盆底肌锻炼对改善产后女性盆底功能临床疗效的Meta分析

A meta-analysis of the clinical effect of pelvic floor muscle training on improving pelvic floor function of postpartum women

目的:评估应用盆底肌锻炼(PFMT)对改善产后女性盆底功能的作用。方法:通过检索万方、中国知网、Pubmed、Embase、Cochrane数据库,筛选纳入2018年4月前发表的关于产后盆底康复治疗对盆底功能影响的临床随机对照试验(RCT),随访至产后12个月。提取数据,采用GRADE证据分级,利用R语言软件进行Meta分析。结果:共纳入15篇RCT文献。Meta分析结果显示,PFMT组与对照组的POP相关症状、性生活不适、尿失禁及粪失禁发生率比较,差异有统计学意义(P<0.05),POP-Q分期、阴道收缩力比较,差异无统计学意义(P>0.05)。结论:产后行规范的PFMT治疗可能降低POP相关症状、性生活不适及粪尿失禁的发生率,但因纳入的文献数量较少、缺乏高级别证据等所限,PFMT对POP的预防作用仍不明确,有待更多高质量的临床RCT支持。

Objective: To evaluate the efficacy of PFMT in improving the puerperal pelvic floor function.Methods: Two reviewers independently screened literature about the postpartum pelvic floor rehabilitation based on Wanfang,CNKI,Pubmed,Embase,the Cochrane database and published before Apr. 2018.Follow-up period of at least 12 months after delivery,extracted data,USES the GRADE classification of evidence,using R software for Meta analysis.Results: Total 15 randomized controlled trials were included in this study.Meta-analysis results revealed that a statistical difference was found in the incidence of POP related symptoms,sexual discomfort,urinary incontinence and fecal incontinence between PFMT group and control group( P<0.05).There was no significant difference for the POP-Q staging and vaginal squeeze pressure( P>0.05).Conclusion: Postpartum PFMT treatment may reduce the incidence of POP related symptoms,sexual discomfort,urinary incontinence and fecal incontinence,but lack of high level of evidence.There remains a need for high quality clinical randomized controlled trials to evaluate whether postpartum PFMT treatment can prevent postpartum POP in the future.