇顺产、胎儿体重较重和胎儿头顶径较大的产妇发生产后SUI的比例较高。多元逻辑回归结果显示是否顺产和胎儿体重是产妇产后发生SUI的独立预测因素(P<0.05)。将患者根据分娩方式进行亚组分析,结果显示:胎儿体重是剖宫产产妇发生产后SUI的独立预测因素(P<0.05),产妇年龄和胎儿头顶径是顺产产妇发生产后SUI的独立预测因素(P<0.05)。结论产后患者引起压力性尿失禁的风险因素众多。医护人员应针对不同人群的风险因素,实施有针对性的健康宣教,以预防产后压力性尿失禁的发生。
Objective To investigate the predicting factors of postpartum stress urinary incontinence(SUI).Methods By convenience sampling method, 126 parturients from a hospital in Shanghai who had SUI during 6-8 weeks postpartum were selected, and 150 women who had no SUI during the same period were selected as control group. Data were collected from the medical records and by the international consultation on incontinence questionnaire short-form.Results The incidence of postpartum SUI was higher among parturients with spontaneous delivery, heavy fetal weight and large fetal head diameter. Multivariate logistic regression showed that spontaneous delivery and fetal weight were independent predictors of postpartum SUI(P<0.05). The results showed that fetal weight was an independent predictor of postpartum SUI in cesarean section women(P<0.05); age and fetal head diameter were independent predictors of postpartum SUI in spontaneous delivery women(P<0.05).Conclusions There are many risk factors for postpartum patients with SUI. To prevent the occurrence of postpartum SUI, specific health education should be carried out according to the risk factors of different groups of people.
Objective To investigate the predicting factors of postpartum stress urinary incontinence(SUI).Methods By convenience sampling method, 126 parturients from a hospital in Shanghai who had SUI during 6-8 weeks postpartum were selected, and 150 women who had no SUI during the same period were selected as control group. Data were collected from the medical records and by the international consultation on incontinence questionnaire short-form.Results The incidence of postpartum SUI was higher among parturients with spontaneous delivery, heavy fetal weight and large fetal head diameter. Multivariate logistic regression showed that spontaneous delivery and fetal weight were independent predictors of postpartum SUI(P<0.05). The results showed that fetal weight was an independent predictor of postpartum SUI in cesarean section women(P<0.05); age and fetal head diameter were independent predictors of postpartum SUI in spontaneous delivery women(P<0.05).Conclusions There are many risk factors for postpartum patients with SUI. To prevent the occurrence of postpartum SUI, specific health education should be carried out according to the risk factors of different groups of people.
引文
[1] HAYLEN B T,MAHER C F,BARBER M D,et al.An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP)[J].Internat Urogynecol J,2016,27(2):165-194.
[2] 洪静娟,向丽娟.不同分娩方式对产后压力性尿失禁的影响[J].中国妇幼保健,2012,27(12):3236-3302.
[3] MILSOM I,ALTMAN D,CARTWRIGHT R,et al.Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS),pelvic organ prolapse (POP) and anal incontinence (AI).Epidemiology of Urinary Incontinence[M].London:Springer,2009:3-13.
[4] KISSLER K,YOUNT S M,RENDEIRO M,et al.Primary prevention of urinary incontinence:a case study of prenatal and intrapartum interventions[J].J Midwifery Womens Health,2016,61(4):507-511.
[5] DUMOULIN C,HAY-SMITH E,J,MAC HABEE-S’ EGUIN G.Pelvic floor muscle training versus no treatment,or inactive control treatments,for urinary incontinence in women[J].Cochrane Database Syst Rev,2014,5:CD005654.
[6] TERNENT L,VALE L,BUCKLEY B,Glazener C.Measuring outcomes of importance to women with stress urinary incontinence[J].BJOG,2009,116(5):719-725.
[7] 闫鹏飞.TVT-A治疗女性压力性尿失禁临床分析[M].长春:吉林大学,2015:10-12.
