PCI后运动康复对冠心病患者心功能和心血管不良事件影响的meta分析

Effect of exercise rehabilitation on cardiac function and cardiovascular adverse events in patients with coronary heart disease after PCI: a meta-analysis

目的:分析经皮冠状动脉介入治疗(PCI)后运动康复对冠心病患者心功能和心血管不良事件的影响。方法:计算机检索PubMed、Embase、Web of Science、MEDLINE、Cochrane Library、中国生物医学文献数据库、中国知网、万方数据库、维普数据库等有关运动应用于PCI术后患者的随机对照试验,检索时限从建库至2019年6月。由2名评价人员按照标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.3软件进行meta分析。结果:共纳入11项随机对照试验,试验组为有运动方案(616例),对照组为常规护理或药物治疗,但不进行运动(611例)。meta分析显示,试验组左心室射血分数明显改善(P<0.01),且心脏病死亡、心肌梗死、冠状动脉血管成形术、心绞痛和冠状动脉再狭窄的发生率显著降低(P<0.05或P<0.01)。而左室舒张末期内径、6 min步行距离及冠状动脉旁路移植术实施率在两组间无统计学差异(P>0.05)。结论:PCI术后进行运动康复,能改善冠心病患者心脏功能,减少不良心血管事件的发生率。

Objective:To analyze the effect of exercise rehabilitation on cardiac function and cardiovascular adverse events in patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods:Randomized controlled trials involving exercise applied to patients after PCI were searched in databases including PubMed,Embase,Web of Science,MEDLINE,Cochrane Library,CBM,CNKI,Wanfang and VIP by computer from the establishment of the database to June 2019.Two reviewers independently conducted literature screening,data extraction and quality evaluation according to the standard,and then meta-analysis was conducted by RevMan 5.3 software.Results:A total of 11 randomized controlled trials were included;among them,616 patients in the experimental group had exercise program,while 611 patients in the control group received routine nursing or drug treatment without exercise.Meta-analysis showed that the LVEF was significantly improved(P<0.01),and the incidences of cardiac death,myocardial infarction,coronary angioplasty,angina pectoris and coronary restenosis were significantly reduced(P<0.05 or P<0.01).There were no significant differences in left ventricular end diastolic diameter,6 min walking distance and the rate of coronary artery bypass grafting between the two groups(P>0.05).Conclusion:Exercise rehabilitation after PCI can improve the cardiac function of patients with coronary heart disease and reduce the incidence of adverse cardiovascular events.