会阴裂伤在孕前BMI与产后盆底肌功能障碍关联性中的中介作用

doi:10.6040/j.issn.1671-7554.0.2018.999

摘要/Abstract

摘要： 目的探讨经阴分娩产妇孕前BMI与产后盆底肌功能障碍的相关性。方法对产后42 d复查的经阴分娩产妇进行盆底肌功能检测并针对分娩情况进行问卷调查。分别采用χ²检验、Logistic回归分析孕前BMI与盆底肌功能障碍的关联性;采用依次检验法和sobel检验法分析会阴裂伤在孕前BMI与盆底肌功能障碍关联性中的中介效应。结果经阴分娩产妇盆底肌功能障碍发生率为85.28%(1 112/1 304)。Logistic回归分析结果显示:控制新生儿体质量、孕周、年龄、产妇学历、产次等可能的混杂因素后,经阴分娩产妇孕前肥胖可增加盆底一类肌功能障碍(OR=2.765, 95% CI: 1.441~5.305)及盆底二类肌功能障碍(OR=2.367, 95% CI: 1.084~5.170)发生风险;经阴分娩产妇会阴2度及以上裂伤可增加盆底一类肌功能障碍(OR=9.159,95%CI:1.910~43.926)及二类肌功能障碍(OR=8.008,95%CI:1.346~47.640)的发生风险;中介效应分析显示,会阴裂伤在肥胖致盆底肌功能障碍的关系中起不完全中介效应,中介效应百分比为25.43%。结论孕前肥胖及会阴裂伤可能与产后盆底肌功能障碍的发生密切相关,会阴裂伤在孕前肥胖致盆底肌功能障碍的发生风险中起到25.43%的中介作用。

关键词: 会阴裂伤, 孕前肥胖, 盆底肌功能障碍, 中介作用, 关联性

Abstract: Objective To explore the correlation between BMI before pregnancy and postpartum pelvic floor dysfunction in women undergoing vaginal delivery. Methods The pelvic floor muscle function of maternity were tested on 42-day-old after childbirth and questionnaire survey was conducted to collect relevant information. Chi-square test and Logistic regression were used to analyze the association between BMI before pregnancy and pelvic floor muscle dysfunction. The median effect of perineal laceration on the relationship between BMI before pregnancy and pelvic floor muscle dysfunction was analyzed by sequential test and sobel test. Results The incidence rate of pelvic floor muscle dysfunction in the women was 85.28%(1 112/1 304). After controlling of the confounding factors, such as body weight, gestational age, age, maternity education and birth times, the results of Logistic regression analysis were as follows: obesity before pregnancy increased the risk of pelvic floor type 1(OR=2.765, 95% CI:1.441-5.305)and type 2(OR=2.367, 95% CI:1.084-5.170)muscle dysfunction. The vaginal delivery of degree two and above perineal laceration increased the risk of pelvic floor type 1 (OR= 9.159, 95%CI:1.910-43.926)and type 2 (OR= 8.008, 95%CI:1.346-47.640)muscle dysfunction. Mediating effect analysis showed that the perineal laceration had an incomplete mediating effect on pelvic floor muscle dysfunction caused by obesity, and the mediating effect percentage was 25.43%. Conclusion Obesity before 山东大学学报 (医学版)57卷2期 -黄凤艳,等.会阴裂伤在孕前BMI与产后盆底肌功能障碍关联性中的中介作用 \=-pregnancy and perineal laceration may be related to the occurrence of postpartum pelvic floor muscle dysfunction. The perineal laceration plays a partial mediating role in the risk of pelvic floor muscle dysfunction caused by obesity before pregnancy.

Key words: Perineal laceration, Obesity before pregnancy, Pelvic floor muscle dysfunction, Mediating effect, Association

中图分类号:

R574

黄凤艳,许俐,刘平,王志萍. 会阴裂伤在孕前BMI与产后盆底肌功能障碍关联性中的中介作用[J]. 山东大学学报 (医学版), 2019, 57(2): 99-104.

HUANG Fengyan, XU Li, LIU Ping, WANG Zhiping. Intermediary role of perineal laceration in the relationship between pre-pregnancy BMI and postpartum pelvic floor dysfunction[J]. Journal of Shandong University (Health Sciences), 2019, 57(2): 99-104.

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