[8] FRITEL X,FAUCONNIER A,LEVET C,et al.Stress urinary incontinence 4 years after the first delivery:a retrospective cohort survey[J].Acta Obstet Gynecol Scand,2004,83(10):941-945.
[9] MEMON H,HANDA V L.Pelvic floor disorders following vaginal or cesarean delivery[J].Curr Opin Obstet Gynecol,2012,24(5):349-354.
[10]CHALIHA C.Postpartum pelvic floor trauma[J].Curr Opin Obstet Gynecol,2009,21(6):474-479.
[11]GILL B C,MOORE C,DAMASER MS.Postpartum stress urinary incontinence:lessons from animal models[J].Expert Rev Obstet Gynecol,2010,5(5):567-580.
[12]SOLANS-DOMENECH M,S ` ANCHEZ E,ESPU ′ NA-PONS M,et al.Urinary and anal in-continence during pregnancy and postpartum:incidence,severity,and risk factors[J].Obstet Gynecol,2010,115(3):618-628.
[13]HVIDMAN L,HVIDMAN L,FOLDSPANG A,et al.Correlates of urinary incontinence in pregnancy[J].Internat Urogynecol J,2002,13(5):278-283.
[14]KOKABI R,YAZDANPANAH D.Effects of delivery mode and sociodemographic factors on postpartum stress urinary incontinency in primipara women:a prospective cohort study[J].J Chin Med Assoc,2017,80(8):498-502.
[15]LEROY LDA S,LUCIO A,LOPES M H.Risk factors for postpartum urinary incontinence[J].Rev Esc Enferm USP,2016,50(2):200-207.
[16]Ebbesen M H,Hunskaar S,Rortveit G,et al.Prevalence,incidence and remission of urinary incontinence in women:longitudinal data from the Norwegian HUNT study (EPINCONT)[J].BMC Urol,2013:13-27.
[17]TAHTINEN R M,CARTWRIGHT R,TSUI J F,et al.Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence:a systematic review and meta-analysis[J].Eur Urol,2016,70(1):148-158.
[18]ABDULLAH B,AYUB S H,MOHD ZAHID A Z,et al.Urinary incontinence in primigravida:the neglected pregnancy predicament[J].Eur J Obstet Gynecol Reprod Biol,2016,198:110-115.
[19]TAHTINEN R M,CARTWRIGHT R,TSUI J R,et al.Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence:a systematic review and meta-analysis[J].Euro Urol,2016,70(1):148-158.
[20]KOKABI R,YAZDANPANAH D.Effects of delivery mode and sociodemographic factors on postpartum stress urinary incontinency in primipara women:a prospective cohort study[J].J Chin Med Assoc,2017,80(8):498-502.
[21]李小平,王晓丽.产妇产后尿失禁相关因素与临床防治的相关研究[J].中国医药科学,2014,4(24):51-53.
[22]谌晓梅.初产妇产后尿失禁相关因素分析[J].中国当代医药,2011,18(6):155-156.
[23]KISSLER K,YOUNT S M,RENDEIRO M,et al.Primary prevention of urinary incontinence:a case study of prenatal and intrapartum interventions[J].J Midwifery Womens Health. 倓2016,61(4):507-511.
[24]FALCONER C,EKMAN G,MALMSTROM A,et al.Decreased collagen synthesis in stress incontinent women[J].Obstet Gynecol,1994,84:583-586.
[2] 洪静娟,向丽娟.不同分娩方式对产后压力性尿失禁的影响[J].中国妇幼保健,2012,27(12):3236-3302.
[3] MILSOM I,ALTMAN D,CARTWRIGHT R,et al.Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS),pelvic organ prolapse (POP) and anal incontinence (AI).Epidemiology of Urinary Incontinence[M].London:Springer,2009:3-13.
[4] KISSLER K,YOUNT S M,RENDEIRO M,et al.Primary prevention of urinary incontinence:a case study of prenatal and intrapartum interventions[J].J Midwifery Womens Health,2016,61(4):507-511.
