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2Hz的连续波电针,刺激时长每次60min,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.
Study on Evidence-Based Decision-Making of Acupuncture for Post-Prostatectomy Urinary Incontinence:based on TOPSIS Combined with Entropy Method
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 sacral region which used continuous-wave electroacupuncture with a frequency of 2 Hz for 60 min each time,and required the needle sensation to radiate to the root of the penis,with the advantages of streamlined selection of acupoints,a significant reduction in ICI-Q-SF,and an increase in the effectiveness rate.Conclusion The final optimized protocol was electroacupuncture at four acupoints of sacral region,which can provide an evidence-based basis for clinical decision-making and guideline development.
prostate cancerpost-prostatectomy urinary incontinenceacupuncture therapyentropy methodtech-nique for order preference by similarity to ideal solutionoptimized protocolevidence-based evaluation
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