经产妇产后早期压力性尿失禁的临床危险因素分析
|
摘要
目的分析经产妇产后早期(6～8周)压力性尿失禁(Stress urinary incontinence, SUI)的临床危险因素。方法回顾性分析于北京大学第三医院2016年1月至2017年10月分娩及产后复查的141例经产妇临床资料,依据尿失禁简表(ICIQ-UI)确诊SUI 81例,非SUI即对照组60例,比较两组的相关危险因素。结果单因素分析显示,与非SUI组相比,经产妇产后早期SUI组的前次阴道分娩和末次阴道分娩比例明显升高(63.2%vs 36.8%,P=0.016;63.3%vs 36.7%,P=0.009)。前次阴道分娩合并会阴侧切和会阴裂伤经产妇发生产后早期SUI比例升高(66.1%vs 33.9%,P=0.014;76.2%vs 23.8%,P=0.009)。末次阴道分娩无会阴侧切或裂伤、合并会阴侧切、合并会阴裂伤三种情况的经产妇产后早期SUI是末次剖宫产分娩的1.6倍、2.0倍以及1.7倍(RR:1.594,P=0.095;RR:1.939,P=0.043;RR:1.723,P=0.014)。末次妊娠时年龄、孕前体质指数、孕期体重增加、新生儿体重、妊娠期糖尿病等因素,在两组之间差异均无统计学意义(P>0.05)。多因素分析显示,末次阴道分娩是经产妇产后早期SUI的独立危险因素(OR=2.939 95%CI:1.232～7.009,P=0.015)。结论末次分娩方式为阴道分娩的经产妇发生产后早期SUI风险明显增加,并及时给予指导和必要的干预。
Objective To evaluate the clinical risk factors of stress urinary incontinence(SUI) 6-8 weeks after delivery in multipara. Methods A retrospective study was used to obtain 141 multipara who have their delivery and subsequent visit in Peking university Third hospital from Jan 2016 to Oct 2017. All of the cases were divided into two groups according to ICIQ-UI, 81 cases with SUI and 60 cases without SUI. The clinical risk factors were compared between the two groups. Result Compared with non-SUI group, the composition of vaginal delivery in previous and latest delivery were higher in SUI group(63.2% vs 36.8%,P =0.016;63.3% vs 36.7%, P =0.009). The risks of early SUI in woman who had vaginal delivery preciously with episiotomy or perineal tear were increased(66.1% vs 33.9%, P=0.014; 76.2% vs 23.8%, P=0.009). The risks of early SUI in woman without episiotomy or perineal tear in the latest vaginal delivery were increased 1.6 times compared with woman with latest caesarean delivery(RR 1.594, P =0.095).For episiotomy and perineal tear, the risks were 2.0 times(RR 1.939, P =0.043) and 1.7 times(RR 1.723, P =0.014). There were no difference in the age of last pregnancy, body mass index before pregnancy, weight gain during pregnancy, newborn weight and diabetes mellitus between two groups(P > 0.05). Multivariate analysis showed vaginal delivery was an independent risk factor of developing early SUI(OR=2.939 95% CI :1.232 ～ 7.009, P =0.015). Conclusion Multipara with vaginal delivery need to take more care about early postpartum SUI and should seek for intervention when necessary.
Objective To evaluate the clinical risk factors of stress urinary incontinence(SUI) 6-8 weeks after delivery in multipara. Methods A retrospective study was used to obtain 141 multipara who have their delivery and subsequent visit in Peking university Third hospital from Jan 2016 to Oct 2017. All of the cases were divided into two groups according to ICIQ-UI, 81 cases with SUI and 60 cases without SUI. The clinical risk factors were compared between the two groups. Result Compared with non-SUI group, the composition of vaginal delivery in previous and latest delivery were higher in SUI group(63.2% vs 36.8%,P =0.016;63.3% vs 36.7%, P =0.009). The risks of early SUI in woman who had vaginal delivery preciously with episiotomy or perineal tear were increased(66.1% vs 33.9%, P=0.014; 76.2% vs 23.8%, P=0.009). The risks of early SUI in woman without episiotomy or perineal tear in the latest vaginal delivery were increased 1.6 times compared with woman with latest caesarean delivery(RR 1.594, P =0.095).For episiotomy and perineal tear, the risks were 2.0 times(RR 1.939, P =0.043) and 1.7 times(RR 1.723, P =0.014). There were no difference in the age of last pregnancy, body mass index before pregnancy, weight gain during pregnancy, newborn weight and diabetes mellitus between two groups(P > 0.05). Multivariate analysis showed vaginal delivery was an independent risk factor of developing early SUI(OR=2.939 95% CI :1.232 ～ 7.009, P =0.015). Conclusion Multipara with vaginal delivery need to take more care about early postpartum SUI and should seek for intervention when necessary.
