机械通气患者吸气肌训练效果的Meta分析  

Inspiratory muscle training in patients with mechanical ventilation:a meta-analysis

作　　者：姚丽 杨琳[4] 杨丽平[2] 张志刚[3] 张彩云[1] 丁楠楠 田金徽[5] YAO Li;YANG Lin;YANG Liping;ZHANG Zhigang;ZHANG Caiyun;DING Nannan;TIAN Jinhui

机构地区：[1]兰州大学第一医院护理部,兰州市730000 [2]兰州大学第一医院特需外科,兰州市730000 [3]兰州大学第一医院重症医学科,兰州市730000 [4]兰州大学护理学院,兰州730000 [5]兰州大学第一医院循证医学中心,兰州市730000

出　　处：《中华护理杂志》2020年第1期141-147,共7页Chinese Journal of Nursing

基　　金：甘肃省自然科学基金(17JR5RA266)。

摘　　要：目的评价吸气肌训练在机械通气患者中的应用效果。方法计算机检索Cochrane Library、PubMed、Web of Science、Embase、中国生物医学文献数据库、中国学术期刊全文数据库和万方数据库中有关机械通气患者吸气肌训练效果的随机对照试验,采用RevMan 5.3软件进行Meta分析。结果最终纳入21篇文献,共1 014例患者。Meta分析结果显示,吸气肌训练能有效改善机械通气患者训练后最大吸气压[WMD=7.98,95%CI(7.22,8.73),P<0.001]、训练前后最大吸气压差值[WMD=5.76,95%CI(4.23,7.29),P<0.001]、动脉氧分压[WMD=9.55,95%CI(4.00,15.10),P<0.001]和动脉血氧饱和度[WMD=2.00,95%CI(1.15,2.85),P<0.001];缩短患者机械通气时间[SMD=-0.33,95%CI(-0.52,-0.14),P<0.001]、脱机时间[SMD=-1.00,95%CI(-1.51,-0.48),P<0.001]和ICU住院时间[WMD=-3.46,95%CI(-5.36,-1.56),P<0.001];并降低病死率[RR=0.55,95%CI(0.33,0.91),P=0.02],差异均具有统计学意义(P<0.05)。结论吸气肌训练能有效改善机械通气患者最大吸气压,提高呼吸肌肌力与耐力,改善患者氧合状态,从而缩短机械通气时间、脱机时间和ICU住院时间,并降低病死率。Objective To evaluate the effectiveness of inspiratory muscle training(IMT) among patients with mechanical ventilation(MV). Methods We searched databases including Cochrane Library,PubMed,Web of Science,EMbase,CBM,CNKI and Wanfang Data. We used RevMan 5.3 software to conduct meta-analysis. Results A total of 21 RCTs including 1,014 patients were included in this meta-analysis. The meta-analysis showed that IMT could improve terminal maximal inspiratory pressure(MIP),difference MIP,PaO2 and SaO2[WMD and 95%CI were 7.98(7.22,8.73);5.76(4.23,7.29);9.55(4.00,15.10);2.00(1.15,2.85)];decrease duration of MV,duration of weaning and length of stay in ICU[SMD/WMD and 95%CI were-0.33(-0.52,-0.14);-0.99(-1.50,-0.48);-3.46(-5.36,-1.56)],and reduce mortality [RR=0.55,95%CI(0.33,0.91),P=0.02]. Conclusion IMT was effective in improving MIP and respiratory muscle strength and endurance,improving patients’ oxygenation status,and reducing duration of MV,weaning,length of stay in ICU,and mortality.

关 键 词：吸气肌训练 机械通气 重症监护 随机对照试验 META分析 

分 类 号：R473[医药卫生—护理学]