盆底肌训练早期干预预防初产妇产后压力性尿失禁效果的Meta分析

Meta-analysis on effect of early pelvic floor muscle training on prevention of postpartum stress urinary incontinence for primiparas

目的评价盆底肌训练对初产妇产后压力性尿失禁的临床效果。方法计算机检索MEDLINE、EMBASE等数据库。纳入盆底肌训练治疗初产妇产后压力性尿失禁的随机对照试验,并追索已纳入文献的参考文献。由2位评价员独立进行文献筛查、质量评价和资料提取,并交叉核对,意见不一致时讨论解决,或向专家咨询解决。采用RevMan 5.2软件进行Meta分析。结果初检出950篇文献,最后纳入5篇文献,随机对照试验(1 520例,其中干预组778例、对照组742例)。Meta分析结果显示:进行盆底肌训练在预防和控制压力性尿失禁发生率方面与常规护理比较有统计学意义,[OR合并=0.78,95%CI(0.61,0.98),P=0.03]。孕期进行盆底肌训练与产后进行盆底肌训练比较无统计学意义[OR=0.91,95%CI(0.66,1.25),P=0.56]。对不适合Meta分析的资料进行系统综述,结果显示盆底肌训练能增强盆底肌力,提高最大盆底肌收缩力(P<0.05),同时患者依从性随着时间的推移下降。结论盆底肌训练能有效预防和治疗产后压力性尿失禁,孕期与产后进行盆底肌训练效果无差异。

Objective To evaluate the clinical effect of pelvic floor muscle training on prevention of postpartum stress urinary incontinence for primiparas.Method Search the database in MEDLINE and EMBASE by computer.Include randomized controlled trials of pelvic floor muscle training on prevention of postpartum stress urinary incontinence.Search for references included.2evaluators screen the documents,evaluate the quality and extract information separately and recheck by another one.Discuss on disagreement or consult experts.Take Meta-analysis by RevMan 5.2.Result 950 references are chosen and 5are included.Randomized controlled trial（1 520 cases,778in intervention group and 742 in control group）.Meta-analysis shows there is significant difference on prevention of postpartum stress urinary incontinence between pelvic floor muscle training and routine nursing care（ORmerge=0.78,95%CI（0.61,0.98）,P=0.03）.There is no significant difference between pelvic floor muscle training in pregnancy and after delivery（OR=0.91,95%CI（0.66,1.25）,P=0.56）.Systematic review of unsuitable for Meta-analysis information shows pelvic floor muscle training can increase pelvic floor muscle strength,improve maximum contractility（P〈0.05）.Patients＇ compliance get lower with time goes by.Conclusion Pelvic floor muscle training can prevent and cure postpartum stress urinary incontinence.There is no difference between pelvic floor muscle training in pregnancy and after delivery.