【作者】 王莉；

【导师】 李兆艾；

【作者基本信息】 山西医科大学 ， 妇产科学， 2008， 硕士

【摘要】 目的:本研究通过回顾性问卷调查的方法对初产妇产后早期尿失禁发病情况进行调查,探讨妊娠和不同分娩方式以及与分娩有关的不同产科因素对产后早期尿失禁的发生率及程度的影响,为疾病的预防和治疗提供可靠依据。方法:选择2007年3月至10月在山西省妇幼保健院妇产科分娩产后6～8周复查的初产妇775例,采用回顾性问卷调查方式,采取国际尿失禁咨询委员会尿失禁问卷表和国际女性下尿路症状调查问卷,于产后3天内及产后6～8周复查时进行问卷调查,询问产妇一般情况、孕前、妊娠期及产后42天尿失禁的发病情况和产后下尿路症状。分析不同分娩方式中尿失禁的发生率和程度,及影响尿失禁发生的相关因素。结果:(1) 775例产妇中有60人(7.74%)在产后42天内至少一次出现尿失禁症状。(2)对尿失禁发生的相关因素进行logistic回归分析,发现剖宫产及孕期发生尿失禁为产后发生尿失禁的影响因素。(3)阴道分娩组与剖宫产组尿失禁发生率分别为12.10%(45/372)和3.72%(15/403),阴道分娩组和剖宫产组产后尿失禁发生率有显著差异(P＜0.01)。(4)阴道分娩组中压力性、急迫性和混合性尿失禁的比例分别为10.20%、0.30%和1.60%,剖宫产组中以上3种尿失禁的比例分别为2.73%、0.25%和0.74%。阴道分娩组压力性尿失禁的发生率明显高于剖宫产组(P＜0.01)。在产后尿失禁发生的程度上,轻、中度患者百分比明显高于重度患者(P＜0.05)。(5)尿失禁发生的时间:60例有尿失禁症状的患者中以孕前即有、孕期出现产后仍有症状、产后首次出现症状3种情况分类,其发生率分别为3.33%(2/60)、61.67%(37/60)、38.33%(23/60)。孕前即有尿失禁症状和孕期有尿失禁症状的产妇产后尿失禁发生率均明显高于孕期无尿失禁组,均有极显著性差异(P＜0.01)。(6)阴道分娩组中与产后尿失禁有明显关系的因素有孕期发生尿失禁、孕前存在尿失禁等症状,而与分娩孕周、产前高体重指数、第一产程时间、第二产程时间、会阴裂伤、会阴侧切、新生儿体重、产后增加腹压活动、分娩后下尿路症状、产后哺乳均无明显相关性。(7)剖宫产中影响产后尿失禁的因素有孕期尿失禁的发生和产前体重指数,而与是否临产后剖宫产、新生儿体重、产后增加腹压活动和产后哺乳等无明显相关性。结论:(1)剖宫产和阴道分娩相比具有明显的保护作用,可以显著降低产后6-8周内尿失禁的发生率。(2)阴道分娩组总的尿失禁和压力性尿失禁的发生率明显高于剖宫产组。(3)孕期发生尿失禁和孕前存在尿失禁可增加阴道分娩后尿失禁发生的机率;而孕期发生尿失禁和产前高体重指数可增加剖宫产后尿失禁发生的机率。(4)产后尿失禁以轻、中度为主,加强孕期和产后盆底肌肉训练可以预防和治疗产后尿失禁。更多还原

【Abstract】 Objective: To investigate the morbidity of postpartum urinary incontinence in primiparae by means of questionnaire and to evaluate the effect of different delivery modes and the risk factors in pregnancy and delivery to the prevalence of postpartum urinary incontinence, providing basis to the prevention and treatment of such a desease.Methods: Seven hundred and eighty-nine primipara, delivered from March to October 2007 in our hospital and were followed up 42 days after delivery, were telephone recruited and their symptoms of urinary incontinence before, after and during pregnancy, along with lower urinary tract symptoms after delivery were investigated. The questionnaire was designed according to International Consultant Incontinence and Bristol female lower urinary tract symptom questionnaires. The incidence and degrees of different kinds of postpartum urinary incontinence in connection with difierent ways of delivery and the associated factors were evaluated.Results:(1) 60 of 775 (7.74 %) women complained of urinary leakage at least once after delivery.(2) According to logistic regression, cesarean section and the occurrence of urinary incontinence during pregnancy were associated factors with postpartum urinary incontinence.(3) The incidence of urinary incontinence in spontaneous vaginal and cesarean section delivery was 12.10%(45/372), 3.72%(15/403), and the incidence of postpartum urinary incontinence in spontaneous vaginal delivery was also higher than that of the cesarean section group (P< 0.05).(4) The incidences of stress urinary incontinence, urgent urinary incontinence and mixed urinary incontinence were 10.20%, 0.30% and 1.60% respectively in spontaneous vaginal delivery and 2.73%, 0.25% and 0.74% in cesarean section. The incidence of stress urinary incontinence was higher in vaginal delivery women than in cesarean section women (P<0.05). Severe cases of stress urinary incontinence were more in spontaneous vaginal delivery than in cesarean section(P<0.05). Mild cases of urinary incontinence was higher than severe cases of urinary incontinence women (P<0.05), from the degrees of postpartum urinary incontinence.(5) 3.33% (2/60) women reported urinary inconfinence before pregnancy; 61.67% (37/60) during pregnancy; 38.33%(23/60) after delivery.(6) The risk factor to postpartum urinary incontinence in vaginal delivery was the occurrence of urinary incontinence during pregnancy and urinary incontinence before pregnancy. But the other events, such as pudendal tears, episiotomy, the duration of the first or second period of delivery,fetal weight, increaseing abdominal pressure, lower urinary tract symptoms after delivery andlactation ,were not correlated.(7) The factor that associated with postpartum urinary incontinence in cesarean section was theurinary incontinence during pregnancy and BMI before pregnancy, but not the weight ofnewborn, the cesarean section itself and lactation.Conclusion:(1) Cesarean section is obviously protective to postpartum urinary incontinence than vaginal delivery and can significant decrease the incidence of postpartum urinary incontinence in 6-8 week.(2) The incidence of stress urinary incontinence was higher in vaginal delivery women than in cesarean section women.(3) Occurrence of urinary incontinence before and during pregnancy are significant risk factors of postpartum urinary incontinence in spontaneous vaginal and the urinary incontinence during pregnancy and BMI before pregnancy are significant risk factors of postpartum urinary incontinence in Cesarean section.(4) The symptoms of the most women with postpartum urinary incontinence are mild, Pelvic floor exercise during pregnancy and after delivery is valid to prevent postpartum urinary incontinence.更多还原