肛门括约肌疲劳评估肛门失禁:系统回顾。

Neurogastroenterology & Motility Pub Date : 2022-09-01 Epub Date: 2022-03-05 DOI:10.1111/nmo.14342
Dakshitha Wickramasinghe, Nilanka Wickramasinghe, Sohan Anjana Kamburugamuwa, Nandadeva Samarasekera, Janindra Warusavitarne, Carolynne Vaizey
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引用次数: 0

摘要

背景:基于测压结果诊断肛门失禁(AI)是具有挑战性的,因为有和没有AI的患者之间的正常值变化和重叠。本研究旨在对人工智能患者和非人工智能患者的括约肌疲劳差异进行系统回顾。方法:检索MEDLINE、EMBASE、SCOPUS、谷歌Scholar。如果研究包括成年患者,并在使用测压法之间评估肛门括约肌疲劳,则纳入研究。效应量以95%置信区间的标准化平均差(SMD)估计。采用随机效应模型。结果:数据库检索鉴定出125篇独特的文章,并从文献参考列表中鉴定出5篇额外的文章。通过题目和摘要综述排除了113例。最后的分析包括九篇文章。两组患者静息压力差异无统计学意义。AI患者挤压压力明显降低。两组患者疲劳率差异无统计学意义。AI患者的FRI显著降低(SMD为1.636,p = 0.001)。在一项研究中,大约三分之一的患者能够在不降低压力的情况下保持20岁的收缩。研究中存在显著的异质性。现有的数据不足以进行更可靠的计算。结论:疲劳率指数测量的括约肌疲劳对肛门失禁有较好的鉴别能力。未来的研究人员需要遵循标准化的方案。分析采用6项研究413例患者,比较AI患者和对照组的疲劳率指数。所有研究均报道尿失禁患者的FRI较低,AI患者的FRI显著较低(标准化平均差[SMD] 1.636, p= 0.001)。关于FRI和AI症状评分之间的相关性,报告了相互矛盾的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anal sphincter fatigability in assessing anal incontinence: A systematic review.

Background: Diagnosing anal incontinence (AI) based on manometry results is challenging due to the variation of the normal values and overlap between patients with and without AI. This study aimed to perform a systematic review on the difference in sphincter fatigability between patients with and without AI.

Methods: MEDLINE, EMBASE, SCOPUS, and Google Scholar were searched. Studies were included if they included adult patients and assessed anal sphincter fatigability between using manometry. The effect size was estimated as the standardized mean difference (SMD) with 95% confidence intervals. A random-effects model was used.

Results: The database searches identified 125 unique articles, and five additional articles were identified from the reference list of articles. One hundred thirteen were excluded through title and abstract review. Nine articles were included in the final analysis. There was no statistically significant difference in the resting pressure between the two groups. Patients with AI had significantly lower squeeze pressure. There was no statistically significant difference between the groups in the fatigue rate. The FRI was significantly lower in patients with AI (SMD 1.636, p = 0.001). Approximately a third of the patients in one study were able to maintain a contraction for 20s without reducing pressure. There was significant heterogeneity in the studies. The data available were inadequate for more robust calculations.

Conclusions: Sphincter fatigability, measured by the Fatigability Rate Index, has good discriminating power for anal incontinence. A standardized protocol needs to be followed by future researchers. Graphical Abstract The analysis used six studies with 413 patients to compare Fatigue Rate Index between patients with AI and controls. All studies reported a lower FRI in patients with incontinence and the FRI was significantly lower in patients with AI (standardized mean difference [SMD] 1.636, p= 0.001). Conflicting results were reported on the correlation between FRI and AI symptom scores.

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