脚踏车运动对维持性血液透析患者运动能力和循环状态影响的Meta分析  

Effect of Cycling on Exercise Capacity and Circulatory State in Maintenance Hemodialysis Patients:a Meta-analysis

作　　者：赵萍 黄燕林[1] 何莉 杨震 卢海珍 ZHAO Ping;HUANG Yanlin;HE Li;YANG Zhen;LU Haizhen(Department of Nephrology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院肾内科,广西壮族自治区南宁市530021

出　　处：《中国全科医学》2020年第14期1769-1777,共9页Chinese General Practice

基　　金：广西自然科学基金资助项目(2010GXNSFA013192)。

摘　　要：背景血液透析是终末期肾脏病替代治疗方式之一,但可能带来失衡综合征、运动能力减弱、血管通路感染等并发症。运动疗法被广泛应用于防治相关并发症,但关于脚踏车运动能否显著改善维持性血液透析(MHD)患者运动能力和循环状态仍存在不同意见。目的系统评价脚踏车运动对改善MHD患者运动能力和循环状态的临床效果。方法使用计算机检索PubMed、Web of Science、ScienceDirect、CINAHL、Physiotherapy Evidence Database(PEDro)、Wily Online Library、中国知网(CNKI)、万方数据知识服务平台、维普网(VIP)、中国生物医学文献数据库(CBM)等数据库,检索时限为2000年1月-2019年4月,收集MHD患者应用脚踏车运动的随机对照试验(RCT)。对纳入文献进行质量评价和数据提取,并对6 min步行试验(6MWT)距离、最大摄氧量(VO2 peak)、手握力、脉搏波速度(PWV)、收缩压(SBP)、舒张压(DBP)、心率(HR)、生理健康评分(PCS)、心理健康评分(MCS)等指标进行Meta分析。结果共纳入22项RCT,710例患者,文献质量均为B级。Meta分析结果显示,脚踏车运动能提高MHD患者运动能力〔SMD=62.31,95%CI(48.43,76.19),P<0.001〕,提高其VO2 peak〔SMD=3.06,95%CI(1.70,4.41),P<0.001〕,改善其手握力〔SMD=6.30,95%CI(3.64,8.95),P<0.001〕、SBP〔SMD=-5.65,95%CI(-9.52,-1.78),P=0.004〕、DBP〔SMD=-3.76,95%CI(-5.95,-1.58),P=0.0007〕、HR〔SMD=-4.86,95%CI(-8.82,-0.89),P=0.020〕、PCS〔SMD=4.12,95%CI(1.19,7.05),P=0.006〕。结论MHD患者在血液透析期间进行以脚踏车运动为主的有氧运动能有效提升运动能力,改善循环状况和生活质量。Background Hemodialysis is one of the alternative therapies for end-stage renal disease,but it may cause complications such as dialysis disequilibrium syndrome,decreased motor ability,vascular access-related infections,etc.Exercise therapy is widely used to prevent and treat the aforementioned complications,but there are still different opinions on whether cycling can significantly improve the exercise ability and circulation status of patients with maintenance hemodialysis(MHD).Objective To systematically evaluate the clinical effects of cycling on exercise capacity and circulatory state of MHD patients.Methods Electronic databases,including Pub Med,Web of Science,Science Direct,CINAHL,Physiotherapy Evidence Database(PEDro),Wily Online Library,CNKI,Wanfang Data Knowledge Service Platform,VIP,and CMB were systematically searched for randomized controlled trials(RCTs) of MHD patients using cycling interventions included from January 2000 to April 2019.Quality assessment and data extraction were performed.And meta-analysis was carried out on outcome indicators of six-minute walking test,VO2 peak,hand grip strength,pulse wave velocity,systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),physical component score(PCS),and mental component score(MCS).Results Twenty-two RCTs with 710 participants were included.The quality of all of them was evaluated as "B".The results of meta-analyses showed that cycling could improve the exercise capacity of MHD patients[SMD=62.31,95%CI(48.43,76.19),P<0.001],increase their VO2 peak [SMD=3.06,95%CI(1.70,4.41),P<0.001],and improve their hand grip strength[SMD=6.30,95%CI(3.64,8.95),P<0.001],SBP[SMD=-5.65,95%CI(-9.52,-1.78),P=0.004],DBP[SMD=-3.76,95%CI(-5.95,-1.58),P=0.000 7],HR[SMD=-4.86,95%CI(-8.82,-0.89),P=0.020],and PCS[SMD=4.12,95%CI(1.19,7.05),P=0.006].Conclusion Aerobic exercise with cycling as the main form in MHD patients during hemodialysis interval can effectively improve exercise capacity,circulatory state and quality of life.

关 键 词：肾脏疾病 维持性血液透析 有氧运动 脚踏车运动 运动能力 循环状态 收缩压 舒张压 META分析 

分 类 号：R459.5[医药卫生—治疗学]