13种非药物疗法治疗脊髓损伤后神经源性膀胱网状Meta分析

Network Meta-Analysis of 13 Non-Pharmacological Therapies for Neurogenic Bladder after Spinal Cord Injury

摘要: 目的：通过网状meta分析系统评价多种非药物疗法在脊髓损伤后神经源性膀胱患者中的应用效果。方法：计算机检索PubMed、EMbase、Web of Science、Cochrane Library、中国知网(CNKI)、万方数据库(WangFang Date)、维普数据库(VIP)中有关脊髓损伤后神经源性膀胱患者非药物疗法的随机对照试验，检索时间为2013年至2023年3月20日，由2名研究人员独立进行文献检索、筛选、资料提取、质量评价，并交叉核对结果，对最终纳入的文献使用RevMan 5.4和Stata17软件进行数据分析。结果：最终纳入31篇临床随机对照试验(RCT)，涉及2383例患者，共涵盖13种不同的非药物疗法，网状meta分析显示：在总有效率方面，累积排序曲线下面积(SUCRA)排名第一的治疗方法为中频脉冲电治疗结合常规膀胱功能训练(68.4%)；在残余尿量方面，排名第一为电针合体表神经电刺激联合常规膀胱功能训练(87.5%)；在最大尿流率方面，排名第一为盆底肌电刺激合盆底肌训练联合常规膀胱功能训练(99.8%)；在日平均单次尿量方面，排名第一为盆底肌电刺激联合常规膀胱功能训练(99.9%)。结论：中频脉冲电治疗联合常规膀胱功能训练在总有效率方面疗效最佳，电针合体表神经电刺激联合常规膀胱功能训练在改善残余尿量方面疗效更佳，盆底肌电刺激合盆底肌运动训练在改善最大尿流率方面疗效最佳，盆底肌电刺激联合常规膀胱功能训练在改善日平均单次尿量方面疗效最佳。但不同干预措施文献量太少，纳入文献质量不算很高，存在发表偏倚，故此结论需要开展高质量的研究后进一步验证。

Abstract: Objective: To systematically evaluate the application effect of a variety of non-drug therapies in pa-tients with neurogenic bladder after spinal cord injury by network Meta-analysis. Methods: Pub-Med, EMbase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), WangFang Database and VIP Database were searched by computer (from 2013 to March 20, 2023) for randomized controlled trials of non-drug therapies for patients with neurogenic bladder after spinal cord injury. Two researchers independently conducted literature search, screening, data ex-traction, quality evaluation, and cross-check results. RevMan 5.4 and Stata17 software were used to analyze the data of the included studies. Results: A total of 31 randomized controlled trials (RCTS) involving 2383 patients were included, covering 13 different non-drug therapies. The network me-ta-analysis showed that the treatment method ranked first in terms of the total effective rate, and the area under the cumulative ranking curve (SUCRA) was medium- frequency pulse electrical therapy combined with conventional bladder function training (68.4%). In terms of residual urine volume, electroacupuncture combined with surface nerve stimulation combined with conventional bladder function training ranked the first (87.5%); In terms of maximum urinary flow rate, the first ranked was pelvic floor electrical stimulation and pelvic floor muscle training combined with con-ventional bladder function training (99.8%). In terms of average daily single urine volume, pelvic floor electrical stimulation combined with conventional bladder function training ranked first (99.9%). Conclusions: Electroacupuncture combined with surface nerve electrical stimulation com-bined with conventional bladder function training has the best effect in improving residual urine volume. Pelvic floor muscle electrical stimulation combined with pelvic floor muscle exercise train-ing has the best effect in improving maximum urinary flow rate. Pelvic floor electrical stimulation combined with conventional bladder function training has the best effect in improving the average daily single urine volume. However, the number of literatures on different interventions is too small, and the quality of the included literatures is not very high, and there is publication bias. Therefore, the conclusion needs to be further verified by high-quality studies.