阴道松弛症患者发生压力性尿失禁的危险因素分析

Analysis of risk factors for stress urinary incontinence in patients with vaginal laxity syndrome

摘要:

目的 探讨阴道松弛症患者发生压力性尿失禁的相关危险因素。方法 选取2021年5月—2023年5月于郑州大学第三附属医院盆底重建科就诊的452例阴道松弛症合并压力性尿失禁患者（观察组）与415例阴道松弛症未合并压力性尿失禁患者（对照组）。对两组患者的临床资料进行单因素分析，采用多因素一般Logistic回归模型分析阴道松弛症患者发生压力性尿失禁的危险因素。结果 对照组与观察组盆底压力相关参数（包括前静息阶段平均值、快速收缩阶段最大值、快速收缩阶段放松时间、紧张收缩阶段平均值、紧张收缩阶段放松时间、耐力收缩阶段平均值、后静息阶段平均值）、盆底肌力测定相关参数（包括深层Ⅰ类肌分级、深层Ⅱ类肌分级、浅层Ⅰ类肌分级、浅层Ⅱ类肌分级）、阴道后壁膨出占比、子宫脱垂占比、盆底肌筋膜炎占比、会阴裂伤占比的比较，差异无统计学意义（P >0.05）。对照组与观察组年龄、顺产次数、剖宫产次数、体质量指数、有无阴道前壁膨出的比较，差异均有统计学意义（P <0.05）；多因素一般Logistic回归分析结果表明，年龄大［O^R =1.023（95% CI：1.005，1.041）］、初次顺产［O^R =2.205（95% CI：1.286，3.781）］、多次顺产［O^R =2.472（95% CI：1.372，4.455）］、体质量指数高［O^R =1.125（95% CI：1.071，1.183）］和有阴道前壁膨出［O^R =11.050（95% CI：2.338，52.225）］是阴道松弛症患者发生压力性尿失禁的危险因素，差异均有统计学意义（P <0.05）。结论 年龄大、分娩方式、顺产次数、体质量指数高及有阴道前壁膨出均为阴道松弛症患者发生压力性尿失禁的独立危险因素。临床工作者应及早对这些危险因素进行预防和识别，从而避免或减少阴道松弛症患者发生压力性尿失禁的风险，同时为临床积极干预和选择合理治疗方案提供参考。

Abstract:

Objective To investigate the risk factors associated with stress urinary incontinence (SUI) in patients with vaginal laxity syndrome (VLS).Methods In this study, the relevant variables of 452 VLS patients with SUI (observation group) and 415 VLS patients without SUI (control group) admitted to the outpatient and inpatient departments of Pelvic floor Reconstruction Department of the Third Affiliated Hospital of Zhengzhou University from May 2021 to May 2023 were analyzed. Univariate and multifactorial general Logistic regression analysis were used to explore the risk factors for SUI in VLS patients.Results The relevant parameters of pelvic floor pressure in the control group and the observation group (including the average value of the pre-resting stage, the maximum value of the rapid contraction stage, the relaxation time of the rapid contraction stage, the average value of the relaxation time of the tension contraction stage, the average value of the endurance contraction stage, and the average value of the post-resting stage), and the relevant parameters of the determination of the pelvic floor muscle strength (including the classification of the deep I muscle, the classification of the deep Ⅱ muscle, and the shallow one) There was no statistically significant difference between layer-I muscle classification, superficial class Ⅱ muscle classification, posterior vaginal wall swelling, uterine prolapsis, pelvic floor myofascitis and perineal laceration (P > 0.05). There were statistically significant differences between control group and observation group in age, frequency of couvade, frequency of couvade, BMI and presence or absence of anterior vaginal wall swelling (P < 0.05). Multivariate logistic regression analysis showed that older age [O^R =1.023 (95%CI: 1.005, 1.041)], first couvade [O^R =2.205 (95%CI: 1.286, 3.781)], multiple couvade [O^R =2.472 (95%CI: 1.372, 4.455)], high BMI [O^R =1.125 (95% CI: 1.071, 1.183)] and anterior vaginal wall bulge [O^R =11.050 (95% CI: 2.338, 52.225)] was a risk factor for SUI in VLS patients, and the differences were statistically significant (P < 0.05).Conclusions Advanced age, mode of delivery, number of vaginal deliveries, higher BMI, and anterior vaginal wall prolapse are independent risk factors for SUI in VRS patients. Early prevention and identification of these risk factors are critical to reducing the risk of SUI in VRS patients. These findings provide valuable insights for clinical intervention and the selection of appropriate treatment strategies.