非手术干预方案改善产后盆底功能障碍有效性的网状Meta分析

Efficacy of non⁃surgical interventions in improving postpartum pelvic floor dysfunction:a network Meta⁃analysis

目的:系统评价不同非手术干预方案对产后盆底功能障碍性疾病的干预效果。方法:检索中国知网、维普、万方、中国生物医学文献服务系统(SinoMed)、PubMed、Web of Science、EMbase、the Cochrane Library数据库中自建库至2021年12月26日的有关不同非手术干预方案改善产后盆底功能障碍性疾病效果的随机对照试验,由2名研究员独立进行文献筛选、资料提取及质量评价,采用Stata16.0软件进行网状Meta分析。结果:共纳入49项研究,涉及5278例病人、15种干预方案。网状Meta分析结果显示,在盆底肌力评分方面,针灸联合生物反馈电刺激效果最好,与Kegel运动比较差异有统计学意义(P<0.05);在尿失禁治疗有效率方面,针灸联合电刺激效果最好,与Kegel运动、Kegel运动联合生物反馈电刺激及阴道哑铃、常规护理、Kegel运动联合阴道哑铃比较差异有统计学意义(P<0.05);在盆腔脏器脱垂发生率方面,Kegel运动联合电刺激效果最好,与Kegel运动、常规护理比较差异有统计学意义(P<0.05)。结论:现有证据表明,针灸联合电刺激能有效改善尿失禁症状,同时结合生物反馈可有效增强盆底肌的收缩力,Kegel运动联合电刺激对降低盆腔脏器脱垂发生率的效果好,可根据病人病情特点选择适合的干预方案。

Objective:To systematically evaluate the effect of different non-surgical interventions on postpartum pelvic floor dysfunction.Methods:Randomized controlled trials on the effect of different non-surgical interventions to improve postpartum pelvic floor dysfunction were searched in databases including CNKI,VIP,Wanfang,SinoMed,PubMed,Web of Science,EMbase and the Cochrane Library from inception to December 26,2021.Two researchers independently performed literature screening,data extraction and quality evaluation.Stata 16.0 was used to conduct a network meta⁃analysis.Results:A total of 49 RCTs including 5278 patients were included,involving 15 interventions.The results of the network meta⁃analysis showed that acupuncture combined with biofeedback and electric stimulation had the best effect on pelvic floor muscle strength scores,compared with Kegel exercise,the difference was statistically significant(P<0.05).For effective rate of urinary incontinence treatment,acupuncture combined with electric stimulation had the best effect,compared with Kegel exercise,Kegel exercise combined with biofeedback and electric stimulation and vaginal dumbbell,routine care,or Kegel exercise combined with vaginal dumbbell,the differences were all statistically significant(P<0.05).Kegel exercise combined with electric stimulation had the best effect on the incidence of pelvic organ prolapse,compared with Kegel exercise or routine care,the differences were statistically significant(P<0.05).Conclusion:Current evidence shows that acupuncture combined with electric stimulation can improve urinary incontinence symptoms effectively,while combined with biofeedback can effectively enhance pelvic floor muscle strength,and Kegel exercise combined with electric stimulation has the good effect on reducing the incidence of pelvic organ prolapse.At the same time,it should be suggested to choose the appropriate intervention according to the characteristics of the patient's condition.