心脏瓣膜疾病手术患者运动康复的证据图谱

Evidence mapping of exercise rehabilitation in patients undergoing surgery for valvular heart disease

目的应用证据图谱方法对现有运动康复在心脏瓣膜疾病手术患者的相关证据进行梳理、描述及评价。方法检索中国知网、万方数据、维普、中国生物医学文献数据库、Embase、PubMed、Cochrane Library、Web of Science、Ovid和CINAHL等多个数据库中关于心脏瓣膜疾病手术患者运动康复的系统评价和随机对照研究,检索时限为建库至2024年4月23日。对纳入文献进行质量评价,并通过气泡图和表格形式可视化地呈现纳入文献的特征信息。结果最终纳入51篇文献(包括44篇随机对照研究和7篇系统评价)。44篇随机对照研究中,运动类型主要涉及无氧运动(3篇)、有氧运动(11篇)、柔韧性训练(8篇)和多元运动(22篇);术后住院康复占比较高(16篇),其次是整体的术后康复(13篇)和术前预康复(7篇);27篇文献结论被归类为“有益”,15篇为“可能有益”,各有1篇评为“不清楚”和“不影响”。7篇系统评价均进行了Meta分析,在纳入的研究设计方面,仅纳入随机对照试验的系统评价有3篇;研究结论中,3篇为“有益”,3篇为“可能有益”,有1篇为“不清楚”。结论证据图谱显示运动康复对心脏瓣膜疾病手术患者的康复效果是普遍有益或可能有益的,主要应用于术后住院康复阶段。对运动方案中不同强度、频率和持续时间的有效性以及不同瓣膜类型、运动不良反应和其他结局指标等方面,需要高质量研究进一步探讨。

Objective The existing evidence of exercise rehabilitation in patients undergoing surgery for valvular heart disease was analyzed,described and evaluated by using evidence mapping methods.Methods Systematic reviews and randomized controlled trials on exercise rehabilitation of patients undergoing valvular heart disease surgery were searched from CNKI,Wanfang Data,VIP,CBM,Embase,PubMed,Cochrane Library,Web of Science,Ovid,CINAHL and other databases,and the search period was established until April 23,2024.The quality of the included literature was evaluated,and the feature information of the included literature was visualized in the form of bubble map and table.Results Fifty-one literatures(including 44 randomized controlled trials and 7 systematic evaluations)were finally included.Among the 44 randomized controlled trials,the types of exercise were mainly related to anaerobic exercise(3 literatures),aerobic exercise(11 literatures),flexibility training(8 literatures),and multisport exercise(22 literatures);postoperative inpatient rehabilitation accounted for a relatively high proportion(16 literatures),followed by overall postoperative rehabilitation(13 literatures)and pre-operative prehabilitation(7 literatures).Twenty-seven conclusions were categorized as“beneficial”,15 as“possibly beneficial,”and one ach as“unclear”and“no effect”.Seven systematic evaluations were subjected to Meta-analysis,and in terms of the design of the included studies,there were only 3 systematic reviews that included randomized controlled trials.Of the study conclusions,three were“beneficial”,three were“possibly beneficial”and one was“unclear”.Conclusion The evidence mapping shows that exercise rehabilitation is generally beneficial or potentially beneficial in the rehabilitation of valvular heart disease surgery,mainly in the postoperative inpatient rehabilitation phase.High-quality studies are needed to further investigate the effectiveness of exercise programs with different intensities,frequencies,and durations,as well as different valve types,adverse effects of exercise,and other outcome indicators.