摘要目的 探讨盆底肌功能对压力性尿失禁(SUI)发生的预测作用.方法 选取2016年6—12月就诊于解放军福州总医院妇科门诊并自愿接受盆底肌功能检查的经产妇女258例,采用阴道内测压法测量其盆底肌功能相关指标.(1)根据增加腹压时是否有漏尿或妇科检查时压力试验是否阳性分为尿失禁组和非尿失禁组,比较两组患者的一般临床资料和盆底肌功能相关指标;(2)采用分类树的方法,建立SUI发生的分类树预测模型,分析盆底肌功能对SUI发生的预测作用.结果 (1)258例患者中,尿失禁组114例、非尿失禁组144例,尿失禁组与非尿失禁组患者的体质指数[BMI,分别为(22.8±2.9)、(21.5±2.7)kg/m2]和最大新生儿出生体质量[分别为(3396±424)、(3284±384)g]分别比较,差异均有统计学意义(P<0.05);而两组患者的年龄、产次和分娩方式分别比较,差异则均无统计学意义(P>0.05).尿失禁组与非尿失禁组患者的阴道最大收缩压分别为(21±7)、(35±9)mmHg(1 mmHg=0.133 kPa),阴道平均收缩压分别为(13±7)、(23±9)mmHg,疲劳度分别为(-65±20)％、(-46±17)％,募集时间分别为(1.0±0.6)、(0.8±0.5)s,两组患者间上述盆底肌功能相关指标分别比较,差异均有统计学意义(P<0.01).(2)将影响SUI发生的因素(包括BMI、阴道最大收缩压、疲劳度、募集时间)纳入分类树分析,得出SUI发生的分类树预测模型.该模型的预测结果显示,阴道最大收缩压≤26.2 mmHg时,SUI的发生率为88.6％(70/79),而当阴道最大收缩压>28.2 mmHg时,SUI的发生率为0(0/7);BMI>22.6 kg/m2时,SUI的发生率增加,为4/5.结论 SUI的发生与BMI及盆底肌功能密切相关,阴道最大收缩压下降(≤26.2 mmHg)、BMI增加(>22.6 kg/m2)者易发生SUI,而当阴道最大收缩压>28.2 mmHg时SUI的发生率明显降低.根据分类树预测模型可筛选出SUI的高危人群并及早干预,对减少SUI的发生有一定的临床意义.

abstractsObjective To explore the predictive effect of pelvic floor muscle function on stress urinary incontinence (SUI). Methods A total of 258 women in gynecological outpatients at Fuzhou General Hospital were evaluated the pelvic floor muscle function by intravaginal manometery,then all of outpatients were divided into urinary incontinence group and non-incontinence group, and compared pelvic floor muscle function and clinical characteristic to establish prediction model of SUI by classification tree and analyse the predictive role of pelvic floor muscle function for SUI. Results There were significant difference in body mass index [BMI;(22.8±2.9)vs(21.5±2.7)kg/m2, P<0.05], maximum newborn weight [ (3396 ± 424) vs (3284 ± 384) g, P<0.05] between urinary incontinence group (n=114) and non-incontinence group(n=144). However, there were no significant differences in age, parity and mode of delivery between two groups(all P>0.05). There were significant differences(all P<0.01)in maximum vaginal pressure [(21±7)vs(35±9)mmHg(1 mmHg=0.133 kPa)], average pressure [(13±7)vs(23±9)&nbsp;mmHg], fatigue [(-65±20)％ vs(-46±17)％] and collecting time [(1.0±0.6)vs(0.8±0.5)s] between two groups. Prediction model, which obtained by classification tree analysis with the affecting factors of SUI (including BMI, maximum vaginal pressure, fatigue and collecting time), suggested that the incidence of SUI was 88.6％(70 / 79), when maximum vaginal pressure ≤26.2 mmHg. While, when maximum vaginal pressure was greater than 28.2 mmHg, there was no occurrence of SUI(0/7). But it would increase, when BMI >22.6 kg/ m2. Conclusions The occurrence of SUI is related to the BMI and pelvic floor muscles function. It would increase the risk of SUI with vaginal maximum pressure(≤26.2 mmHg)and BMI(>22.6 kg/m2). While there is almost no SUI, while vaginal maximum pressure >28.2 mmHg. To select high-risk group of SUI and intervene early according to the prediction model, which may be make sense of reducing incidence of SUI.