慢性心力衰竭患者吸气肌训练最佳运动方案的Meta分析

Best Exercise Plan for Inspiratory Muscle Training in Patients with Chronic Heart Failure:a Meta-analysis

目的采用Meta分析方法探讨慢性心力衰竭(CHF)患者吸气肌训练的最佳运动方案。方法计算机检索Cochrane Library、Scopus、PubMed、Web of Science、中国知网、维普网、万方数据知识服务平台公开发表的吸气肌训练对CHF患者干预效果的随机对照试验(试验组采用吸气肌训练或吸气肌训练联合常规康复疗法/常规护理,对照组采用无阻力吸气肌训练或常规康复疗法或常规护理)。检索时间为建库至2023-12-01。通过溯源法追溯参考文献。提取纳入文献的资料,使用RevMan 5.3和State 15.1软件进行Meta分析。结果共纳入15篇文献,总计544例CHF患者,其中对照组269例、试验组275例。Meta分析结果显示,试验组患者峰值耗氧量(pVO_(2))高于对照组〔均数差(MD)=2.42,95%CI(1.43~3.40),P<0.00001〕,6分钟步行距离长于对照组〔MD=65.96,95%CI(39.89~92.04),P<0.00001〕,呼吸困难评分低于对照组〔标准均数差(SMD)=-1.38,95%CI(-2.45~-0.30),P=0.01〕。以pVO_(2)为结局指标,根据吸气肌训练的运动强度、每日运动时间、运动频率、运动周期、周运动时间、总运动时间进行亚组分析,结果显示,在中等强度、高强度、30~40 min/d、3次/周、5~6次/周、7次/周、≤10周、≥12周、140~150 min/周、210~280 min/周、≤1800 min、2520 min患者中,试验组患者pVO_(2)高于对照组(P<0.05)。运动频率为7次/周的患者MD值大于5~6次/周的患者,周运动时间为210~280 min/周的患者MD值大于140~150 min/周的患者,总运动时间为2520 min的患者MD值大于≤1800 min的患者(P<0.05)。结论吸气肌训练可提高CHF患者pVO_(2),延长6分钟步行距离,降低呼吸困难评分。CHF患者吸气肌训练的最佳方案为运动强度从中等强度开始,根据患者疾病严重程度及耐受程度循序渐进,逐渐增加运动强度至高强度,30~40 min/d,7次/周,共12周。

Objective To explore the best exercise plan for inspiratory muscle training in patients with chronic heart failure(CHF)by meta-analysis.Methods Databases including the Cochrane Library,Scopus,PubMed,Web of Science,CNKI,VIP,Wanfang Data were retrieved to search for randomized controlled trials of effect of inspiratory muscle training in patients with CHF(the experimental group received inspiratory muscle training,inspiratory muscle training combined with routine rehabilitation therapy or routine nursing care,the control group received non resistance inspiratory muscle training,routine rehabilitation therapy,or routine nursing care).The search period was from inception to December 1,2023.The data of the included literature was extracted,RevMan 5.3 and Stata 15.1 were used for meta-analysis.Results A total of 15 articles were included,and involving 544 patients with CHF,with 269 cases in the control group and 275 cases in the experimental group.Meta-analysis results showed that peak oxygen consumption(pVO_(2))in experimental group was higher than that in control group[mean difference(MD)=2.42,95%CI(1.43-3.40),P<0.00001],6-minute walk distance was longer than that in control group[MD=65.96,95%CI(39.89-92.04),P<0.00001],and dyspnea score was lower than that in control group[standardized mean difference(SMD)=-1.38,95%CI(-2.45--0.30),P=0.01].Using pVO_(2) as the outcome indicator,subgroup analysis was conducted based on the exercise intensity,each exercise time,exercise frequency,exercise cycle,weekly exercise time,and total exercise time of inspiratory muscle training,and the results showed that pVO_(2) in experimental group was higher than that in control group in patients with moderate intensity,high intensity,30-40 min/d,3 times/week,5-6 times/week,7 times/week,≤10 weeks,≥12 weeks,140-150 min/week,210-280 min/week,≤1800 min,2520 min(P<0.05).The MD in patients with a exercise frequency of 7 times/week was larger than that in patients with 5-6 times/week,the MD in patients with a weekly exercise time of 210-280 min/week was larger than that in patients with 140-150 min/week,the MD in patients with a total exercise time of 2520 min was larger than that in patients with≤1800 min(P<0.05).Conclusion Inspiratory muscle training can increase pVO_(2),extend 6-minute walking distance,and reduce dyspnea scores in patients with CHF.The best exercise plan for inspiratory muscle training in patients with CHF is to start with moderate intensity of exercise,gradually increase the intensity of exercise to high intensity according to the severity of the patient's disease and tolerance level,30-40 min/d,7 times/week,and persist for 12 weeks.