Nội dung được dịch bởi AI, chỉ mang tính chất tham khảo
Tham vấn urogynecology quốc tế chương 3 ủy ban 2; điều trị bảo tồn cho bệnh nhân mắc sa cơ quan vùng chậu: Đào tạo cơ vùng đáy chậu
Tóm tắt
Bài viết này từ Chương 3 của Tham vấn Urogynécologie Quốc tế (IUC) về Sa Cơ Quan Vùng Chậu (POP) mô tả các bằng chứng hiện tại và gợi ý hướng nghiên cứu trong tương lai về tác động của việc đào tạo cơ vùng đáy chậu (PFMT) trong việc phòng ngừa và điều trị POP. Một nhóm quốc tế gồm bốn chuyên gia vật lý trị liệu, bốn bác sĩ chuyên khoa urogynecology và một nữ hộ sinh/nhà nghiên cứu khoa học cơ bản đã tiến hành tìm kiếm tài liệu sử dụng các từ khóa đã chỉ định trước trên các thử nghiệm ngẫu nhiên có đối chứng (RCT) trong các cơ sở dữ liệu Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro và Scopus cho các tài liệu được công bố trong khoảng thời gian từ 1996 đến 2021. Các ấn phẩm đầy đủ hoặc các tóm tắt mở rộng bằng tiếng Anh hoặc các ngôn ngữ khác có tóm tắt bằng tiếng Anh đều được đưa vào. Thang đánh giá PEDro (0–10) được sử dụng để đánh giá chất lượng nghiên cứu. Các RCT được đưa vào được xem xét để tóm tắt bằng chứng trong sáu phần chính: (1) bằng chứng về PFMT trong phòng ngừa POP ở nữ giới nói chung; (2) bằng chứng về can thiệp sớm PFMT trong giai đoạn xung quanh sinh nở để phòng ngừa và điều trị POP; (3) bằng chứng về PFMT trong điều trị POP ở nữ giới nói chung; (4) bằng chứng cho PFMT trong phẫu thuật; (5) bằng chứng cho PFMT trên các tình trạng liên quan ở phụ nữ có POP; (6) bằng chứng về tác động lâu dài của PFMT đối với POP. Các ấn phẩm đầy đủ bằng tiếng Anh hoặc các ngôn ngữ khác với tóm tắt bằng tiếng Anh và tóm tắt mở rộng được trình bày tại các hội nghị quốc tế chuyên môn cụ thể đều được đưa vào. Độ tin cậy nội bộ được kiểm tra bằng thang đánh giá PEDro (0–10). Sau khi loại bỏ các thử nghiệm trùng lặp và không liên quan, chúng tôi đã phân loại và đưa vào 2 thử nghiệm phòng ngừa, 4 thử nghiệm trong giai đoạn sau sinh, 11 thử nghiệm điều trị PFMT cho POP ở nữ giới nói chung so với không điều trị hoặc can thiệp lối sống, 10 thử nghiệm trên PFMT như một phương pháp điều trị bổ trợ cho phẫu thuật POP và 9 thử nghiệm điều trị lâu dài. Chỉ có ba nghiên cứu điều trị so sánh PFMT với việc sử dụng vòng nâng. Các RCT được chấm điểm từ 4 đến 8 trên thang PEDro. Không tìm thấy nghiên cứu phòng ngừa chính, và có rất ít bằng chứng không đồng nhất về can thiệp sớm trong thời kỳ hậu sản. Có bằng chứng tốt/khuyến nghị từ 11 RCT rằng PFMT có hiệu quả trong việc giảm triệu chứng POP và/hoặc cải thiện giai đoạn POP (giảm một giai đoạn) ở phụ nữ có giai đoạn POP-Q I, II và III trong nữ giới nói chung, nhưng không có bằng chứng từ 9/10 RCT rằng việc thêm PFMT trước và sau phẫu thuật cho POP là hiệu quả. Có rất ít nghiên cứu theo dõi lâu dài và kết quả không đồng nhất. Không có tác dụng phụ nghiêm trọng hoặc biến chứng nào được báo cáo liên quan đến PFMT. Có rất ít nghiên cứu về phòng ngừa và trong thời kỳ hậu sản, và tác động là không rõ ràng. Có bằng chứng cấp cao từ 11 RCT để khuyến nghị PFMT như một phương pháp điều trị hàng đầu cho POP ở nữ giới nói chung. PFMT trước và sau phẫu thuật POP dường như không có tác động bổ sung nào đối với POP. PFMT có hiệu quả và an toàn nhưng cần có sự hướng dẫn và giám sát kỹ lưỡng để phát huy hiệu quả.
Từ khóa
#Sa cơ quan vùng chậu #đào tạo cơ vùng đáy chậu #nghiên cứu lâm sàng ngẫu nhiên #điều trị bảo tồn #phụ nữTài liệu tham khảo
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