远程心脏康复对慢性心力衰竭患者影响的Meta分析

Effects of remote cardiac rehabilitation on the patients with chronic heart failure:a Meta-analysis

目的:系统评价远程心脏康复(CR)对慢性心力衰竭(CHF)患者的影响。方法:计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网(CNKI)、中国生物医学文献数据库、万方数据知识服务平台、维普中文科技期刊数据库(VIP),收集远程CR应用于CHF患者的随机对照试验相关文献,检索时限为建库至2022年4月。对符合纳入、排除标准的文献进行质量评价,使用RevMan 5.3软件对提取数据进行Meta分析。结果:最终纳入20篇文献,共2670例患者。Meta分析结果显示,与传统康复护理相比,远程CR能有效地提高CHF患者心肺功能(MD=31.58,95%CI:10.5~52.67,P=0.003)、运动功能(MD=38.59,95%CI:22.73~54.46,P<0.05)、VO_(2)峰值(MD=2.72,95%CI:0.62~4.82,P=0.01)、生活质量(MD=-10.24,95%CI:-13.51~-6.97,P<0.0001)、CR依从性(RR=2.51,95%CI:1.58~3.99,P<0.0001);在缓解焦虑(MD=-0.30,95%CI:-0.61~0.02,P>0.05)和抑郁方面(MD=-0.19,95%CI:-0.52~0.15,P>0.05)两者差异无统计学意义。结论:远程CR与传统康复护理相比,能有效地改善CHF患者的心肺功能和运动能力,提升其生活质量和CR依从性,但在改善心理健康方面缺乏证据支持。需要进一步的研究验证远程CR对CHF患者的有效性、安全性和成本效益。

Objective:To systematically evaluate the effect of remote cardiac rehabilitation(CR)on patients with chronic heart failure(CHF).Methods:Computerized search of PubMed,Web of Science,Cochrane Library,Embase,CNKI,China biomedical literature database,Wanfang and VIP were performed to collect randomized controlled trials of remote CR applied to CHF patients,with a search timeframe of the period from inception to April 2022.Literatures that met the inclusion and exclusion criteria were evaluated for quality,and Meta-analysis of the extracted data were performed using RevMan 5.3 software.Results:A total of 20 studies with 2670 patients were included.The results of the Meta-analysis showed that compared with traditional rehabilitation care,remote CR can effectively improve the cardiopulmonary function(MD=31.58,95%CI:10.5-52.67,P=0.003),motor function(MD=38.59,95%CI:22.73-54.46,P<0.05),peak VO_(2)(MD=2.72,95%CI:0.62-4.82,P=0.01),quality of life(MD=-10.24,95%CI:-13.51--6.97,P<0.0001),and adherence CR compliance(RR=2.51,95%CI:1.58-3.99,P<0.0001)of CHF patients.There was no statistically significant difference in relieving anxiety(MD=-0.30,95%CI:-0.61-0.02,P>0.05)and depression(MD=-0.19,95%CI:-0.52-0.15,P>0.05).Conclusion:Remote CR is effective in improving cardiopulmonary function and motor function,quality of life and CR compliance in patients with CHF compared with traditional rehabilitation care,but there is a lack of evidence to support the improvement in mental health.Further studies are needed to validate the effectiveness,safety,and cost-effectiveness of remote CR for CHF patients.