手术前握力锻炼对拟行动静脉内瘘术的慢性肾脏病患者前臂血管影响的Meta分析

A meta-analysis about the effect of preoperative grip strength exercise on forearm vascular diameter in patients with chronic kidney disease preparing for arteriovenous fistula surgery

目的系统评价手术前握力锻炼对拟行动静脉内瘘(arteriovenous fistula,AVF)术的慢性肾脏病(chronic kidney disease,CKD)患者前臂血管内径的影响。方法计算机检索中国生物医学文献数据库、中国知网期刊数据库、维普中文科技期刊数据库、万方期刊数据库、PubMed、Medline、Cochrane library中已发表的相关文献,检索时限为建库至2021年2月26日。由2名研究员独立筛选文献、提取资料、文献质量评价并进行交叉核对,采用RevMan5.3软件进行Meta分析。结果共纳入研究12篇,累计样本量343例。Meta分析结果显示:①锻炼后血管内径大于锻炼前血管内径(SMD=1.03,95%CI:0.62~1.45,P<0.01)。②加压锻炼增加血管内径(SMD=1.31,95%CI:0.26~2.36,P=0.01),非加压锻炼同样增加血管内经(SMD=0.92,95%CI:0.49~1.34,P<0.01)。③不同锻炼时间节点血管内径与锻炼前血管内径比较:锻炼第2周(SMD=0.72,95%CI:0.05~1.38,P=0.03)、第4周(SMD=1.60,95%CI:0.75~2.45,P<0.01)、第6~8周(SMD=1.47,95%CI:0.77~2.18,P<0.01)血管内径均大于锻炼前血管内径;④锻炼第8周血管内径与锻炼第4周血管内径比较差异无统计学意义(SMD=0.31,95%CI:-0.43~1.05,P=0.41)。结论手术前握力锻炼可增加拟行AVF手术的CKD患者前臂血管内径,加压锻炼与非加压锻炼均有利于血管内径的增加,可将握力锻炼时间提前到手术前4周或8周。

Objective To systematically evaluate the effect of preoperative grip strength exercise on forearm vascular diameter in chronic kidney disease(CKD)patients preparing for arteriovenous fistula(AVF)surgery.Methods We searched the China Biology Medicine disc,China National Knowledge Infrastructure,VIP database,Wanfang data,PubMed,Medline and Cochrane library for relevant literature from inception to February 26,2021.Literature screening,data extraction and bias assessment of all eligible studies were conducted independently by two reviewers.Meta-analysis was conducted by using the RevMan 5.3 software.Results A total of 12 studies including 343 participants were analyzed.Meta-analysis showed that①the blood vessel diameter after exercise was larger than that before exercise(SMD=1.03,95%CI 0.62~1.45,P<0.01);②pressurized exercises increased the diameter of blood vessels(SMD=1.31,95%CI 0.26~2.36,P=0.01),and non-pressurized exercise also increased the endovascular meridian(SMD=0.92,95%CI 0.49~1.34,P<0.01).③comparison of vascular diameter at different exercise time nodes and before exercise found that the vascular diameter was statistically greater after exercise at the second week(SMD=0.72,95%CI 0.05~1.38,P=0.03),the fourth week(SMD=1.60,95%CI 0.75~2.45,P<0.01)and the sixth to eighth week(SMD=1.47,95%CI 0.77~2.18,P<0.01);and④there was no significant difference between the vascular diameter at the fourth week and that at the eighth week of the exercise(SMD=0.31,95%CI-0.43~1.05,P=0.41).Conclusion Preoperative grip strength exercise can increase the forearm vascular diameter in CKD patients preparing for AVF surgery.Both pressurized exercise and non-pressurized exercise were beneficial to the increase of vascular diameter.Grip exercise should be preceded by 4-8 weeks of the surgery.