稳定期COPD患者家庭肺康复效果评价的Meta分析

Effects of home-based pulmonary rehabilitation in patients with stable COPD： a Meta-analysis

目的 通过Meta分析评价家庭肺康复对提高COPD患者生活质量的有效性和安全性.方法 计算机检索PubMed、Science Direct、Cochrane Library、CBM、CNKI和万方数据库,检索关于家庭肺康复干预与常规治疗对提高COPD患者生活质量的随机对照试验（RCT）的文献.检索时限均为建库至2016年1月31日,按纳入及排除标准由两名研究员独立对检索的RCT研究进行筛选、资料提取和质量评价后,采用RevMan 5.1软件进行Meta分析.结果 共纳入14项研究共495例COPD患者.Meta分析结果显示：试验组患者的SGRQ问卷得分明显降低[MD=-10.54,95%CI（-15.44,-5.64）]（干预时间为12周）,6MWD距离显著增加[（MD=45.85,95%CI（26.98,64.72）],差异有统计学意义（P〈0.05）.两组患者FEV1%[MD=0.52,95%CI（-6.75,7.80）]和FEV1/FVC[MD=-0.30,95%CI（-6.43,5.83）]比较,差异无统计学意义（P〉0.05）.两组患者死亡率[RR=1.28,95%CI（0.41,4.02）]和急性加重发生率[RR=1.34,95%CI（0.60,2.97）]比较,差异均无统计学意义（P〉0.05）.结论 家庭肺康复是一种安全有效的康复训练形式,可有效改善稳定期COPD患者生活质量、运动能力及呼吸困难症状,但对稳定期COPD患者的肺功能无明显改善作用.

Objective To investigate the efficacy and safety of home-based pulmonary rehabilitation on the improvement of quality of life in patients with COPD by Meta-analysis.Methods Randomized controlled tests （RCT） about the effectiveness of home-based pulmonary rehabilitation on quality of life in COPD patients were retrieved from electronic databases including PubMed, Science Direct, Cochrane Library, CBM, China National Knowledge Infrastructure （CNKI） and Wanfang Database from their establishment to January 31th, 2016. According to inclusion and exclusion criteria, RCT screening, data extraction and quality assessment were conducted by two reviewers independently. Meta-analysis was performed using RevMan 5.1 software.Results A total of 14 RCT involving 495 COPD patients were included. The Meta-analysis showed that： the home-based pulmonary rehabilitation intervention could significantly improve the quality of life evaluated by Saint-George＇s Respiratory Questionnaire [MD=-10.54, 95%CI （-15.44, -5.64）]（intervention for 12 weeks） and improve the exercise capacity （six minutes walking distance） [MD=45.85, 95%CI （26.98, 64.72）]in COPD patients compared with the conventional treatment （P〈0.05）. Statistically significant differences in improving pulmonary function were not found between the two groups （FEV1%） [MD=0.52, 95%CI （-6. 75, 7.80）], （FEV1/FVC） [MD=-0.30, 95%CI（-6.43, 5.83）]（P〉0.05）. There were no statistically significant differences in the mortality rate [RR=1.28, 95%CI （0.41, 4.02）] and the frequency of acute exacerbation [RR=1.34, 95%CI （0.60, 2.97）]between the two groups （P〉0.05）. Conclusions The home-based pulmonary rehabilitation is a safe and effective rehabilitation training form, which can effectively improve the quality of life and exercise capacity, reduce the degree of dyspnea in patients with stable COPD, but has no effects in the improvement of pulmonary function of stable COPD patients.