引文
[1]Haylen BT,de Ridder D,Freeman RM,et al.An International Urogynecological Association(IUGA)/International Continence Society(ICS)joint report on the terminology for female pelvic floor dysfunction[J].Neurourology and urodynamics,2010,29(1):4-20.
[2]Zhang L,Zhu L,Xu T,et al.A Population-based Survey of the Prevalence,Potential Risk Factors,and Symptom-specific Bother of Lower Urinary Tract Symptoms in Adult Chinese Women[J].European urology,2015,68(1):97-112.
[3]Lukacz ES,Santiago-Lastra Y,Albo ME,et al.Urinary Incontinence in Women:A Review[J].JAMA,2017,318(16):1592-1604.
[4]Lin YH,Chang SD,Hsieh WC,et al.Persistent stress urinary incontinence during pregnancy and one year after delivery;its prevalence,risk factors and impact on quality of life in Taiwanese women:An observational cohort study[J].Taiwan J Obstet Gynecol,2018,57(3):340-345.
[5]李旻,石婧,吕秋波,等.再生产妇产后早期盆底肌力受损的多因素分析[J].中华医学杂志,2018,(11):818-822.
[6]Chang S,Chen K,Lin H,et al.Association of mode of delivery with urinary incontinence and changes in urinary incontinence over the first year postpartum[J].Obstetrics and gynecology,2014,123(3):568-577.
[7]林丽莎,黄吴健,宋岩峰,等,分娩方式对产妇早期盆底功能障碍的影响分析[J].实用妇产科杂志,2012,28(9):785-788.
[8]Fritel X,Ringa V,Quiboeuf E,et al.Female urinary incontinence,from pregnancy to menopause:a review of epidemiological and pathophysiologicalíndings[J].Acta obstetricia et gynecologica Scandinavica,2012,91(8):901-910.
[9]Zhu L,Li L,Lang J,et al.Prevalence and risk factors for periand postpartum urinary incontinence in primiparous women in China:a prospective longitudinal study[J].International urogynecology journal,2012,23(5):563-572.
[10]Leijonhufvud A,Lundholm C,Cnattingius S,et al.Risks of stress urinary incontinence and pelvic organ prolapse surgery in relation to mode of childbirth[J]Am J Obstet Gynecol,2011,204(1):70-71.
[2]Zhang L,Zhu L,Xu T,et al.A Population-based Survey of the Prevalence,Potential Risk Factors,and Symptom-specific Bother of Lower Urinary Tract Symptoms in Adult Chinese Women[J].European urology,2015,68(1):97-112.
[3]Lukacz ES,Santiago-Lastra Y,Albo ME,et al.Urinary Incontinence in Women:A Review[J].JAMA,2017,318(16):1592-1604.
[4]Lin YH,Chang SD,Hsieh WC,et al.Persistent stress urinary incontinence during pregnancy and one year after delivery;its prevalence,risk factors and impact on quality of life in Taiwanese women:An observational cohort study[J].Taiwan J Obstet Gynecol,2018,57(3):340-345.
[5]李旻,石婧,吕秋波,等.再生产妇产后早期盆底肌力受损的多因素分析[J].中华医学杂志,2018,(11):818-822.
[6]Chang S,Chen K,Lin H,et al.Association of mode of delivery with urinary incontinence and changes in urinary incontinence over the first year postpartum[J].Obstetrics and gynecology,2014,123(3):568-577.
[7]林丽莎,黄吴健,宋岩峰,等,分娩方式对产妇早期盆底功能障碍的影响分析[J].实用妇产科杂志,2012,28(9):785-788.
[8]Fritel X,Ringa V,Quiboeuf E,et al.Female urinary incontinence,from pregnancy to menopause:a review of epidemiological and pathophysiologicalíndings[J].Acta obstetricia et gynecologica Scandinavica,2012,91(8):901-910.
[9]Zhu L,Li L,Lang J,et al.Prevalence and risk factors for periand postpartum urinary incontinence in primiparous women in China:a prospective longitudinal study[J].International urogynecology journal,2012,23(5):563-572.
[10]Leijonhufvud A,Lundholm C,Cnattingius S,et al.Risks of stress urinary incontinence and pelvic organ prolapse surgery in relation to mode of childbirth[J]Am J Obstet Gynecol,2011,204(1):70-71.