【作者】 刘金凤；

【导师】 叶琳；

【作者基本信息】 吉林大学 ， 公共卫生硕士（专业学位）， 2018， 硕士

【摘要】 目的:通过对在沈阳某医院进行超声检查的产后6周女性的盆底结构进行观察,评估产妇产后早期盆底功能状况,诊断盆底功能障碍性疾病,分析产后早期盆底功能障碍性疾病的影响因素,可为预防盆底功能障碍性疾病的发生、促进已育妇女身心健康提供科学依据。方法:选择2016年7月~2016年12月在沈阳某医院进行盆底超声检查的产后6周女性为研究对象。通过超声检测盆底相关指标,评估产妇产后早期盆底功能状况,并对盆底功能障碍性疾病进行诊断。通过自行设计调查表,收集研究对象的一般资料、生产分娩资料和分娩的新生儿资料等。应用Excel 2010软件建立数据库,使用IBM SPSS24.0软件进行统计分析。正态性计量资料结果以`x±s表示,组间比较采用t检验;计数资料结果以率/构成比表示,组间比较采用c~2检验;并采用多因素Logistic回归分析产妇产后早期盆底功能影响因素。检验水准为α=0.05。结果:1.根据纳入和排除标准,共纳入2016年7月~2016年12月在沈阳某医院进行盆底超声检查的产后6周女性271例。在271名研究对象中,最小年龄21岁,最大年龄45岁,平均年龄为(29.67±3.05)岁;产前平均BMI为(28.05±3.49)kg/m~2;新生儿平均体重(3.68±0.43)kg,平均双顶径(9.47±0.33)cm。2.采用超声评估产妇盆底功能,271名产妇膀胱颈移动度最小移动度为0.44cm,最大移动度为5.98cm,平均测量值为(2.85±1.00)cm;膀胱颈旋转角度,最小旋转度数为2.20°,最大旋转度数为126.62°,平均测量值为(65.05±28.08)°;膀胱尿道后角最小值为93.92°,最大值为212.13°,平均测量值为(160.14±20.39)°,生殖裂口面积最小值为8.12 cm~2,最大值为40.68cm~2,平均面积为(21.14±5.59)cm~2。3.产妇的膀胱颈移动度在阴道分娩组和剖宫产组异常率分别为79.23%和35.94%,膀胱颈旋转角度在阴道分娩组和剖宫产组的异常率分别为95.17%和79.69%,生殖裂口面积在阴道分娩组和剖宫产组的异常率分别为66.18%和32.81%,且差异具有统计学意义(P<0.05)。4.根据临床诊断并结合超声结果,共检出产后盆腔器官脱垂212例,检出率为78.23%,产后压力性尿失禁44例,检出率为16.24%。5.产后压力性尿失禁在阴道分娩组女性和剖宫组产女性中的检出率分别为20.77%和1.56%,差异具有统计学意义(P<0.05)。6.产后压力性尿失禁在产妇年龄<35岁组和≥35岁组的检出率分别为14.75%和29.63%,且差异具有统计学意义(P<0.05);产后盆腔器官脱垂在阴道分娩组女性和剖宫产组女性中的检出率分别是86.47%和51.56%,差异具有统计学意义(P<0.05);新生儿双顶径在产后患盆腔器官脱垂组女性和产后未患盆腔器官脱垂组女性间差异显著,具有统计学意义(P<0.05),产后患盆腔器官脱垂产妇组的新生儿双顶径显著高于未患盆腔器官脱垂组产妇的新生儿双顶径。7.产妇年龄是压力性尿失禁的危险因素(OR=3.541,95%CI:1.312-9.555),剖宫产是产后压力性尿失禁的保护因素(OR=0.050,95%CI:0.007-0.382),是产后盆腔器官脱垂的保护因素(OR=0.100,95%CI:0.048-0.209)。新生儿双顶径是产后盆腔器官脱垂的危险因素(OR=9.209,95%CI:3.027-28.017)。结论:1.本研究271名研究对象盆底结构异常者为260人,膀胱颈移动度异常者187人,占总人数的69.00%,膀胱颈旋转角异常者248人,占总人数的91.51%,膀胱尿道后角异常者136人,占总人数的50.18%,生殖裂口面积异常者158人,占总人数58.30%;阴道分娩对盆底结构影响较大;2.本研究共检出产后盆腔器官脱垂212例,检出率为78.23%;产后压力性尿失禁44例,检出率为16.24%;3.高龄和分娩方式是产妇产后盆底功能障碍性疾病的影响因素;4.新生儿双顶径是产后盆腔器官脱垂的影响因素,随着新生儿双顶径长度增加,POP的发生率也增高。更多还原

