六字诀康复法对稳定期慢性阻塞性肺疾病患者的疗效及安全性的系统评价及Meta分析

The systematic evaluation and meta-analysis of the efficacy and safety of the Liuzijue rehabilitation method on stable chronic obstructive pulmonary disease

目的:评价六字诀康复法对稳定期慢性阻塞性肺疾病患者的疗效及安全性。方法:系统检索六大数据库(中国知网、万方、维普、中国生物医学文献服务系统、Pub Med和The Cochrane Library),按照预先规定的纳入与排除标准筛选临床随机对照试验,应用风险评估工具进行研究质量评价,提取数据并运用Revman 5.3软件进行Meta分析。共检索到186篇文献,最终纳入18个研究,总样本量为1036例,试验组518例和对照组518例。结果:六字诀康复法能够提高慢性阻塞性肺疾病患者的6分钟步行距离(Sixminute Walking Distance,6MWD)[MD=33.76,95%CI(18.99,48.52),P<0.00001],降低患者改良英国医学研究委员会呼吸困难指数(Modified British Medical Research Council Dyspnea Scale,m MRC)评分[MD=-0.55,95%CI(-0.75,-0.36),P<0.00001],降低慢性阻塞性肺疾病评估测试(COPD Assessment Test,CAT)评分[MD=-2.43,95%CI(-2.99,-1.86),P<0.00001],提高第1秒用力呼气容积(Forced Expiratory Volume in 1 Second,FEV1)[MD=0.17,95%CI(0.06,0.27),P=0.004]和FEV1占预计值百分比(FEV1%)[MD=6.08,95%CI(2.55,9.62),P=0.0007]。所纳入的研究暂未发现任何不良反应。结论:六字诀康复法可以提高慢性阻塞性肺疾病患者的运动耐力,减轻呼吸困难症状,改善生活质量,延缓患者肺功能下降,是一种安全有效的康复方法。由于纳入的研究质量偏低,研究结论仍有待更多高质量的随机对照试验予以验证。

Objective:To systematically evaluate the efficacy and safety of the Liuzijue(六字诀)rehabilitation method for patients with stable chronic obstructive pulmonary disease.Methods:RCTs were electronically retrieved in the six major databases(CNKI,Wanfang Data,VIP,SinoMed,Pubmed and The Cochrane Library)according to the preset inclusion and exclusion criteria.Then risk assessment tools were used to evaluate the quality of the included studies,the data was extracted,and a Meta-analysis was conducted by RevMan 5.3 software.A total of 186 articles were retrieved,and 18 studies were finally included,with a total sample size of 1036 cases,518 cases in the experimental group and 518 cases in the control group.Results:The Liuzijue rehabilitation method can increase the six-minute walking distance[MD=33.76,95%CI(18.99,48.52),P<0.00001],decrease the mMRC scores of dyspnea[MD=-0.55,95%CI(-0.75,-0.36),P<0.00001],decrease the CAT scores[MD=-2.43,95%CI(-2.99,-1.86),P<0.00001]and raise FEV1 level[MD=0.17,95%CI(0.06,0.27),P<0.004]and FEV1%level[MD=6.08,95%CI(2.55,9.62),P<0.0007].No adverse reaction was found in the included studies.Conclusion:The Liuzijue rehabilitation method can improve the exercise endurance of COPD patients,alleviate dyspnea symptoms,improve the quality of life,and delay the decline of pulmonary function.It is a safe and effective rehabilitation method.However,because of low-quality of the included studies,more high-quality RCTs are needed to verify the findings.