运动干预对维持性血液透析患者躯体功能影响的Meta分析

Effects of exercise on physical function in maintenance hemodialysis patients:a meta-analysis

目的系统评价运动对维持性血液透析(maintenance hemodialysis,MHD)患者躯体功能的影响。方法计算机检索PubMed、Cochrane Library、Embase、Web of Science、中国知网、万方、维普、中国生物医学文献数据库中运动对提高MHD患者躯体功能的随机对照试验,检索时限截至2022年1月。采用RevMan 5.3进行统计分析。结果纳入文献25篇,共1478例患者。Meta分析结果显示:运动可以提高MHD患者峰值摄氧量(MD=2.923,95%CI:1.763~4.083,Z=4.940,P<0.001)、30s坐立试验(MD=3.005,95%CI:1.403~4.607,Z=3.680,P<0.001)、60s坐立试验(MD=2.456,95%CI:1.140~3.772,Z=3.660,P<0.001)、计时起立行走测试(MD=-1.061,95%CI:-2.009~-0.114,Z=2.200,P=0.030)、握力(MD=2.436,95%CI:0.278~4.595,Z=2.210,P=0.030),但对5次坐立试验改善效果不明显(MD=0.184,95%CI:-0.360~0.730,Z=0.660,P=0.510)。结论运动可以提高MHD患者峰值摄氧量、30s坐立试验、60s坐立试验、计时起立行走测试、握力。在临床工作中,可以结合实际情况进行不同运动干预,提高患者躯体功能。

Objective To systematically evaluate the effect of exercise on physical function in maintenance hemodialysis(MHD)patients.Methods PubMed,Cochrane Library,Embase,Web of Science,CNKI,Wanfang,VIP,and CBM were searched for randomized controlled trials(RCTs)about the effects of exercise on physical function in MHD patients from the inception to January 1,2022.Meta-analysis was performed by RevMan 5.3.Results A total of 25 RCTs with 1478 participants were included.Meta-analysis showed that exercise significantly improved peak oxygen uptake(MD=2.923,95%CI:1.763~4.083,Z=4.940,P<0.001),30s sit-to-stand(STS)(MD=3.005,95%CI:1.403~4.607,Z=3.680,P<0.001),60s STS(MD=2.456,95%CI:1.140~3.772,Z=3.660,P<0.001),time up and go(MD=-1.061,95%CI:-2.009,-0.114,Z=2.200,P=0.030),and handgrip strength(MD=2.436,95%CI:0.278~4.595,Z=2.210,P=0.030),but there was no significant improvement in 5 times STS(Z=0.660,P=0.510).Conclusion Exercise can improve peak oxygen uptake,30s STS,60s STS,time up and go,and handgrip strength in MHD patients.In practice,we can combine the condition of dialysis centers and MHD patients,actively carry out different exercises,improve the physical function of patients.