不同运动疗法对维持性血液透析患者疲乏干预效果的贝叶斯网状meta分析

Effect of different exercise therapies on fatigue intervention in maintenance hemodialysis patients:A Bayesian Network meta-analysis

目的运用贝叶斯网状meta评价不同运动疗法缓解维持性血液透析(MHD)患者疲乏的效果。方法计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、中国知网、中国生物医学文献、万方、维普数据库收集不同运动疗法干预MHD患者疲乏的随机对照试验(RCT),检索时间从建库至2022年6月。由2名研究者独立筛选文献、提取资料,并使用Cochrane手册推荐的RCT偏倚风险评估工具对纳入文献进行方法学质量评价,采用OpenBUGS和Stata14.0软件进行贝叶斯网状meta分析。结果共纳入36个RCT,合计2942例患者,包括5种运动疗法。贝叶斯网状meta分析结果显示:5种运动疗法在缓解MHD患者疲乏方面效果均优于单纯常规护理,其中有氧运动效果最佳;在改善睡眠质量方面,八段锦优于有氧运动、肌肉放松训练、抗阻联合有氧运动、单纯常规护理。结论在常规护理基础上,有氧运动对MHD患者疲乏干预效果最佳,八段锦在改善维持性血液透析患者睡眠质量方面效果显著,建议未来继续开展更多高质量、多中心、大样本的RCT以进一步验证结论。

Objective To evaluate the effect of different exercise therapies on fatigue in maintenance hemodialysis(MHD)patients by Bayesian network meta-analysis.Methods PubMed,EMbase,Web of Science,The Cochrane Library,CNKI,CBM,WanFang and VIP databases were searched to collect randomized controlled trials(RCTs)of different exercise therapies on fatigue in MHD patients from inception to June 2022.Two reviewers independently screened literature,extracted data and evaluated the methodology quality of the included literature using the RCT bias risk assessment tool recommended by the Cochrane Handbook.Bayesian network meta-analysis was performed using OpenBUGS and Stata14.0 software.Results A total of 36 RCTs involving 2942 patients were included,including five kinds of exercise therapy.The results of Bayesian network meta-analysis showed that the effects of five kinds of exercise therapy on alleviating fatigue in MHD patients were better than those of simple routine nursing,among which aerobic exercise had the best effect.In terms of improving sleep quality,Baduanjin is superior to aerobic exercise,muscle relaxation training,resistance combined with aerobic exercise,and simple routine nursing.Conclusion On the basis of routine nursing,aerobic exercise has the best effect on fatigue intervention in MHD patients.Baduanjin has a significant effect on improving sleep quality in maintenance hemodialysis patients.It is suggested that more high-quality,multi-center and large-sample RCTs should be carried out in the future to further verify the conclusion.