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目的探讨阴道分娩后尿潴留相关因素,并对盆底康复干预的效果进行观察。方法选取2015年1月-2016年6月在普宁市人民医院治疗的120例阴道分娩后尿潴留患者为研究对象。采用随机数字表法分为观察组和对照组,每组各60例。同时选取正常健康的60名无尿潴留产妇为正常组。对照组予以一般常规治疗,观察组在对照组的基础上予以盆底康复干预。统计尿潴留组和正常组产妇的年龄、新生儿体质量、产程时间、手转胎头等一般基线资料情况。比较观察组和对照组产妇残余尿量、排尿时间、治疗前后肌力及部分凝血活酶时间(APTT)、凝血酶时间(TT)等指标变化情况。结果两组产妇在产程时间、产钳助产术、胎头吸引术、手转胎头分娩镇痛比较,差异有统计学意义(P<0.05);第一、二产程时间、胎头吸引术、手转胎头是产生尿潴留发生的独立危险因素。观察组治愈率和总有效率分为43.3%和91.7%,对照组为21.7%和80.0%,两组比较,差异有统计学意义(P<0.05)。观察组和对照组治疗后各指标与治疗前比较,差异均有统计学意义(P<0.05或P<0.01);观察组残余尿量和日均失禁频率与对照组比较,差异有统计学意义(P<0.05)。两组患者APTT和TT治疗前后变化比较,差异均无统计学意义(P>0.05)。结论影响阴道分娩后尿潴留的因素较多,在产妇临产中要做好预防性干预,对已经发生尿潴留的产妇要采取积极有效的治疗措施。
Objective To investigate the related factors of urinary retention after vaginal delivery and to observe the effect of pelvic floor rehabilitation intervention. Methods From January 2015 to June 2016, 120 cases of urinary retention after vaginal delivery were treated in Puning People’s Hospital for the study. Using random number table divided into observation group and control group, 60 cases in each group. At the same time select the normal and healthy 60 patients without urinary retention for the normal group. The control group was given routine treatment, and the observation group was given pelvic floor rehabilitation intervention on the basis of the control group. Statistics urinary retention group and the normal group of maternal age, neonatal body mass, labor duration, hand-transfer of fetal first-line general baseline information. The changes of residual urine volume, urination time, strength and partial thromboplastin time (APTT) and thrombin time (TT) before and after treatment were compared between the observation group and the control group. Results There were significant differences in labor analgesia between the two groups during labor, forceps and midwifery, fetal head aspiration and hand-transferred fetal headparture (P <0.05). The first and second stage of labor, fetal head suction, Hand turned fetal head is an independent risk factor for urinary retention. The cure rate and total effective rate were 43.3% and 91.7% in the observation group and 21.7% and 80.0% in the control group, respectively. There was significant difference between the two groups (P <0.05). The difference between the observation group and the control group after treatment was statistically significant (P <0.05 or P <0.01). The residual urine volume and average daily incontinence frequency in the observation group were significantly different from those in the control group (P <0.05). There was no significant difference between the two groups in APTT and TT before and after treatment (P> 0.05). Conclusion There are many factors that affect the postoperative urinary retention after vaginal delivery. Preventive intervention should be done during the labor termination and active and effective treatment should be taken for those who have had urinary retention.