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目的:评价宫内节育器(IUD)种类、放置时期和放置技术对其失败率的影响。方法:用循证医学方法,检索7个数据库和9种相关杂志,纳入相关临床研究并予以质量评价,提取原始研究的数据和进行合并分析。对无异质性可合并的文献使用Meta分析,对不可合并的资料作定性系统评价。结果:纳入16项(共计23295例)研究,因文献间异质性大,仅进行定性系统评价。结果显示活性带铜IUD较惰性IUD的失败率低;在放置时期比较中,剖宫产后即时放置IUD的脱落率低于阴道分娩后放置者;人流后即时和哺乳期放置IUD的脱落率可能较高,但哺乳期放置因症取出率低;服务提供人员置器技术与脱落率相关。结论:活性IUD值得推广使用。对阴道分娩后放器者应该加强随访,哺乳期放置IUD的脱落率可能较高,但因症取出率低,为知情选择提供了依据。放置IUD应该由技术娴熟和有经验的服务提供者完成。因纳入分析的文献以回顾性病例分析和病例-对照研究为主,结论需要进一步论证。
PURPOSE: To evaluate the impact of intrauterine device (IUD) type, placement period and placement technique on its failure rate. Methods: Evidence - based medical methods were used to search 7 databases and 9 related journals, to include relevant clinical studies and to evaluate their quality, to extract data from the original study and to conduct a combined analysis. Meta-analysis was performed on heterogeneously combinable documents, and qualitative and systematic reviews of non-combinable data were performed. Results: A total of 16 items (23295 cases in total) were included. Due to the large heterogeneity of the literature, only qualitative systematic reviews were performed. The results showed that the IUD with reactive copper IUD had a lower failure rate than the inactive IUD. During the placement period, the rate of IUD release immediately after cesarean section was lower than that after vaginal delivery Higher, but lactation placement due to low removal rate; service provider finisher technology and shedding rate. Conclusion: The activity IUD is worth promoting. Vaginal delivery after the device should be enhanced follow-up, lactation IUD placement may be higher off rate, but due to the low removal rate, provided the basis for informed choice. Placing an IUD should be done by a skilled and experienced service provider. Due to the literature included in the analysis of retrospective case analysis and case-control studies, the conclusion needs further argument.