| 摘要: |
| ［摘要］ 目的 探讨非分娩镇痛初产妇经阴道分娩产后尿潴留（PUR）的影响因素，为临床制订针对性预防措施提供循证依据。方法 选取首都医科大学附属北京妇产医院2021年12月至2024年12月收治的非分娩镇痛经阴道分娩初产妇105例，根据是否发生PUR分为非PUR组（70例）和PUR组（35例）。比较两组一般资料及临床指标，采用多因素logistic回归分析影响PUR发生的因素，采用受试者工作特征（ROC）曲线分析研究指标预测PUR的效能。结果 两组产后出血量、第Ⅲ产程时长、孕期增重分类及助产方式比较差异有统计学意义（P<0.05）。多因素logistic回归分析结果显示，孕期增重过多［OR（95%CI）=5.028（1.500～16.854），P=0.009］，孕期增重过少［OR（95%CI）=2.892（1.010～8.283），P=0.048］以及产后出血量增加［OR（95%CI）=1.009（1.003～1.015），P=0.002］是PUR发生的独立危险因素。基于上述3项危险因素指标构建预测模型，ROC曲线分析结果显示，该模型可有效预测PUR发生［AUC（95%CI）=0.762（0.663～0.861）］，灵敏度为65.7%，特异度为78.6%，Youden指数为0.443。结论 非分娩镇痛初产妇经阴道分娩后发生PUR的危险因素为孕期增重异常（过多或过少）及产后出血量增加，临床应加强孕期体重的管理及产后出血防控，以降低PUR发生率。 |
| 关键词: 产后尿潴留 非分娩镇痛 初产妇 经阴道分娩 孕期增重 产后出血 |
| DOI：10.3969/j.issn.1674-3806.2025.11.06 |
| 分类号:R 714.64 |
| 基金项目:北京市医院管理局青年人才培养“青苗”计划项目（编号：QML20181401）；首都医科大学附属北京妇产医院/北京妇幼保健院中青年学科骨干培养专项课题（编号：FCYY202002）；首都医科大学附属北京妇产医院/北京妇幼保健院管理专项课题（编号：FCYYGL202008） |
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| Analysis on influencing factors of postpartum urinary retention in vaginal delivery primiparas without labor analgesia |
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ZHANG E1, ZHAO Yue1, LAN Xueli2, JU Rui3
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1.Medical Administration Division, Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing 100026, China; 2.Department of Perinatal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing 100026, China; 3.Drug Clinical Trial Institution Office, Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
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| Abstract: |
| ［Abstract］ Objective To explore influencing factors of postpartum urinary retention(PUR) in vaginal delivery primiparas without labor analgesia, and to provide evidence-based basis for the formulation of targeted preventive measures in clinical practice. Methods A total of 105 primiparas who were admitted to Beijing Obstetrics and Gynecology Hospital, Capital Medical University for vaginal delivery without labor analgesia from December 2021 to December 2024 were selected. According to whether the patients developed PUR, they were divided into non-PUR group(70 patients) and PUR group(35 patients). The general data and clinical indicators were compared between the two groups. Multivariate logistic regression was used to analyze the factors affecting the development of PUR and receiver operating characteristic(ROC) curve was used to analyze the efficacy of the research indicators in predicting PUR. Results There were statistically significant differences between the two groups in terms of postpartum hemorrhage volume, duration of the third stage of labor, classification of gestational weight gain, and midwifery method(P<0.05). The results of multivariate logistic regression analysis indicated that excessive weight gain during pregnancy［OR(95%CI)=5.028(1.500-16.854), P=0.009］, insufficient weight gain during pregnancy［OR(95%CI)=2.892(1.010-8.283), P=0.048］ and large postpartum hemorrhage volume［OR(95%CI)=1.009(1.003-1.015), P=0.002］ were independent risk factors for the development of PUR. The prediction model was constructed based on the above 3 risk factors. The results of ROC curve analysis indicated that the model could effectively predict the development of PUR［ area under the curve(AUC)(95%CI)=0.762(0.663-0.861)］, with a sensitivity of 65.7%, a specificity of 78.6%, and a Youden′s index of 0.443. Conclusion The risk factors for the development of PUR after vaginal delivery in primiparas without labor analgesia are abnormal gestational weight gain(excessive weight gain or insufficient weight gain) and large postpartum hemorrhage volume. Reasonable management of weight during pregnancy and prevention and control of postpartum hemorrhage should be strengthened in clinical practice to reduce the incidence of PUR. |
| Key words: Postpartum urinary retention(PUR) Non-labor analgesia Primiparas Vaginal delivery Gestational weight gain Postpartum haemorrhage |
