太极拳对冠心病患者血压的影响:系统综述与Meta分析

Influence of Tai Chi exercise on blood pressure in patients with coronary heart disease: a systematic review and Meta-analysis

目的系统评价太极拳对冠状动脉粥样硬化性心脏病(冠心病)患者血压的影响。方法计算机检索以下数据库:Pub Med、EMbase、Cochrane、CNKI、万方、维普、CBM,纳入采用太极拳作为冠心病患者的治疗措施,且疗程超过1个月的临床研究,对检索到已发表的太极拳干预冠心病的系统综述的相关参考文献进行补充手工检索。文献筛选、评价,数据提取过程均由两位研究成员独立进行。采用Rev Man5.3软件使用完整病例数据进行分析数据。采用GRADEpro在线软件对纳入研究进行证据评价。结果共纳入6个研究,包括4个随机对照试验,2个非随机对照试验,共280例患者。未出现严重心血管事件及并发症的报道。太极拳能够降低冠心病患者运动后即刻血压,但与有氧运动相比,其降压作用未显示出有统计学意义的优势[收缩压(SBP):MD=-1,95%CI:-3.89~1.89,P=0.50;舒张压(DBP):MD=1,95%CI:-0.62~2.62,P=0.23)]。与对照组相比,经太极拳锻炼后,冠心病患者的静息SBP血压似有下降的趋势,但差异无统计学意义(SBP:MD=-3.59,95%CI:-8.70~1.52,P=0.17);与不运动相比,太极拳锻炼能够显著降低冠心病患者静息DBP,差异有统计学意义(MD=-5.50,95%CI:-10.57^-0.43,P=0.03)。太极拳锻炼后冠心病患者的峰值血压较对照组略高,但差异无统计学意义(SBP:MD=0.68,95%CI:-11.10~12.45,P=0.91;DBP:MD=3,95%CI:-3.28~9.28,P=0.35)。GRADEprp证据评级显示证据等级为低与极低。结论太极拳应用于冠心病患者相对安全,可能降低患者血压,但受纳入研究数量和质量限制,上述结论尚需开展更多高质量的研究予以验证。

Objective To systematically review the influence of Tai Chi exercise on blood pressure in patients with coronary heart disease（CHD）. Methods The databases of Pub Med, EMbase, Cochrane, CNKI, Wan Fang Data, VIP and CBM were retrieved for choosing the clinical studies on Tai Chi exercise as a therapeutic measure in CHD patients with treatment course over 1 month. Meanwhile, the bibliographies related to retrieved and published systematic reviews about Tai Chi exercise intervening CHD were retrieved manually. The screen, review and data extract of all literature were carried out independently by 2 researches. The data of complete case information was analyzed by using Rev Man5.3 software, and included studies were given evidence review by using online GRADEpro software. Results There were totally 6 studies collected including 4 randomized controlled trials（RCT） and 2 nonrandomized controlled trials（N-RCT） involved 280 patients. There were no reports on severe cardiovascular events and complications. Tai Chi exercise decreased instant blood pressure（BP） after exercise in CHD patients, but had no statistical significance compared with aerobic exercise（SBP： MD=-1, 95%CI：-3.89~1.89, P=0.50; DBP： MD=1, 95%CI：-0.62~2.62, P=0.23）. Compared with control group, resting SBP seemed to have descending trend in Tai Chi group after Tai Chi exercise, but difference had no statistical significance（SBP： MD=-3.59, 95%CI：-8.70~1.52, P=0.17）. Tai Chi exercise decreased significantly resting DBP in Tai Chi group compared with control group（MD=-5.50, 95%CI：-10.57^-0.43, P=0.03）. The peak BP was slightly higher in Tai Chi group than that in control group but the difference had no statistical significance（SBP： MD=0.68, 95%CI：-11.10-12.45, P=0.91; DBP： MD=3, 95%CI：-3.28~9.28, P=0.35）. GRADEprp evidence grading showed that evidence grade was low or very low. Conclusion Tai Chi exercise is safe and can reduce BP in CHD patients. Because of limitation of quantity and quality, more studies with higher quality are needed to verify the above conclusion needs.