Fader Mandy, Cottenden Alan M, Getliffe Kathryn
Continence and Skin Health Technology Group, School of Nursing and Midwifery, University of Southampton, University Road, Highfield, Southampton, UK, SO17 1BJ.
Cochrane Database Syst Rev. 2008 Oct 8(4):CD007408. doi: 10.1002/14651858.CD007408.
Incontinence is a common and embarrassing problem which has a profound effect on social and psychological well-being. Many people wear absorbent products to contain urine and/or faeces and protect their clothes and dignity. Users of absorbent pads are very diverse, including younger women, particularly those who have had children, older men with prostate disease, people with neurological conditions and older people with mobility and mental impairment. Whilst small absorbent pads for light incontinence are adequate for some users with low volumes of urine loss, for others with higher volumes more absorbent products are needed. A practical definition of moderate-heavy incontinence is urine or faecal loss that requires a large absorbent pad (typically with a total absorbent capacity of 2000 g to 3000 g) for containment.
To assess the effectiveness of the different types of absorbent product designed for moderate-heavy incontinence.
We searched the Cochrane Incontinence Group Specialised Register for trials carried out between 1 January 1998 and 1 January 2008 (searched 7 February 2008), and the reference lists of relevant articles. Absorbent pads are subject to frequent modification by manufacturers and trials more than 10 years old were therefore not included in this review.
All randomised or quasi-randomised trials of absorbent products for moderate-heavy incontinence.
Two review authors assessed the methodological quality of potentially eligible studies and independently extracted data from the included trials.
Two studies with a total of 185 participants met the selection criteria. These trials studied all the absorbent product designs included in this review. One trial took place in nursing homes, the other in people's own homes. Gender was found to be a significant variable in both trials, and accordingly the results were analysed in gender groups. Data were presented on all included outcomes, except for quality of life.The results show that there is no single best design (i.e. one design that is significantly better than all other designs and for all users). Of the disposable designs, the more expensive pull-up and T-shaped diaper designs were not better overall than the diaper for men, but the diaper was better than the insert (the cheapest), making the diaper the most cost-effective disposable design for men both day and night. For women, disposable pull-ups were better overall than the other designs (except for those living in nursing homes when disposable diapers are better when used at night), but they are expensive. Unlike men, women in the community did not favour diapers (or T-shape diapers) and insert pads are therefore the most cost-effective alternative. Washable diapers are the least expensive design but are unacceptable to most women at any time. However, some people (particularly men living at home) prefer them at night and for them they are a cost-effective design.No firm conclusions could be drawn about the performance of designs for faecal incontinence and there was no firm evidence that there are differences in skin health between designs.
AUTHORS' CONCLUSIONS: Although data were available from only two eligible trials the data were sufficiently robust to make some recommendations for practice. There is evidence that different designs are better for men and women. Diapers are the most cost-effective disposable design for men. Disposable pull-ups are most preferred for women but are expensive: disposable inserts are a cheaper alternative (except in nursing homes where diapers are preferred to inserts at night). Washable diapers are the cheapest design but have limited acceptability, confined mainly to some men at night. There were not enough people in the trials to draw any conclusions about which designs are best for faecal incontinence and no particular design seemed to be better or worse for skin health. People have different preferences for absorbent product designs and using a combination (different designs for day/night, going out/staying in) may be more effective and less expensive than using one design all the time.
尿失禁是一个常见且令人尴尬的问题，对社会和心理健康有着深远影响。许多人使用吸收性产品来容纳尿液和/或粪便，以保护衣物和尊严。吸收性护垫的使用者非常多样化，包括年轻女性，尤其是有孩子的女性、患有前列腺疾病的老年男性、患有神经系统疾病的人以及行动不便和有精神障碍的老年人。虽然轻度尿失禁用的小型吸收性护垫对一些尿量损失少的使用者足够了，但对于其他尿量较多的人则需要更具吸收性的产品。中度至重度尿失禁的一个实际定义是尿液或粪便损失量大到需要使用大型吸收性护垫（通常总吸收能力为2000克至3000克）来容纳。
评估为中度至重度尿失禁设计的不同类型吸收性产品的有效性。
我们检索了Cochrane尿失禁小组专业注册库，以查找1998年1月1日至2008年1月1日期间进行的试验（2008年2月7日检索），以及相关文章的参考文献列表。吸收性护垫会经常被制造商改进，因此超过10年的试验未纳入本综述。
所有针对中度至重度尿失禁吸收性产品的随机或半随机试验。
两位综述作者评估了可能符合条件的研究的方法学质量，并独立从纳入的试验中提取数据。
两项共185名参与者的研究符合选择标准。这些试验研究了本综述中包含的所有吸收性产品设计。一项试验在养老院进行，另一项在人们自己家中进行。在两项试验中均发现性别是一个显著变量，因此按性别组对结果进行了分析。除生活质量外，所有纳入的结局均有数据呈现。结果表明，没有单一的最佳设计（即一种比所有其他设计都显著更好且适用于所有使用者的设计）。在一次性设计中，较昂贵的拉拉裤和T形尿布设计总体上并不比男性专用尿布好，但男性专用尿布比插入式护垫（最便宜的）好，这使得男性专用尿布成为白天和晚上最具成本效益的一次性设计。对于女性，一次性拉拉裤总体上比其他设计好（住在养老院的女性除外，晚上使用一次性尿布更好），但它们价格昂贵。与男性不同，社区中的女性不喜欢尿布（或T形尿布），因此插入式护垫是最具成本效益的选择。可洗尿布是最便宜的设计，但在任何时候大多数女性都无法接受。然而，一些人（尤其是居家男性）晚上更喜欢使用，对他们来说这是一种性价比高的设计。关于粪便失禁产品设计的性能无法得出确切结论，也没有确凿证据表明不同设计在皮肤健康方面存在差异。
尽管仅有两项符合条件的试验的数据，但这些数据足够有力，可以为实践提出一些建议。有证据表明不同设计对男性和女性各有优势。尿布是男性最具成本效益的一次性设计。一次性拉拉裤最受女性青睐但价格昂贵：一次性插入式护垫是更便宜的选择（养老院除外，晚上那里更喜欢用尿布而不是插入式护垫）。可洗尿布是最便宜的设计，但可接受性有限，主要限于一些晚上使用的男性。试验中的人数不足以得出哪种设计最适合粪便失禁的结论，而且似乎没有哪种特定设计在皮肤健康方面更好或更差。人们对吸收性产品设计有不同偏好，组合使用（白天/晚上、外出/居家使用不同设计）可能比一直使用一种设计更有效且成本更低。
