术前肺康复对肺癌患者术后肺部并发症影响的Meta分析

Meta-analysis of the effect of preoperative pulmonary rehabilitation on postoperative pulmonary complications in patients with lung cancer

目的系统评价术前肺康复对肺癌患者术后肺部并发症的影响。方法检索近10年中国生物医学文献数据库、中国知网、维普网、万方数据库、PubMed、Embase、Web of Science、Cochrane Library和Wiley Online Library公开发表的肺癌术前肺康复的临床随机对照试验研究,检索时限为2010年1月1日—2021年1月1日。对纳入的文献进行质量评价与数据提取,对术后肺部并发症的结局指标进行Meta分析。结果共纳入12篇文献。Meta分析结果显示,干预组术后肺部并发症发生率低于对照组,差异有统计学意义[RR=0.42,95%CI:0.32~0.55,P<0.01]。以干预时间的长短进行亚组分析,结果显示干预时间为1周时,干预组和对照组比较差异有统计学意义[RR=0.36,95%CI:0.24~0.55,P<0.01],干预时间>1周时,干预组和对照组比较差异有统计学意义[RR=0.48,95%CI:0.33~0.68,P<0.01]。以术后的不同评估时间进行亚组分析,结果显示评估时间为1个月时,干预组和对照组比较差异有统计学意义[RR=0.48,95%CI:0.34~0.68,P<0.01];评估时间>1个月时,干预组和对照组比较差异无统计学意义[RR=0.39,95%CI:0.08~1.85,P=0.24]。除肺炎或肺部感染、肺不张、支气管胸膜瘘外,肺癌患者其余术后肺部并发症发生率比较差异无统计学意义(P>0.05)。结论至少1周包含呼吸训练在内的运动是术前肺康复的常见干预模式。术前肺康复干预有利于减少肺癌术后整体和1个月内的术后肺部并发症发生,对评估时间超过1个月和具体术后肺部并发症的影响仍需进一步研究。

Objective To systematically review the effect of preoperative pulmonary rehabilitation on postoperative pulmonary complications in patients with lung cancer.Methods The randomized controlled trials of preoperative pulmonary rehabilitation for lung cancer published in the past 10 years were retrieved in China Biomedical Literature Database,China National Knowledge Infrastructure,VIP,WanFang Data,PubMed,Embase,Web of Science,Cochrane Library and Wiley Online Library.The search limit was from January 1,2010 to January 1,2021.The quality evaluation and data extraction of the included article were carried out,and the Meta-analysis of the outcome indicators of postoperative pulmonary complications was conducted.Results A total of 12 articles were included.Meta-analysis showed that the incidence of postoperative pulmonary complications in the intervention group was lower than that in the control group,and the difference was statistically significant[RR=0.42,95%CI(0.32,0.55),P<0.01].Subgroup analysis was performed according to the duration of intervention,and the results showed that when the intervention duration was one week,the difference between the intervention group and the control group was statistically significant[RR=0.36,95%CI(0.24,0.55),P<0.01],when the intervention duration was more than one week,the difference between the intervention group and the control group was statistically significant[RR=0.48,95%CI(0.33,0.68),P<0.01)].Subgroup analysis was conducted with different evaluation time after operation,and the results showed that when the evaluation time was one month,the difference between the intervention group and the control group was statistically significant[RR=0.48,95%CI(0.34,0.68),P<0.01],when the evaluation time was more than one month,there was no significant difference between the intervention group and the control group[RR=0.39,95%CI(0.08,1.85),P=0.24].Except for pneumonia or pulmonary infection,atelectasis,and bronchopleural fistula,there was no significant difference in the incidence of postoperative pulmonary complications in patients with lung cancer(P>0.05).Conclusions Exercise that includes breathing training for at least one week is a common intervention for preoperative pulmonary rehabilitation.Preoperative pulmonary rehabilitation is beneficial to reduce the overall and one month postoperative pulmonary complications after lung cancer surgery,but the impact on postoperative pulmonary complications evaluated for more than one month and specific complications requires further study.