基于整体理论采用会阴盆底超声探讨孕期压力性尿失禁发生机制的研究

doi:10.12114/j.issn.1007-9572.2019.00.642

摘要/Abstract

摘要： 背景　孕期压力性尿失禁（SUI）发生率高，对患者生活质量影响大，发生机制尚不明确，整体理论是目前普遍用于探讨SUI发生机制的理论。然而该理论多用在手术与非孕期人群中，整体理论是否适用于孕期人群还有待探索。目的　基于整体理论，采用经会阴盆底超声探索孕期SUI发生机制。方法　采取便利抽样法，选取2016年10月—2017年1月于深圳市妇幼保健院及南方医科大学深圳医院产科门诊就诊的孕早、中期孕妇245例（样本A），行经会阴盆底三维超声检查，采用同质性检验和探索性因子分析筛选超声指标条目、提取公因子。基于筛选结果，采用1∶1的病例对照研究，于2017年5—9月收集孕早、中期孕妇206例作为样本B用于构建孕期SUI发生机制的结构方程模型，国际尿失禁咨询委员会尿失禁问卷简表（ICI-Q-SF）得分0分为对照组，非0分为病例组。结果　通过同质性检验和探索性因子分析，筛选出10个超声指标，提取出3个公因子，因子累积方差贡献率为73.339%。修正后的结构方程模型各项重要拟合指数均拟合良好。模型包含9个观测变量，2个外潜变量，分别为膀胱尿道连接部的移动度，盆底裂孔面积的改变。模型的各路径标准化回归系数为0.18~0.92。结论　本研究基于整体理论构建结构方程模型，模型拟合良好，结果发现孕期SUI的发生机制主要是与膀胱尿道连接部移动度的改变、盆底裂孔面积的变化有关。

关键词: 尿失禁, 压力性；妊娠；整体理论；超声检查

Abstract: Background　Stress urinary incontinence（SUI） is a disease often occurring during pregnancy，which impairs the quality of life greatly，but its pathogenic mechanism is unclear.The Integral Theory is a universally accepted theories that explains the mechanism of SUI，mostly in the surgical and non-pregnant populations，but whether it applicable to pregnant population remains to be explored.Objective　To perform a Integral Theory-based trans-perineum ultrasound exploration of the pathogenesis of SUI during pregnancy.Methods　Participants were women in the first and second trimesters recruited from those undergoing trans-perineum ultrasound in the Obstetric Clinic，Shenzhen Maternity & Child Healthcare Hospital and Shenzhen Hospital of Southern Medical University by convenience sampling.Among them，245（group A） were enrolled during October 2016 to January 2017，and their ultrasound parameters were analyzed and screened with homogeneity test，and common factors were extracted with exploratory factor analysis（EFA）．In accordance with the results，other 206 cases（group B） were enrolled during May to September 2017 based on a 1∶1-matched case-control design，and their ultrasound parameters were used to develop a structural equation model（SEM） of the mechanism of SUI during pregnancy.Results　Ten ultrasound parameters were screened out.And 3 common factors were extracted，explaining 73.339% of the total cumulative variance.The important indices of the improved SEM showed good fit.The SEM includes 9 observation variables，and two latent variables（changes in bladder-urethral junction and pelvic hiatal area）．And the standardized regression coefficients of path ranged from 0.19 to 0.92.Conclusion　The fitted well SEM developed based on the Integral Theory showed that SUI occurring during pregnancy may related with the changes in bladder-urethral junction and pelvic hiatal area.
Urinary incontinence，stress；Pregnancy；Integral theory；Ultrasonography

罗丹,陈玲,余霞娟,等. 基于整体理论采用会阴盆底超声探讨孕期压力性尿失禁发生机制的研究[J]. 中国全科医学, 2019, 22(36): 4520-4525. DOI: 10.12114/j.issn.1007-9572.2019.00.642.
LUO Dan,CHEN Ling,YU Xiajuan, et al. Integral Theory-based Trans-perineum Ultrasound Exploration of the Pathogenesis of Stress Urinary Incontinence during Pregnancy　[J]. Chinese General Practice, 2019, 22(36): 4520-4525. DOI: 10.12114/j.issn.1007-9572.2019.00.642.

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