Fink Howard A, Taylor Brent C, Tacklind Jim W, Rutks Indulis R, Wilt Timothy J
Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
Mayo Clin Proc. 2008 Dec;83(12):1332-43. doi: 10.1016/S0025-6196(11)60781-7.
To determine the efficacy and safety of treatments for nursing home residents with urinary incontinence (UI).
A systematic review was conducted of randomized controlled trials published from January 1985 through May 2008. Data sources were MEDLINE and Cochrane Library databases, proceedings of the 3rd International Consultation on Incontinence, and reference lists of retrieved clinical trials and review articles. Trials were eligible if they consisted of nursing home or long-term institutionalized residents with UI. Eligible trials compared interventions for improving UI with controls, including comparisons of UI outcomes and/or adverse events between randomized groups.
Fourteen unique clinical trials, consisting of 1161 patients, met inclusion criteria. Treatments included antimuscarinic medications, oral estrogen plus progesterone, and behavioral interventions (eg, prompted voiding). Compared with usual care, prompted voiding alone or prompted voiding plus exercise reduced daytime incontinence and increased appropriate toileting. Efficacy outcomes indicated that neither prompted voiding plus exercise nor prompted voiding plus oral estrogen and progesterone was superior to prompted voiding alone for incontinence management. Prompted voiding plus oxybutynin slightly reduced incontinence compared with prompted voiding plus placebo.
In nursing home residents with UI, prompted voiding alone and prompted voiding with exercise were associated with modest short-term improvement in daytime UI. Results do not clearly support an independent effect of exercise in improving UI. Oxybutynin may provide small additional benefit when used with prompted voiding. There appears to be no role for oral estrogen in UI treatment. Long-term clinical trials of prompted voiding alone, prompted voiding with exercise, and antimuscarinic medications should be conducted with targeted nursing home residents who have UI. These trials should include measures of UI, patient quality of life, and cost outcomes.
确定针对养老院尿失禁（UI）居民的治疗方法的疗效和安全性。
对1985年1月至2008年5月发表的随机对照试验进行系统评价。数据来源为MEDLINE和Cochrane图书馆数据库、第三届尿失禁国际咨询会议论文集以及检索到的临床试验和综述文章的参考文献列表。如果试验对象为患有UI的养老院或长期机构化居民，则该试验符合条件。符合条件的试验将改善UI的干预措施与对照进行比较，包括随机分组之间UI结局和/或不良事件的比较。
14项独特的临床试验（共1161名患者）符合纳入标准。治疗方法包括抗胆碱能药物、口服雌激素加孕激素以及行为干预（如定时排尿）。与常规护理相比，单独定时排尿或定时排尿加运动可减少白天失禁并增加适当如厕次数。疗效结果表明，定时排尿加运动或定时排尿加口服雌激素和孕激素在失禁管理方面并不优于单独定时排尿。与定时排尿加安慰剂相比，定时排尿加奥昔布宁可略微减少失禁。
在患有UI的养老院居民中，单独定时排尿和定时排尿加运动与白天UI的适度短期改善相关。结果并未明确支持运动在改善UI方面的独立作用。奥昔布宁与定时排尿联合使用时可能会带来小的额外益处。口服雌激素在UI治疗中似乎没有作用。应针对患有UI的目标养老院居民进行单独定时排尿、定时排尿加运动以及抗胆碱能药物的长期临床试验。这些试验应包括UI测量、患者生活质量和成本结果。
