八段锦改善非小细胞肺癌术后康复效果的meta分析

Effect of Baduanjin exercise on rehabilitation of postoperative patients with non-small cell lung cancer:a meta-analysis

目的通过meta分析了解八段锦对非小细胞肺癌术后的康复效果。方法检索数据库:PubMed、Web of Science、Cochrane Library、Embase、CNKI、CBM、VIP和万方数据库,搜索有关八段锦改善非小细胞肺癌术后患者康复效果的随机对照试验(RCT),检索时限为建库至2023年4月。由2名研究者独立筛选文献、提取资料并采用考克兰偏倚风险评估工具ROB2.0评价纳入研究的偏倚风险,采用STATA17.0软件、RevMan5.3软件进行meta分析。结局指标:主要结局指标6分钟步行试验(6MWD)、焦虑自评量表(SAS)、抑郁自评量表(SDS),次要结局指标为Borg评分、肺功能测试[第一秒用力呼气量(FEV1)、用力肺活量(FVC)]、肿瘤治疗功能评价量表-肺癌(FACT-L4.0)。结果最终纳入7个RCT,包括437例患者。meta分析显示,与对照组相比,八段锦组在6MWD[WMD=21.73,95%CI(16.07,27.40),P<0.001]、SAS得分[WMD=-9.23,95%CI(-10.13,-8.32),P<0.001]、SDS得分[WMD=-4.67,95%CI(-7.39,-1.95),P=0.001]、肺功能测试的FEV1[WMD=0.17,95%CI(0.06,0.28),P=0.003]、FVC[WMD=0.18,95%CI(0.06,0.30),P=0.003]、FACT-L4.0中的生理状况评分[WMD=3.94,95%CI(2.89,4.99),P<0.001]、情感状况评分[WMD=3.73,95%CI(0.57,6.90),P=0.021]、功能状况评分[WMD=7.23,95%CI(6.07,8.38),P<0.001]、总分[WMD=14.96,95%CI(0.35,29.57),P=0.045]均优于对照组,但在改善患者Borg呼吸困难评分[WMD=-0.19,95%CI(-0.39,0.01),P=0.06]、FEV1/FVC[SMD=0.14,95%CI(-0.24,0.51),P=0.468]、FACT-L4.0中的社会/家庭状况评分[WMD=0.44,95%CI(-0.72,1.61),P=0.455]、附加的关注状况评分[WMD=1.87,95%CI(-1.33,5.06),P=0.252]与对照组比较,差异无统计学意义(P>0.05)。结论八段锦可有效提升非小细胞肺癌术后患者的活动耐量、心理状况及肺功能,且安全可行,但在改善呼吸困难方面、生活质量方面期待更多高质量研究证实。

Objective To investigate the effect of Baduanjin on postoperative rehabilitation of non-small cell lung cancer(NSCLC)by meta-analysis.Methods Electronic literature search was performed on PubMed,Embase,Cochrane Library,Web of Science,CNKI,CBM,VIP and Wan Fang database.The randomized controlled trials(RCTS)of the effect of Baduanjin in improving postoperative rehabilitation of patients with NSCLC was searched from the database establishment until April 2023.Two investigators independently screened the literature,extracted data and evaluated the risk of bias using the Cochrane risk of bias assessment tool ROB 2.0.Meta-analysis was conducted using STATA17.0 software and RevMan 5.3 software.The main outcome measures were 6-minute walking test(6MWD),self-rating Anxiety Scale(SAS),and self-rating Depression Scale(SDS).The secondary outcome measures were Borg score,pulmonary function test[forced expirative volume in the first second(FEV1),forced vital capacity(FVC)],and Functional Assessment of Cancer Therapy-Lung 4.0(FACT-L 4.0).Results A total of seven articles and 437 cases were included in the literature.Compared with the control group,Meta-analysis showed that,Baduanjin group at 6MWD[WMD=21.73,95%CI(16.07,27.40),P<0.001],SAS scores[WMD=-9.23,95%CI(-10.13,-8.32),P<0.001],SDS scores[WMD=-4.67,95%CI(-7.39,-1.95),P=0.001],FEV1[WMD=-0.17,95%CI(0.06,0.28),P=0.003],FVC[WMD=-0.18,95%CI(0.06,0.30),P=0.003],the physiologic condition scores in FACT-L4.0[WMD=3.94,95%CI(2.89,4.99),P<0.001],emotional status scores[WMD=3.73,95%CI(0.57,6.90),P=0.021],functional status scores[WMD=7.23,95%CI(6.07,8.38),P<0.001],and the total scores[WMD=14.96,95%CI(0.35,29.57),P=0.045]were all better than the control group,the differences were statistically significant.However,it was not statistically significant in the improved Borg dyspnea scores[WMD=-0.19,95%CI(-0.39,0.01),P=0.06],FEV1/FVC[SMD=0.14,95%CI(-0.24,0.51),P=0.468],social/family status scores in the FACT-L 4.0[WMD=0.44,95%CI(-0.72,1.61),P=0.455],additional status of concern scores[WMD=1.87,95%CI(-1.33,5.06),P=0.252].Conclusion Baduanjin can effectively improve the activity tolerance,psychological status and lung function of patients after NSCLC surgery,which is safe and feasible,but more high-quality studies are expected to confirm the improvement of dyspnea symptoms and quality of life.