增强型体外反搏治疗慢性心力衰竭效果的系统评价与Meta分析

Effects of enhanced external counterpulsation for patients with chronic heart failure:A systematic review and meta-analysis

目的评估增强型体外反搏治疗(enhanced external counterpulsation,EECP)对慢性心力衰竭患者运动能力和生活质量的影响。方法计算机检索PubMed、The Cochrane Library、EMbase、中国知网、万方、维普和中国生物医学文献数据库中关于心力衰竭患者EECP干预的随机对照试验,检索时限为2010年1月1日—2022年10月1日。两位研究员独立筛选文献和提取数据。采用RevMan 5.3软件进行Meta分析。结果共纳入19项随机对照试验。EECP诱导可显著改善6分钟步行距离[MD=57.37,95%CI(40.89,70.85),P<0.001]和左心室射血分数[SMD=0.85,95%CI(0.55,1.14),P<0.001],降低B型利钠肽水平[SMD=-0.67,95%CI(-1.09,-0.25),P=0.002],缩小左心室舒张末期内径[MD=-7.77,95%CI(-11.49,-4.04),P<0.001]和左心室收缩末期内径[MD=-8.53,95%CI(-13.47,-3.60),P<0.001],可改善患者生活质量[MD=16.34,95%CI(0.59,32.10),P=0.04]。结论EECP可以提高心力衰竭患者的运动能力、改善生活质量。但仍需要更多更大规模、设计良好的随机对照试验进行验证。

Objective To evaluate the effects of enhanced external counterpulsation(EECP)on exercise capacity and quality of life in patients with chronic heart failure.Methods PubMed,The Cochrane Library,EMbase,CNKI,Wanfang Data,VIP and CBM databases from January 1,2010 to October 1,2022 were searched by computer for the randomized controlled trial(RCT)about the intervention of EECP in patients with heart failure.Two researchers independently screened literature and extracted data.The meta-analysis was performed by RevMan 5.3.Results Nineteen RCTs were included.After EECP treatment,6-minute walk distance(MD=57.37,95%CI 40.89 to 70.85,P<0.001)and left ventricular ejection fraction improved(SMD=0.85,95%CI 0.55 to 1.14,P<0.001).B-type natriuretic peptide decreased significantly(SMD=−0.67,95%CI−1.09 to−0.25,P=0.002).The left ventricular end diastolic diameter(MD=−7.77,95%CI−11.49 to−4.04,P<0.001),and the left ventricular end systolic diameter were significantly reduced(MD=−8.53,95%CI−13.47 to−3.60,P<0.001).The quality of life of patients was improved(MD=16.34,95%CI 0.59 to 32.10,P=0.04).Conclusion EECP can improve the exercise ability and the quality of life in patients with heart failure.However,more and larger well-designed RCTs are still needed to verify this conclusion.