慢性心力衰竭患者吸气肌训练效果的Meta分析

Effectiveness of inspiratory muscle training in chronic heart failure patients:a meta-analysis

目的评价吸气肌训练在慢性心力衰竭患者中的应用效果。方法计算机检索Cochrane Library、PubMed、Web of Science、EMBASE、中国生物医学文献数据库、中国学术期刊全文数据库、万方和维普等国内外数据库中有关吸气肌训练应用于慢性心力衰竭患者的随机对照试验。经筛选文献,提取资料与评价文献质量后,采用RevMan 5.3软件进行Meta分析。结果最终纳入9篇文献,共505例患者。Meta分析结果显示,吸气肌训练能改善慢性心力衰竭患者的第1秒用力呼气量、用力肺活量和最大自主分钟通气量[WMD=0.37,95%CI(0.25,0.48),P<0.001;WMD=0.48,95%CI(0.37,0.58),P<0.001;WMD=11.26,95%CI(10.25,12.27),P<0.001],提高患者的6 min步行距离[WMD=43.11,95%CI(34.48,51.74),P<0.001],缓解患者的呼吸困难[WMD=-0.83, 95%CI(-1.31,-0.35),P<0.001],降低患者的静息心率[WMD=-4.69,95%CI(-9.18,-0.21),P=0.04],提高患者的生活质量[WMD=-23.61,95%CI (-26.61,-20.61),P<0.001]。结论吸气肌训练可有效地改善慢性心力衰竭患者的肺功能,提高患者的6min步行距离,缓解患者的呼吸困难,降低患者的静息心率,提高患者的生活质量。由于涉及本研究评价指标的纳入研究数量较少且部分评价指标间存在异质性,故未来仍需多中心、高质量、大样本的研究进一步评价吸气肌训练在慢性心力衰竭患者中的应用效果。

Objective To evaluate the effectiveness of inspiratory muscle training （IMT） in chronic heart failure （CHF） patients. Methods We searched databases including Cochrane Library,PubMed,Web of Science,EMBASE, CBM,CNKI,Wanfang,and V1P. We included all randomized controlled trials （RCTs） that reported the efficacy of IMT in CHF patients. We selected studies according to inclusion and exclusion criteria,extracted data,and assessed quality. We used RevMan 5.3 software to conduct recta-analysis. Results A total of 9 RCTs including 505 patients were included in this meta-analysis. The meta-aualysis showed that IMT could improve FEV1,FVC,and MVV [WMD=0.37,95%CI （0.25,0.48） ,P〈0.001 ;WMD=0.48,95%CI （0.37,0.58） ,P〈0.001 ;WMD=I 1.26,95%CI （ 10.25,12.27 ）, P〈0.001 ],increase six-minute walk distance [WMD=43.11,95%CI （34.48,51.74） ,P〈0.001 ], relieve symptom of dysp nea [ WMD=-0.83,95%CI （- 1.31, -0.35 ）, P〈0.001 ], decrease resting heart rate [ WMD=-4.69,95%CI （ -9.18, -0.21 ）, P=0.04] ,and promote quality of life[WMD=-23.61,95%CI（-26.61,-20.61 ） ,P〈0.001 ]. Conclusion IMT was effective in improving pulmonary function,increasing six-minute walk distance ,relieving symptom of dyspnea,decreasing resting heart rate ,and promoting quality of life. Due to a small number of included studies and heterogeneity of indicators,multi-centered,high-quality RCTs with large sample size are needed in the future to assess the effects of IMT in CHF patients.