吸气肌训练改善食管癌患者术后效果的Meta分析

Clinical application of inspiratory muscle training in postoperative patients with esophageal cancer:a meta-analysis

目的系统评价吸气肌训练改善食管癌患者术后结局的效果。方法计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、CNKI、WanFang Data和VIP数据库,搜集吸气肌训练改善食管癌患者术后的随机对照试验(RCT)和队列研究,检索时限均从建库至2022年1月16日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入8个研究,包括7个RCT和1个队列研究,共计728例患者。Meta分析结果显示,吸气肌训练能提高食管癌患者术后的呼吸肌功能[最大吸气压(MIP):MD=5.75,95%CI(0.81,10.70),P=0.02,最大呼气压(MEP):MD=8.19,95%CI(4.14,12.24),P<0.001]和肺功能[FEV_(1)%:MD=6.94,95%CI(5.43,8.45),P<0.001,FVC%:MD=4.65,95%CI(2.70,6.60),P<0.001,MVV:MD=8.66,95%CI(7.17,10.14),P<0.001和FEV_(1)/FVC%:MD=8.04,95%CI(4.68,11.40),P<0.001];改善患者术后的运动能力[6分钟步行距离(6MWT):MD=66.99,95%CI(10.13,123.85),P=0.02;Borg指数:MD=-1.03,95%CI(-1.26,-0.81),P<0.001],但不能降低术后并发症的发生。结论吸气肌训练可改善食管癌患者术后结局,促进患者康复,具有较好的临床推广价值。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研究予以验证。

Objective To systematically review the effect of inspiratory muscle training(IMT)on postoperative clinical outcomes among esophageal cancer patients.Methods The PubMed,EMbase,Web of Science,The Cochrane Library,CNKI,WanFang Data and VIP databases were searched from inception to January 16th,2022 for randomized controlled trials(RCTs)and cohort studies on the clinical application of IMT among postoperative esophageal cancer patients.Two reviewers independently screened the literature,extracted data,and assessed the risk of bias of the included studies.Meta-analysis was then performed using RevMan 5.4 software.Results Eight studies were included,including 7RCTs and 1 cohort study,involving 728 participants.The results of the meta-analysis demonstrated that IMT significantly enhanced postoperative respiratory muscle function[maximum inspiratory pressure(MIP):MD=5.75,95%CI 0.81 to10.70,P=0.02;maximum expiratory pressure(MEP):MD=8.19,95%CI 4.14 to 12.24,P<0.001]and pulmonary function(FEV_(1)%:MD=6.94,95%CI 5.43 to 8.45,P<0.001;FVC%:MD=4.65,95%CI 2.70 to 6.60,P<0.001;MVV:MD=8.66,95%CI7.175010.14,P<0.001;FEV_(1)/FVC%:MD=8.04,95%CI 4.68 to 11.40,P<0.001).Additionally,the results indicated that IMT could substantially improve postoperative functional performance[six-minute walk test(6MWT):MD=66.99,95%CI10.13 to 123.85,P=0.02;Borg index:MD=-1.03,95%CI-1.26 to-0.81,P<0.001].However,no significant reduction in the incidence of postoperative complications was observed.Conclusion IMT can improve the postoperative clinical outcomes of esophageal cancer patients and facilitate patient recovery after surgery,which has high clinical value.Due to the limited quantity and quality of the included studies,more high-quality studies are needed to verify the above conclusion.