导尿管不同留置时间对剖宫产后泌尿系统并发症影响的网状Meta分析

Effect of urinary catheter removal on different occasions after Cesarean section on urinary complications:a network meta-analysis

目的分析剖宫产术不留置尿管与尿管留置不同时间对尿路感染及排尿困难的影响。方法检索PubMed,EMbase,The Cochrane Library,Web of Science,中国生物医学文献数据库,中国知网和万方中文数据库,并辅助其他检索方式,纳入比较剖宫产术不留置导尿管及尿管留置不同时间的随机对照试验(RCTs)。使用网状Meta分析方法评价尿路感染排尿困难发生率。结果共纳入14篇文献,2 731例患者。在尿路感染方面,4~6 h拔管与6~12 h拔管、12~24 h拔管,>24 h拔管相比,差异有统计学意义(均P<0.05);排序结果显示,4~6 h拔管的尿路感染发生概率最低,其后依次为不留置尿管,术后即刻拔管,6~12 h拔管、12~24 h拔管,>24 h拔管。在排尿困难方面,不留置尿管与其他5个时间段相比,差异有统计学意义均(P<0.05)。排序结果显示,4~6 h拔管排尿困难发生的概率最低,其次为术后即刻拔管,6~12 h拔管,12~24 h拔管,>24 h拔管,不留置尿管。结论基于网状Meta分析结果和概率排序结果,剖宫产术后4~6 h拔除尿管可降低尿路感染及排尿困难发生率。

Objective To evaluate the effect of urinary catheter removal on different occasions after Cesarean section（CS）, and the effect of using versus not using urinary catheter during CS, on urinary tract infection（UTI）, and difficult urination（DU）. Methods PubMed, EMbase, The Cochrane Library, Web of Science, CBM, CNKI and Wanfang Chinese Database were searched for randomized controlled trials（RCTs） on urinary catheter removal on different occasions after CS, and on using versus not using urinary catheter during CS. Then a network recta-analysis was performed to compare the incidence rates of UTI and DU under different interventions. Results A total of 14 RCTs and 2 731 patients were included. The results of network meta-analysis showed that inci dence rates of UTI in post CS 4-6 hours extubation group had significant difference with 6-12 hours group, 12-24 hours group, and 〉24 hours group respectively （P〈0.05 for all）. Probability of the map showed that post CS 4-6 hours extubation group had the lowest chance to develop UTI , followed by the not using urinary catheter group , instant removal after CS group, 6-12 hours group, 12-24 hours group, and 〉24 hours group. Incidence rates of DU in the not using urinary catheter group had significant difference with that in the other 5 intervention groups （P〈0.05 for all）. Probability of the map showed that post CS 4-6 hours extubation group had the lowest chance to develop DU, followed by the instant removal after CS group, 6-12 hours group, 12- 24 hours group, 〉24 hours group, and the not using urinary catheter group. Conclusion Based on the results of the network meta analysis and probability sequencing, the removal of urinary catheter within 4-6 hours after CS has advantages in reducing the incidence rates of UTI and DU.