优化前列腺癌根治术病人术后结局围术期运动的最佳证据总结

Summary of the best evidence on perioperative exercise to optimize outcomes in patients undergoing radical prostatectomy

目的:总结前列腺癌根治术围术期运动相关证据,为临床改善前列腺癌根治术后尿失禁和健康相关生活质量提供依据。方法:计算机检索BMJ最佳临床实践、循证卫生保健中心数据库、UpToDate、the Cochrane Library、PubMed、中国知网、医脉通等数据库和相关网站,获取前列腺癌根治术围术期运动的相关文献,文献类型包括临床决策、指南、证据总结、专家共识、系统评价、未被系统评价和证据总结纳入的随机对照试验,检索时限为2012年1月1日—2022年12月29日。由2名接受过系统循证护理培训的研究者独立筛选文献、提取资料并对纳入的文献进行质量评价后,从符合质量标准的文献中提取证据,并对证据进行质量分级,总结前列腺癌根治术围术期运动的最佳证据。结果:共检索到8879篇文献,最终纳入21篇文献,包括2篇指南、9篇系统评价、2篇证据总结、8篇随机对照试验,纳入文献总体质量较高。汇总得到运动益处、运动评估、盆底肌肉训练、全身运动、术后早期活动5个方面的36条证据。结论:基于循证总结的前列腺癌根治术围术期运动方案,专业人员需结合临床情境、地区文化因素及病人选择偏好,为前列腺癌根治术病人制定围术期个性化运动方案。

Objective:To summarize the evidence related to perioperative exercise after radical prostatectomy in order to provide a basis for clinical improvement of urinary incontinence and health-related quality of life after radical prostatectomy.Methods:Relevant literature on perioperative exercise for radical prostatectomy,including clinical decision-making,guidelines,evidence summaries,expert consensus,systematic reviews,and randomized controlled trials(RCTs)which are not included in the systematic reviews and evidence summaries were retrieved from BMJ Best Clinical Practice,Evidence-Based Health Care Center Database,UpToDate,the Cochrane Library,PubMed,CNKI,Yimaitong,and other databases and related websites.The search time limit was from January 1,2012,to December 29,2022.Two researchers who have received systematic evidence-based nursing training independently screened the literature,extracted data,and evaluated the quality of the included literature.Then,they extracted evidence from the literature that met the quality standards,graded the quality of the evidence,and summarized the best evidence of perioperative exercise after radical prostatectomy.Results:A total of 8879 documents were retrieved,and 21 documents were finally included,including 2 guidelines,9 systematic reviews,2 evidence summaries,and 8 RCTs.The overall quality of the included documents was high.A total of 36 pieces of evidence covering 5 aspects were summarized:exercise benefits,exercise assessment,pelvic floor muscle training,whole-body exercise,and early postoperative activities.Conclusions:Perioperative exercise can effectively improve urinary incontinence and health-related quality of life after radical prostatectomy.Professionals should develop personalized perioperative exercise programs for patients undergoing radical prostatectomy based on clinical situations,regional cultural factors,and patient preferences.