基于优劣解距离算法联合熵值法的针刺治疗前列腺癌术后尿失禁的循证决策研究  

Study on Evidence-Based Decision-Making of Acupuncture for Post-Prostatectomy Urinary Incontinence:based on TOPSIS Combined with Entropy Method

作　　者：董志威 王钧岚 谢韬 叶雁影 李停 俞聪 田宁 DONG Zhiwei;WANG Junlan;XIE Tao;YE Yanying;LI Ting;YU Cong;TIAN Ning(Guangdong Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Guangzhou University of Chinese Medicine,Foshan,528200;School of Acupuncture,Moxibustion and Tuina,Jiangxi University of Traditional Chinese Medicine;The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine)

机构地区：[1]广州中医药大学附属广东中西医结合医院,广东省佛山市528200 [2]江西中医药大学针灸推拿学院 [3]广州中医药大学第四临床医学院

出　　处：《中医杂志》2024年第23期2434-2441,共8页Journal of Traditional Chinese Medicine

基　　金：佛山市“十四五”高水平重点专科和培育专科建设项目(FSGSP145082);佛山市“十四五”中医重点专科、特色专科和专病建设项目(ZDZKJS26,TSZBPY08)。

摘　　要：目的筛选前列腺癌术后尿失禁(PPUI)针刺优势方案,为临床决策提供参考。方法检索MEDLINE、Embase、Cochrane Library、Web of Science、中国生物医学文献库、中国知网、万方医学及重庆维普数据库,检索时间为建库至2024年2月1日,收集针刺治疗PPUI的随机对照试验,评价文献质量,排除整体偏倚风险高或改良Jadad<3分的研究,构建针刺方案并进行Meta分析,以国际尿失禁咨询简表(ICI-Q-SF)评分、生活质量分数、总有效率、改良Jadad分数为效益性指标,选穴数量、刺激时长、针刺次数以及疗程为成本性指标,得出标准化方案矩阵,用熵值法确定不同决策指标的权重,最后结合优劣解距离算法(TOPSIS)综合评价。结果9篇文献纳入研究,涉及的针刺疗法构建为六类方案(穴位低频电刺激、电针骶四穴、益气固元针法、体针+盆底肌训练、耳针疗法及电针+盆底肌训练),决策指标中ICI-Q-SF评分、针刺次数以及总有效率获得较高权重,刺激时长和疗程权重较低;TOPSIS熵值法评价结果电针骶四穴方案最佳,该方案使用频率2 Hz的连续波电针,刺激时长每次60 min,要求针感放射到阴茎根部,优势在于选穴精简、显著降低ICI-Q-SF评分和提高临床总有效率。结论最终筛选的优势方案以电针骶四穴最佳,可为临床决策和指南制定提供循证依据。Objective To screen optimized protocol of acupuncture for post-prostatectomy urinary incontinence(PPUI)patients,and to provide evidence for clinical practice.Methods MEDLINE,Embase,Cochrane Library,Web of Science,Chinese Biomedical Literature Database,China National Knowledge Infrastructure,WanFang and VIP databases were searched to collect randomized controlled trials of acupuncture for PPUI.The search was con⁃ducted from the establishment of the database to February 1,2024,and the quality of the literature was evaluated to exclude the studies with a high risk of overall bias or modified Jadad<3,and constructed acupuncture protocol and performed meta-analysis.We used International Consultation on Urinary Incontinence Short Form(ICI-Q-SF)scores,quality of life scores,overall effective rate,and modified Jadad scores as beneficial indicators,and the number of acupoints selected,stimulation duration,the number of acupuncture,and the duration of the treatment course as costly indicators,to derive the standardized protocol matrix,and used the entropy method to determine the weights of the different decision-making indicators,and finally combined with the Technique for Order Preference by Similarity to Ideal Solution(TOPSIS)for comprehensive evaluation.Results Nine studies met the criteria,and the acupunc⁃ture treatments involved were constructed as six protocols including electrical acupoint stimulation with low-frequency,electroacupuncture at four acupoints of sacral region,replenishing qi and tonifying kidney acupuncture,body acu⁃puncture plus pelvic floor muscle training,auricular acupuncture,and electroacupuncture plus pelvic floor muscle training.The ICI-Q-SF,number of acupuncture sessions,and total effectiveness rate were given higher weights in the decision-making indexes,while the stimulation duration and the duration of treatment course were given lower weights;the entropy method of TOPSIS was used for the evaluation and proved that the best protocol was the elec⁃troacupuncture at four acupoints of sa

关 键 词：前列腺癌 术后尿失禁 针刺疗法 熵值法 优劣解距离算法 优势方案 循证评价 

分 类 号：R246.5[医药卫生—针灸推拿学]