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作 者:康静 蒋运兰[2] 李滔 宋爽 易晓冬 杜秋凤 KANG Jing;JIANG Yunlan;LI Tao;SONG Shuang;YI Xiaodong;DU Qiufeng(School of Nursing,Chengdu University of Traditional Chinese Medicine,Sichuan 610032 China;Affiliated Hospital of Chengdu University of Traditional Chinese Medicine)
机构地区:[1]成都中医药大学护理学院,四川610032 [2]成都中医药大学附属医院
出 处:《循证护理》2025年第7期1267-1278,共12页Chinese Evidence-Based Nursing
基 金:国家重点研发计划课题,编号:2020YFC2003104。
摘 要:目的:系统评价产后压力性尿失禁风险预测模型,为构建更高性能的产后压力性尿失禁风险预测模型提供依据。方法:检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Web of Science、EMbase、the Cochrane Library中发表的有关产后压力性尿失禁风险预测模型的文献,检索时限为建库至2024年1月4日。由2名研究者通过自主筛选、获取文献并使用预测模型研究的偏倚风险与适用性评估方法对文献内容进行评估,并使用RevMan 5.4软件对高频率的预测因子进行Meta分析。结果:共纳入22篇文献,涉及27个预测模型;受试者工作特征曲线下面积为0.68~0.97。Meta分析结果显示,阴道分娩[OR=3.54,95%CI(2.73,4.59)]、年龄[OR=1.17,95%CI(1.08,1.26)]、妊娠≥2次[OR=2.91,95%CI(1.72,4.91)]、膀胱颈漏斗形成[OR=6.56,95%CI(2.21,19.54)]、孕期压力性尿失禁[OR=3.63,95%CI(3.05,4.31)]、膀胱颈位置[OR=3.03,95%CI(1.19,7.72)]是产后发生压力性尿失禁的影响因素(P<0.05)等。结论:现有证据表明,产后压力性尿失禁风险预测模型仍需进一步完善,未来构建时应考虑研究设计、样本量、数据缺失处理及模型的校准与验证方面。未来风险预测因子可重点关注分娩方式(阴道分娩)、产妇年龄、妊娠次数、孕期压力性尿失禁、膀胱颈漏斗形成及位置方面。Objective:To systematically evaluate the risk prediction model of postpartum stress urinary incontinence,and to provide the basis for building a higher performance risk prediction model of postpartum stress urinary incontinence.Methods:The literature on risk prediction models of postpartum stress urinary incontinence were retrieved from CNKI,WanFang Database,VIP,CBM,PubMed,Web of Science,EMbase and the Cochrane Library.The retrieval time was from the inception to January 4,2024.Two researchers independently screened the literature,extracted data,and evaluated the quality of the included literature using the Risk of Bias and Suitability Assessment Tool for predictive model studies.Meta-analysis of high frequency predictors were performed using RevMan 5.4 software.Results:A total of 22 articles involving 27 prediction models were included;the area under the receiver operating characteristic curve ranged from 0.68 to 0.97.The results of the Meta-analysis showed that the vaginal deliveries(OR=3.54,95%CI 2.73-4.59),age(OR=1.17,95%CI 1.08-1.26),≥2 pregnancies(OR=2.91,95%CI 1.72-4.91)bladder neck funneling(OR=6.56,95%CI 2.21-19.54),stress urinary incontinence during pregnancy(OR=3.63,95%CI 3.05-4.31),bladder neck position(OR=3.03,95%CI 1.19-7.72)were influential factors of the occurrence of stress urinary incontinence in the postpartum period(P<0.05).Conclusion:Existing evidence shows that risk prediction model for postpartum stress urinary incontinence still needs to be further improved,and aspects of study design,sample size,treatment of missing data,and calibration and validation of the model should be considered in future construction.Future risk predictors may focus on the aspects of mode of delivery(vaginal delivery),maternal age,number of pregnancies,stress urinary incontinence during pregnancy,and bladder neck funnel formation and location.
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