| 摘要: |
| 目的分析初产妇产后早期盆底肌张力状况，探讨初产妇产后压力性尿失禁（stress urinary incontinence, SUI）的发生率及其危险因素，并构建初产妇产后压力性尿失禁的预测模型。方法选取所有于2020年6月1日—2021年5月31日在上海交通大学医学院附属国际和平妇幼保健院行产后盆底功能检测的初产妇为研究对象，收集所有研究对象的一般临床资料，包括年龄、孕次、孕前体质量指数、分娩方式、第二产程时间、新生儿体质量等。将研究对象分为产后压力性尿失禁组(SUI组)及非产后压力性尿失禁组（非SUI组），采用卡方检验进行产后压力性尿失禁的单因素分析，单因素分析有统计学意义的危险因素带入Logistic多因素回归模型分析产后压力性尿失禁的独立危险因素。根据Logistic回归分析得出的独立危险因素，构建产后压力性尿失禁的预测模型，并绘制该预测模型的受试者工作曲线（ROC曲线）。结果1 600例研究对象中，SUI组336例，非SUI组1 264例，初产妇产后压力性尿失禁的发生率为21.0%；（2） SUI组的盆底肌张力低于非SUI组，差异有统计学意义（P＜0.05）；卡方检验的单因素分析显示，年龄、孕次、孕前体质量指数、孕期体质量增长、孕期尿失禁、阴道分娩、第二产程时间、新生儿体质量是SUI的危险因素，差异有统计学意义（P＜0.05）；单因素分析的危险因素纳入Logistic回归模型，分析结果显示，年龄≥35岁、孕前体质量指数≥28 kg/m2、新生儿体质量≥3.5 kg、阴道分娩、第二产程≥2 h是产后压力性尿失禁发生的独立危险因素；根据Logistic分析出的独立危险因素构建了产后压力性尿失禁的预测模型，其ROC曲线下面积为0.888(95%CI: 0.866~0.909，P<0.001)，该预测模型的敏感度为84.8%，特异度为77.5%。结论对初产妇的孕期及围产期情况进行评估，确定压力性尿失禁的高危因素，对于压力性尿失禁的早期防治具有重要意义。 |
| 关键词: 初产妇 产后压力性尿失禁 危险因素 预测模型 |
| DOI：10.12289/j.issn.1008-0392.21432 |
| 投稿时间：2021-10-12 |
| 基金项目:上海交通大学医工交叉项目（YG2019QNA08） |
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| Risk factors of postpartum stress urinary incontinenceand construction of a prediction model in primiparas |
| YU Jing,XIE Jun |
| (Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Embryo Original Diseases,
Shanghai Municipal Key Clinical Specialty, Shanghai 200030, China) |
| Abstract: |
| ObjectiveTo explore the risk factors of postpartum stress urinary incontinence(PSUI) and to construct a prediction model in primiparas. MethodsPrimiparas who underwent postpartum pelvic floor function test in the international maternal and Child Health Hospital from June 2020 to May 2021 were recruited in the study. The clinical data were collected, including age, number of pregnancy, pre-pregnant body mass index(BMI), mode of delivery, time of the second stage of labor, neonatal weight, pre-delivery fetal biparietal diameter in ultrasonography, etc. The clinical data were analyzed by χ2 test; the risk factors of PSUI were analyzed by univariate and multivariate Logistic regression; based on the risk factors a prediction model was constructed and evaluated. ResultsAmong 1 600 primiparas, there were 336 cases with PSUI, accounting for 21.0% of all primiparas. The maximum contraction value of fast muscle and the average 10 second contraction value of slow muscle in PSUI group were significantly lower than those in non-PSUI group(P＜0.05). Univariate analysis showed that increased age, increased number of pregnancy, increased BMI before pregnancy, excessive weight gain during pregnancy, urinary incontinence during pregnancy, vaginal delivery, time of the second stage of labor≥2 h, neonatal weight gain were significantly associated with PSUI(P<0.05). The multivariate Logistic regression model showed that age ≥35 years, pre-pregnancy BMI≥28 kg/m2, newborn weight ≥3.5 kg, vaginal delivery, second stage of labor ≥2 h were independent risk factors for PSUI. Based on the risk factors a prediction model for PSUI was constructed, the area under ROC curve(AUC) of the model was 0.888( 95%CI: 0.866-0.909, P<0.001), and the sensitivity and specificity were 84.8% and 77.5%, respectively. ConclusionBased on the risk factors of PSUI, the constructed prediction model may used for early prevention and treatment of stress urinary incontinence in primiparas. |
| Key words: primipara postpartum stress urinary incontinence risk factors prediction model |
