间歇导尿预防脊髓损伤后神经源性膀胱病人泌尿系统感染的Meta分析

Effects of intermittent catheterization on preventing urinary system infection in patients with neurogenic bladder after spinal cord injury:a Meta-analysis

目的:评价间歇导尿预防脊髓损伤(SCI)后神经源性膀胱(NB)病人泌尿系统感染的干预效果。方法:计算机检索中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方(WanFang)、维普(VIP)、The Cochrane Library、PubMed、Web of Science和Embase从建库至2022年10月收录的相关文献,由2名研究者进行质量评价后采用RevMan 5.4软件进行Meta分析。结果:共纳入14篇随机对照试验(RCT),包括1013例SCI后NB病人。Meta分析结果显示,间歇导尿能降低SCI后NB病人泌尿系统感染发生率[RR=0.31,95%CI(0.24,0.41),P<0.00001],减少膀胱残余尿量[MD=-81.99,95%CI(-112.69,-51.29),P<0.00001],增加膀胱容量[MD=86.48,95%CI(15.78,157.19),P=0.02],提高病人的生活质量评分[MD=1.82,95%CI(0.58,3.06),P<0.01],同时降低了肾积水的发生率(P<0.05)。结论:间歇导尿不仅能降低SCI后NB病人泌尿系统感染发生率,且在膀胱功能的恢复及提升病人生活质量方面效果显著,由于研究中仅纳入中文文献且质量偏低,今后仍需纳入更多高质量文献来进一步验证。

Objective:To evaluate the effect of intermittent catheterization in preventing urinary tract infection in patients with neurogenic bladder(NB)after spinal cord injury(SCI).Methods:Both Chinese and English databases(CBM,CNKI,WanFang,VIP,the Cochrane Library,PubMed,Embase,Web of Science)were searched from their inception to October 2022.After quality evaluation by two researchers,meta-analysis was performed using RevMan 5.4 software.Results:A total of 14 randomized controlled trials(RCT)were included,including 1013 NB patients after SCI.Meta-analysis showed that intermittent catheterization could reduce the incidence of urinary tract infection in NB patients after SCI[RR=0.31,95%CI(0.24,0.41),P<0.00001]and residual urine volume[MD=-81.99,95%CI(-112.69,-51.29),P<0.00001],increase the bladder volume[MD=86.48,95%CI(15.78,157.19),P=0.02],improve patients′quality of life score[MD=1.82,95%CI(0.58,3.06),P<0.01],and reduce the incidence of hydronephrosis(P<0.05).Conclusions:Intermittent catheterization can not only reduce the incidence of urinary system infection in NB patients after SCI,but also has significant effects on the recovery of bladder function and improvement of patients′quality of life.Since only Chinese literature was included in this study and the quality was lower,more high-quality literature should be included for further verification in the future.