慢性稳定期心力衰竭患者运动康复的最佳证据总结

Summary of best evidence for exercise-based rehabilitation for heart failure

目的检索和分析心力衰竭患者运动康复的相关证据,并对最佳证据进行总结。方法计算机检索BMJ Best Practice、JBI循证卫生保健国际合作中心图书馆、国际指南图书馆(GIN)、加拿大安大略注册护士协会(RNAO)、英国国家临床医学研究所指南网(NICE)、苏格兰学院间指南网(SIGN)、Cochrane Library、PubMed、CINAHL、Embase、中国生物医学文献数据库(CBM)、中国知网、万方数据库、维普网等数据库中关于慢性稳定期心力衰竭患者运动康复的相关证据,包括指南、共识、证据总结、推荐实践、系统评价。由2名研究者对纳入的文献质量进行评价,并对符合质量标准的文献进行证据提取。结果共纳入证据15篇,包括指南8篇、专家共识2篇、系统评价4篇、推荐实践1篇,最终总结出运动的总体要求(10个方面18条最佳证据)及运动种类的具体要求(5种共17条最佳证据)。结论心功能分级为Ⅰ~Ⅲ级的稳定期慢性心力衰竭患者规律进行运动锻炼是安全有益的,建议对此类患者全面详细评估后进行个体化的有氧联合抗阻训练。在患者可耐受且保证安全性的情况下,高强度间歇运动可作为有氧运动的推荐之一。部分心功能Ⅳ级的患者可进行运动锻炼,但具体人群的确定、运动方案的实施和安全性还缺乏相应证据。

Objective To search for the evidence of exercise-based rehabilitation for heart failure patients,and to summarize the best evidence.Methods We searched the databases of BMJ Best Practice,Joanna Briggs Institute(JBI),Guidelines International Network(GIN),Registered Nurses′Association of Ontario(RNAO),National Institute for Health and Care Excellence(NICE),Scottish Intercollegiate Guidelines Network(SIGN),Cochrane Library,PubMed,CINAHL,Embase,CBM,CNKI,WanFang Data and VIP,to collect relevant guidelines,expert consensus,evidence summaries,practice recommendations,systematic reviews.Two researchers independently assessed the quality of the literature and extracted data.Results A total of 15 publications were selected,including 8 guidelines,2 expert consensus statements,4 systematic reviews and 1 practice recommendation.Finally,best evidence regarding the overall requirements of exercise-based rehabilitation(10 aspects totaling 18 pieces of evidence)and specific exercises(5 kinds,totaling 17 pieces of evidence)were summarized.Conclusions Regular exercise is safe and beneficial in patients with stable chronic heart failure(function capacityⅠ-Ⅲ),and individualized combination of both aerobic and resistance training is recommended after a comprehensive and detailed evaluation of the patients.High-intensity intermittent aerobic exercise may be recomm ended if it is tolerable and safe for patients.Some patients with function capacityⅣcan take exercise,but there is no corresponding evidence for the determination of specific population,implementation of exercise program and safety.