目的通过对稳定期慢性阻塞性肺疾病(COPD)患者进行运动联合呼吸肌锻炼康复方式的相关文章评分并进行Meta分析,明确运动联合呼吸肌锻炼对稳定期COPD患者相关康复效果的影响,以期为临床康复护理提供依据。
方法通过计算机检索Cochrane数据库、MEDLINE、Embase、CINAHL 4个英文数据库以及中国生物医学文献数据库(CBM)、中国知网全文数据库(CNKI)、维普数据库(VIP)和万方数据库(wan fang)4个中文数据库,检索关于稳定期COPD患者进行运动联合呼吸肌锻炼的随机对照研究(randomized controlled trial,RCT)。检索时限均为从1990年1月至2017年10月。语种限制为中文、英文2种。由2名研究者独立平行的按照纳入与排除标准对检索文献进行初筛、全文筛查、提取资料,然后按照Cochrane5.1.0版的评价工具对纳入研究的方法学质量进行评价,最后采用RevMan5.3软件进行Meta分析。
结果本研究共纳入7篇相关文献,其中5篇为英文,2篇为中文,总计7项RCT研究包含267名符合纳入标准的稳定期COPD患者。本研究纳入的7项研究结果显示:踏车运动联合呼吸肌锻炼是最常见的复合康复方法。Meta分析结果显示:运动联合呼吸肌锻炼干预组与单纯运动康复组在FEV 1占预计值百分比、6MWD、mMRC方面比较,差异均有统计学意义,在用力肺活量(FVC)和1秒用力呼气容积(FEV 1)指标上敏感性分析前后存在较大差异,在FEV 1/FVC(%)、生命质量和PaO 2上比较,差异无统计学意义,PaCO 2尚不能联合。
结论运动联合呼吸肌锻炼与单纯运动康复比较对稳定期的COPD患者而言是一种可靠的康复方式,它对稳定期COPD患者的FEV 1占预计值的百分比、活动能力、呼吸困难程度的影响有正性作用;对稳定期COPD患者的FVC、FEV 1指标的改善作用结果尚不稳定;对于稳定期COPD患者的FEV 1/FVC(%)、生命质量、PaO 2和PaCO 2影响尚不能确定。
ObjectiveThe purpose of this study was to conduct a Meta-analysis to assess the influence of physical therapy and respiratory muscle training on rehabilitation of patients with stable chronic obstructive pulmonary disease. To provide a basis for better rehabilitation exercise for patients, families, communities and hospitals.
MethodsAccording to the literature search strategy, the relative literatures of randomized controlled trials (RCTS) of physical therapy and respiratory muscle training on rehabilitation of patients with chronic obstructive pulmonary disease were searched in Cochrane Library、MEDLINE、Embase、CINAHL、CBM、Wan Fang、CNKI and VIP from January 1990 to October 2017. Languages are limited to Chinese and English.The literatures were screened according to the predefined inclusion and exclusion criteria by two people . Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 were used to assess the quality of articles. The data were analyzed by Revman5.3.
ResultsA total of 7 articles were finally included, among of these 5 of which were written in English , Others were written in Chinese .They included 7 studies of randomized controlled trial and 267 patients with chronic obstructive pulmonary disease .7 studies show that treadmill exercise and respiratory muscle exercise are the most common rehabilitation methods.7 articles result of Meta-analysis showed that there were statistical differences between physical therapy and respiratory muscle training and other therapies in 6MWD、mMRC and FEV 1%;More research is needed on the impact of other outcome measures.
ConclusionsPhysical therapy and respiratory muscle training is a reliable way of rehabilitation, it to the stabilization of COPD patients FEV 1 % of expected value, activity ability, the influence of the degree of difficulty in breathing has a positive role.It is not stable for the positive effect of FVC and FEV 1 .However, the effects of other outcome measures were not determined.
宋运莲,邵荣雅,韩慧,等. 运动联合呼吸肌锻炼对稳定期慢性阻塞性肺疾病患者康复效果的Meta分析[J]. 中国实用护理杂志,2020,36(29):2313-2321.
DOI:10.3760/cma.j.cn211501-20200107-00072版权归中华医学会所有。
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