[5] DUMOULIN C,HAY-SMITH E,J,MAC HABEE-S’ EGUIN G.Pelvic floor muscle training versus no treatment,or inactive control treatments,for urinary incontinence in women[J].Cochrane Database Syst Rev,2014,5:CD005654.
[6] TERNENT L,VALE L,BUCKLEY B,Glazener C.Measuring outcomes of importance to women with stress urinary incontinence[J].BJOG,2009,116(5):719-725.
[7] 闫鹏飞.TVT-A治疗女性压力性尿失禁临床分析[M].长春:吉林大学,2015:10-12.
[8] FRITEL X,FAUCONNIER A,LEVET C,et al.Stress urinary incontinence 4 years after the first delivery:a retrospective cohort survey[J].Acta Obstet Gynecol Scand,2004,83(10):941-945.
[9] MEMON H,HANDA V L.Pelvic floor disorders following vaginal or cesarean delivery[J].Curr Opin Obstet Gynecol,2012,24(5):349-354.
[10]CHALIHA C.Postpartum pelvic floor trauma[J].Curr Opin Obstet Gynecol,2009,21(6):474-479.
[11]GILL B C,MOORE C,DAMASER MS.Postpartum stress urinary incontinence:lessons from animal models[J].Expert Rev Obstet Gynecol,2010,5(5):567-580.
[12]SOLANS-DOMENECH M,S ` ANCHEZ E,ESPU ′ NA-PONS M,et al.Urinary and anal in-continence during pregnancy and postpartum:incidence,severity,and risk factors[J].Obstet Gynecol,2010,115(3):618-628.
[13]HVIDMAN L,HVIDMAN L,FOLDSPANG A,et al.Correlates of urinary incontinence in pregnancy[J].Internat Urogynecol J,2002,13(5):278-283.
[14]KOKABI R,YAZDANPANAH D.Effects of delivery mode and sociodemographic factors on postpartum stress urinary incontinency in primipara women:a prospective cohort study[J].J Chin Med Assoc,2017,80(8):498-502.
[15]LEROY LDA S,LUCIO A,LOPES M H.Risk factors for postpartum urinary incontinence[J].Rev Esc Enferm USP,2016,50(2):200-207.
[16]Ebbesen M H,Hunskaar S,Rortveit G,et al.Prevalence,incidence and remission of urinary incontinence in women:longitudinal data from the Norwegian HUNT study (EPINCONT)[J].BMC Urol,2013:13-27.
[17]TAHTINEN R M,CARTWRIGHT R,TSUI J F,et al.Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence:a systematic review and meta-analysis[J].Eur Urol,2016,70(1):148-158.
[18]ABDULLAH B,AYUB S H,MOHD ZAHID A Z,et al.Urinary incontinence in primigravida:the neglected pregnancy predicament[J].Eur J Obstet Gynecol Reprod Biol,2016,198:110-115.
[19]TAHTINEN R M,CARTWRIGHT R,TSUI J R,et al.Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence:a systematic review and meta-analysis[J].Euro Urol,2016,70(1):148-158.
[20]KOKABI R,YAZDANPANAH D.Effects of delivery mode and sociodemographic factors on postpartum stress urinary incontinency in primipara women:a prospective cohort study[J].J Chin Med Assoc,2017,80(8):498-502.
[21]李小平,王晓丽.产妇产后尿失禁相关因素与临床防治的相关研究[J].中国医药科学,2014,4(24):51-53.
[22]谌晓梅.初产妇产后尿失禁相关因素分析[J].中国当代医药,2011,18(6):155-156.
[23]KISSLER K,YOUNT S M,RENDEIRO M,et al.Primary prevention of urinary incontinence:a case study of prenatal and intrapartum interventions[J].J Midwifery Womens Health. 倓2016,61(4):507-511.
[24]FALCONER C,EKMAN G,MALMSTROM A,et al.Decreased collagen synthesis in stress incontinent women[J].Obstet Gynecol,1994,84:583-586.