产科因素对压力性尿失禁的发生及盆底肌力的影响

目的：探讨不同产科因素对压力性尿失禁的发生和盆底肌力的影响。方法采用国际尿控协会推荐的国际尿失禁标准问卷，对701例在新疆医科大学第一附属医院产科分娩并进行产后复查的初产妇进行问卷调查，按分娩方式分为阴道妥娩组（161例）和选择性剖宫产组（540例），了解其孕期及产后6 w 尿失禁的发生情况，并测定盆底肌肉收缩及舒张功能，分析与尿失禁发生及影响盆底肌力有关的产科因素。结果701例产妇中有42例（5．99％）在产后6 w 左右出现了尿失禁症状；产后尿失禁的发生与分娩方式、新生儿体质量、孕前体质量、体质指数相关（P ＜0．05）；阴道分娩组、选择性剖宫产组的尿失禁发生率分别为11．18％（18/161）、4．44％（24/540），两组差异有统计学意义（P ＜0．05）；阴道分娩组中与产后尿失禁发生有关的因素有新生儿体质量、孕前体质量和体质指数（P ＜0．05），而与孕周、年龄、第二产程时间均无明显相关性。阴道分娩组的产后盆底肌力检测数值低于选择性剖宫产组，差异有统计学意义（P ＜0．05）。结论阴道分娩、新生儿体质量、孕前体质量、体质指数增加与产后压力性尿失禁的发生有关；阴道分娩、选择性剖宫产2种分娩方式均影响产后盆底肌力，阴道分娩可以明显降低产后盆底肌力。

Effect of obstetrics factors on stress urinary incontinence and pelvic floormuscle strength

Objective To explore the effect of different delivery methods on the stress urinary incontinence and the pelvic floormuscle strength in the early postpartum.Methods 701 primipara who had their child-birth in our hospital were interviewed at 6 weeks postpartum and fulfilled questionair survey of IQ-FLUTS and determined the pelvic floormuscle strength by modified Oxford scale.A analysis were made by comparing among obstetric factors in orde to evaluate the risk factors of SUI and the pelvic floormuscle strength. Results 701 example parturient women had 42 people （5.99%）having the urine incontinence symptom about postnatal 42 days;The postnatal urine incontinence′s occurrence and the childbirth way,the new-born body weight,are pregnant the precursor to be heavy,the body weight index,shrinks the anus exercise related （P ＆lt;0.05）;the vagina delivery group,the selective csection group′s urine incontinence for-mation rate respectively is 11.18%（18/161）,4.44%（24/540）,two groups of between comparisons has the difference （P〈0.05）;in the vagina delivery group has the obvious relational factor with the post-natal u-rine incontinence to have the newborn body weight,to be pregnant the precursor to be heavy and body weight index （P 〈0.05）.Conclusion Vaginal delivery,birth weight,prepregnancy weight,body mass index increases were associated with postpartum stress urinary incontinence;Two delivery methods both impacting on early postpartum pelvic floormuscle strength,vaginal delivery can significantly reduce postpartum pelvic floor muscle strength.