长期氧疗联合运动康复锻炼对慢性阻塞性肺疾病患者康复影响的meta分析

A meta-analysis of the effects of long-term oxygen therapy combined with exercise rehabilitation on the rehabilitation of patients with chronic obstructive pulmonary disease

目的通过meta分析评价长期氧疗联合运动康复锻炼对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的疗效。方法检索PubMed、Cochrane Library、Web of Science、中国知网、万方数据库及维普中文期刊全文数据库,收集长期氧疗联合运动康复锻炼对COPD患者影响的临床试验,检索时限为建库至2023年7月。采用Review Manager 5.4软件进行数据处理。结果共纳入11篇文献,包括研究对象403例(试验组201例和对照组202例)。Meta分析结果显示,长期氧疗联合运动康复锻炼与单纯运动锻炼相比,在改善心肺功能、运动耐力方面,差异均无统计学意义。长期氧疗联合运动康复锻炼可降低血乳酸水平[均数差(standardized mean difference,SMD)=-0.51,95%置信区间(confidence interval,CI):-0.93~-0.09,P=0.02];改善患者氧分压[平均差(mean difference,MD)=10.55,95%CI:9.62~11.49,P<0.01]、降低二氧化碳分压(MD=-5.15,95%CI:-5.67~-4.64),P<0.01;在生活质量方面,采用圣乔治呼吸问卷评价(MD=-8.22,95%CI:-9.32~-7.13,P<0.01)和BODE指数评估均提示改善(MD=0.51,95%CI:0.04~0.98,P=0.03)。结论长期氧疗联合运动康复锻炼相较单纯运动锻炼对COPD患者运动耐量、心肺功能等方面改变不明显,能改善生活质量,可视患者具体情况应用于临床康复治疗。

Objective To evaluate the effect of long-term oxygen therapy combined with exercise rehabilitation on chronic obstructive pulmonary disease(COPD)patients by meta-analysis.Methods PubMed,Cochrane Library,Web of Science,CNKI,Wanfang Database and VIP Chinese journal full-text database were searched to collect clinical trials on the effects of long-term oxygen therapy combined with exercise rehabilitation on COPD patients.The retrieval time was from the establishment of the databases to July 2023.Review Manager 5.4 software was used for data processing.Results A total of 11 literatures were included,including 403 subjects(201 subjects in experimental group and 202 subjects in control group).The results of meta-analysis showed that long-term oxygen therapy combined with exercise rehabilitation had no statistical significance in improving cardiopulmonary function and exercise endurance compared with exercise alone.Longterm oxygen therapy combined with exercise rehabilitation could reduce blood lactate level[standardized mean difference(SMD)=-0.51,95%confidence interval(CI):-0.93—-0.09,P=0.02].The partial pressure of oxygen was improved[mean difference(MD)=10.55,95%CI:9.62—11.49,P<0.01],and the partial pressure of carbon dioxide was decreased(MD=-5.15,95%CI:-5.67—-4.64,P<0.01).In terms of quality of life,both St.George's respiratory questionnaire evaluation(MD=-8.22,95%CI:-9.32—-7.13,P<0.01)and BODE index evaluation indicated improvement(MD=0.51,95%CI:0.04—0.98,P=0.03).Conclusion Long-term oxygen therapy combined with exercise rehabilitation has no significant changes in exercise tolerance,cardiopulmonary function and other aspects of COPD patients compared with exercise alone,and can improve the quality of life.It can be applied to clinical rehabilitation treatment according to the specific situation of patients.