【Abstract】 Objective:Collected the basic cases of maternal women 6 weeks and used the perineal ultrasound to observe the structure of female pelvic floor after 6 weeks postpartum to evaluate the early pelvic floor function of the maternal postpartum and to understand the changes in the structure and function of the pelvic floor.Analyze postpartum influencing factors of early pelvic floor function in order to give some advice on prevention strategies and measures for pelvic floor dysfunction diseases and promote the physical and mental health of women who have been educated and provide a scientific basis for improving the quality of life of women.Methods:Six weeks after delivery from July 2016 to December 2016 in a hospital in Shenyang,women who were born after delivery and those who were pregnant before pregnancy were selected as subjects.Detected the pelvic floor related indicators by ultrasound and assessed maternal postpartum pelvic floor function to diagnose pelvic floor dysfunction.Collected the general information of the research subjects,the delivery situation and the newborn data by designing the questionnaire.The database was built by Excel 2010 software and statistical analysis was performed by IBM SPSS 24.0 software.The normal data were tested by t test;the count data were analyzed by chi-square test and the factors affecting pelvic floor function were analyzed by multivariate logistic regression.Test level sets toα=0.05.Results:1.271 women with postpartum 6 weeks of perineal ultrasonography were performed in a hospital in Shenyang from July 2016 to December 2016.Among them,the youngest was 21 years old and the oldest was 45 years old and the average age was(29.67±3.05)years old;the average prenatal BMI index was(28.05±3.49);the average newborn weight was(3.68±0.43)kg and the average neonatal biparietal diameter was(9.47±0.33)cm.2.Perineal ultrasound was used to evaluate maternal pelvic floor function.The minimum bladder neck down distance of 271 cases was 0.44cm,the maximum bladder neck down distance was 5.98cm,and the average measured value was(2.85±1.00)cm.The minimum bladder neck rotation angle was 2.20°,the maximum bladder neck rotation angle was 126.62°,the average measurement value was(65.05±28.08)°.The minimum retro vesical angle was 93.92°,the maximum retro vesical angle was 212.13°,and the average measurement was(160.14±20.39)°.The minimum levator hiatal area was 8.12 cm~2,the maximum levator hiatal area was 40.68 cm~2,and the average area was(21.14±5.59)cm~2.3.The abnormal rate of bladder neck down distance in vaginal delivery group and cesarean section group was 79.23%and 35.94%.The abnormal rate of bladder neck rotation angle in vaginal delivery group and cesarean section group was 95.17%and 79.69%,The abnormal rate of levator hiatal area in the vaginal delivery group and cesarean section group were 66.18%and 32.81%.The all differences were statistically significant(P<0.05).4.According to the clinical diagnosis standards combing with the ultrasound results,212 cases of postpartum pelvic organ prolapse were detected and the detection rate was 78.23%;44 cases of postpartum stress urinary incontinence were detected and the detection rate was 16.24%.5.The detection rates of postpartum stress urinary incontinence in women with vaginal delivery and cesarean section were 20.77%and 1.56%,and the difference was statistically significant(P<0.05).6.The detection rate of postpartum pelvic organ prolapse in vaginal delivery women and cesarean section women was 86.47%and 51.56%,respectively,the difference was statistically significant(P<0.05);there was a significant difference in the incidence of postoperative pelvic organ prolapse in women with pelvic organ prolapse and postpartum pelvic organ prolapse.(P<0.05),the biparietal diameter of neonates with postpartum pelvic organ prolapse was significantly higher than that of neonates who did not have pelvic organ prolapse.7.The age was a risk factor for stress urinary incontinence(OR=3.541,95%CI:1.312-9.555).Cesarean section was a protective factor for postpartum stress urinary incontinence(OR=0.050,95%CI:0.007-0.382),and was also a protective factor for postpartum pelvic organ prolapse(OR=0.100,95%CI:0.048-0.209).Neonatal double-diameter diameter was a risk factor for postpartum pelvic organ prolapse(OR=9.209,95%CI:3.027-28.017).Conclusion:1.According to the pelvic floor ultrasound results,260 people with abnormal structural abnormalities in 271 cases.There were 187 patients with abnormal bladder neck down distance,accounting for 69.00%.There were 248 patients with abnormal bladder neck rotation angles,accounting for 91.51%.There were 136 patients with abnormal retro vesical angle,accounting for 50.18%of the total number.There were158 persons with abnormal levator hiatal area,accounting for 58.30%.Vaginal delivery had a greater impact on the pelvic floor structure.2.212 cases of postpartum pelvic organ prolapse were diagnosed,accounting for78.23%;44 cases of postpartum stress urinary incontinence were diagnosed by perineal ultrasound,accounting for 16.24%.3.The elderly delivery and delivery methods were the influencing factors of PFD.4.Neonatal double-diameter is a influencing factor for the occurrence of postpartum POP.As the length of the neonatal double-diameter increased,the incidence of POP would also increase.更多还原