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目的:探讨不同分娩方式及产科相关因素对产后压力性尿失禁(SUI)的影响。方法:应用经会阴超声成像技术,测量135例产后15周内初产妇的膀胱颈活动度及尿道旋转角度,分析剖宫产和经阴道分娩后SUI的发生情况,Logistic多因素分析分娩方式及产科相关因素对SUI的影响。结果:135例入选产妇中阴道分娩组70例,剖宫产组65例,两组年龄、分娩孕周、胎儿体重以及孕妇BMI差异均无统计学意义(P>0.05)。阴道分娩组SUI发生率为25.7%,剖宫产组SUI发生率为10.8%,两组比较差异有统计学意义(χ2=4.989,P=0.026)。在产后6、10和15周,阴道分娩组膀胱颈活动度及尿道旋转角度大于剖宫产组,差异均有统计学意义(P<0.05)。Logistic回归分析显示,阴道分娩、产前SUI、产钳助产、会阴撕裂、急产史、饮酒、雌激素治疗、子宫脱垂这8个风险因素与产后SUI相关,其中阴道分娩(OR=3.215,P=0.037),子宫脱垂(OR=4.013,P=0.032)是产后SUI的独立危险因素。结论:与剖宫产相比,阴道分娩增加产后SUI的发生率。阴道分娩以及子宫脱垂是SUI的独立危险因素。
Objective: To investigate the effects of different modes of delivery and obstetric related factors on postpartum stress urinary incontinence (SUI). Methods: Perineal ultrasound imaging was used to measure the activity of the bladder neck and urethral rotation in 135 cases of primiparous women within 15 weeks after delivery. The incidence of SUI after cesarean section and vaginal delivery was analyzed. Logistic multivariate analysis was performed on the modes of delivery and obstetrics The impact of related factors on SUI. Results: Seventy-five cases of vaginal delivery and 65 cases of cesarean section were enrolled in this study. There was no significant difference in age, birth gestational age, fetal weight and pregnant women’s BMI between the two groups (P> 0.05). The incidence of SUI in vaginal delivery group was 25.7%, and the incidence of SUI in cesarean section group was 10.8%. There was significant difference between the two groups (χ2 = 4.989, P = 0.026). At 6, 10 and 15 weeks postpartum, the bladder neck activity and the urethral rotation angle in the vaginal delivery group were greater than those in the cesarean section group, with significant differences (P <0.05). Logistic regression analysis showed that 8 risk factors of vaginal delivery, prenatal SUI, forceps midwifery, perineal tear, history of acute birth, alcohol consumption, estrogen treatment and uterine prolapse were related to postpartum SUI, including vaginal delivery (OR = 3.215 , P = 0.037). Uterine prolapse (OR = 4.013, P = 0.032) was an independent risk factor for postpartum SUI. Conclusions: Compared with cesarean section, vaginal delivery increases the incidence of SUI. Vaginal delivery and uterine prolapse are independent risk factors for SUI.