摘要
目的评价盆底肌训练(PFMT)防治产后压力性尿失禁(SUI)的效果。方法检索The Cochrane Library、Medline、EMBASE、Pubmed、Web of Science、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普网(VIP)、万方数据知识服务平台(WangFang)等数据库中关于PFMT改善产后SUI的随机对照试验(RCT),检索时间为建库至2019年8月。提取纳入文献特征,使用Cochrane手册进行偏倚评估。采用Revman5.3软件进行meta分析,将产后1年内SUI的发生率作为首要结局指标,并根据种族、分娩方式、有无产后盆底功能障碍性疾病(PFD)、干预方式、评价工具、随访时间进行亚组分析。结果最终纳入8篇文献,合并分析的异质性较高(χ^2=15.85,df=7,P=0.03,I2=56%),与对照组相比,经PFMT干预后SUI发生率明显降低(OR=0.46,95%CI:0.31~0.67,P<0.01)。亚组分析中亚裔人群异质性低(χ^2=2.74,df=3,P=0.43,I2=0),与对照组相比,经PFMT干预后SUI发生率明显降低(OR=0.29,95%CI:0.19~0.46,P<0.01);不同分娩方式的异质性较低(χ^2=8.24,df=5,P=0.14,I2=39%),与对照组相比,经PFMT干预后SUI发生率明显降低(OR=0.46,95%CI:0.34~0.63,P<0.01);根据有无产后PFD、干预方式、评价工具、随访时间进行亚组分析的异质性均较高(均I2≥50%),与对照组相比,经PFMT干预后SUI发生率明显降低(OR=0.47,95%CI:0.37~0.61,P<0.01)。结论产后PFMT是改善产后SUI的有效方法,但是在产妇有无产后盆底功能障碍、干预方式、评价工具、随访时间等方面异质性高,建议未来开展结构化的PFMT。
Objective To evaluate the effect of pelvic floor muscle training(PFMT)on prevention and treatment of postpartum stress urinary incontinence(SUI).Methods The randomized controlled trials(RCTs)about PFMT reducing the incidence of postpartum SUI were retrieved from the databases,including the Cochrane Library,Medline,EMBASE,Pubmed,Web of Science,China Biomedical Literature Database(CBM),China Knowledge Network(CNKI),Weipu Periodical Resource Integration Service Platform(VIP)and Wanfang Data Knowledge Service Platform(WanFang Data),from the establishment of the database to August 2019.The data of the included literatures were collected and extracted,and the Cochrane Handbook was used for bias assessment.Meta-analysis was performed by using Revman5.3 analysis software.The incidence of SUI within 1 year after delivery was taken as the primary outcome indicator,and subgroup analysis was conducted according to race,delivery method,postpartum pelvic floor dysfunction(PFD)existed or not,intervention methods,evaluation tools and follow-up time.Results Eight articles were included.The heterogeneity of the combined analysis was high(χ^2=15.85,df=7,P=0.03,I2=56%),compared with the control group,the incidence of postpartum SUI was significantly reduced after PFMT intervention(OR=0.46,95%CI:0.31-0.67,P<0.01).In subgroup analysis,the heterogeneity of the Asian was low(χ^2=2.74,df=3,P=0.43,I2=0),compared with the control group,the incidence of postpartum SUI was significantly reduced after PFMT intervention(OR=0.29,95%CI:0.19-0.46,P<0.01);the heterogeneity of different delivery modes was low(χ^2=8.24,df=5,P=0.14,I2=39%),compared with the control group,the incidence of postpartum SUI was significantly reduced after PFMT intervention(OR=0.46,95%CI:0.34-0.63,P<0.01).The heterogeneity of subgroup analysis was high according to postpartum PFD existed or not,intervention modes,evaluation tools and follow-up time(all I2≥50%).Compared with the control group,the incidence of postpartum SUI was significantly reduced after PFMT intervention(OR=0.47,95%CI:0.37-0.61,P<0.01).Conclusion Postpartum PFMT is an effective method to improve postpartum SUI.However,there is high heterogeneity in the postpartum PLD existed or not,intervention methods,evaluation tools and follow-up time.It is suggested that structured PFMT should be carried out in the future.
作者
夏杰
段霞
于婵
接艳青
张佳男
王可可
XIA Jie;DUAN Xia;YU Chan;JIE Yanqing;ZHANG Jianan;WANG Keke(Nursing Faculty,Shanghai Jian Qiao University,Shanghai 201306,China;School of Medicine,Tongji University,Shanghai 200092,China;Department of Nursing,the First Maternal and Infant Health Care Hospital of Tongji University,Shanghai 201204,China;Department of Surgery ICU,Tenth People′s Hospital of Tongji University,Shanghai 200072,China;Department of Respiratory and Neurology Medicine,Tenth People′s Hospital of Tongji University,Shanghai 200072,China)
出处
《重庆医学》
CAS
2020年第22期3817-3822,共6页
Chongqing medicine
基金
国家自然科学基金项目(71603183)。
关键词
盆底肌训练
产妇
盆底肌功能障碍
尿失禁
压力性
META分析
pelvic floor muscle training
puerperas
pelvic floor muscle dysfunction
urinary incontinence,stress
meta-analysis
