吸气肌训练对脱机失败者脱机疗效的系统综述  

Inspiratory muscle training for weaning outcomes in patients with weaning failure:a systematic review

作　　者：蔡倩 张溪 苏海荣 刘娜 黄颖 李际强 夏金根[3] 郑德采 CAI Qian;ZHANG Xi;SU Hairong;LIU Na;HUANG Ying;LI Jiqiang;XIA Jin'gen;ZHENG Decai(The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510006,China;The Ninth Medical Center of the People's Liberation Army,Beijing 100101,China;Department of Respiratory and Critical Care Medicine,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]广州中医药大学第二附属医院,广东广州市510006 [2]中国人民解放军第九医学中心,北京市100101 [3]中日友好医院呼吸与危重症医学科,北京市100029

出　　处：《中国康复理论与实践》2025年第3期306-313,共8页Chinese Journal of Rehabilitation Theory and Practice

基　　金：广东省中医药健康服务与产业发展研究中心项目(No.2024YBA04);广东省中医院中医康复人才培养项目(No.01020184);中日友好医院"菁英计划"人才培育工程骨干项目(No.ZRJY2023-GG21)。

摘　　要：目的系统评价吸气肌训练(IMT)对脱机失败者的脱机疗效。方法检索PubMed、Cochrane Library、Web of Science、Embase、中国知网、维普、万方和中国生物医学文献数据库中有关IMT对机械通气脱机失败者效果的中、英文文献,检索时限自建库至2024年10月22日。利用物理治疗证据数据库(PEDro)量表对纳入文献进行方法学质量评价,提取相关数据进行系统综述。结果最终纳入9篇随机对照试验,发表时间集中于2011年至2023年,来自巴西、中国、美国、伊朗和澳大利亚5个国家,共涉及499例患者。PEDro量表评分5~8分。研究对象包括延长脱机、困难脱机和气管切开者。IMT方式包括阈值负荷训练和锥形流阻训练。干预强度为30%~80%最大吸气压(MIP),部分研究没有根据MIP设定训练强度,强度进阶的方式各研究间差异较大。干预频率为每组5~30次呼吸,组间休息至少1 min,每次2~6组,每天1~2次,每周5~7 d。干预持续至成功脱机,或脱机后1周,或拔管,或4d~8周。干预疗效方面,IMT不能改善脱机失败者的机械通气时间和ICU住院时间,IMT对脱机失败者脱机成功率、脱机持续时间、MIP和病死率的效果,各项研究间结论不一致。结论IMT不能改善脱机失败者的机械通气时间和ICU住院时间,对脱机失败者脱机成功率、脱机持续时间、MIP和病死率的效果仍存在争议。Objective To systematically evaluate the effect of inspiratory muscle training(IMT)on weaning outcomes in patients with weaning failure.Methods Literatures in Chinese and English were retrieved from databases such as PubMed,Cochrane Library,Web of Science,Embase,CNKI,VIP,Wanfang data and CBM for researches on the effect of IMT in mechanical ventilation weaning failure,from the inception of the databases to October 22,2024.The methodological quality of the researches was evaluated with PEDro scale,and data were extracted for a systematic review.Results Nine randomized controlled trials were included,published between 2011 and 2023,from Brazil,China,the United States,Iran and Australia,with a total of 499 patients.The scores of the PEDro scale ranged five to eight.The population included patients with prolonged weaning,difficult weaning and tracheostomy.The IMT methods included threshold load training and tapered flow resistance training.The training intensity was 30%to 80%of maximal inspiratory pressure(MIP),and some researches did not set the training intensity based on MIP.The progression of intensity varied widely across researches.The intervention frequency ranged from five to 30 breaths per set,with at least one minute rest between sets,two to six sets per session,one to two sessions per day,and five to seven days per week.The duration of the intervention ranged from successful weaning,one week after weaning,extubation,or four days to eight weeks.Regarding the efficacy of the intervention,IMT was not beneficial for the duration of mechanical ventilation and intensive care unit(ICU)length of stay on weaning failure patients.However,the effect of IMT on weaning successful rates,duration of weaning,MIP and mortality was inconsistent.Conclusion IMT can not improve the duration of mechanical ventilation and ICU length of stay for weaning failure patients,and there is still debate regarding its effect on successful rate of weaning,duration of weaning,MIP and mortality.

关 键 词：吸气肌训练 脱机失败 通气机撤除法 系统综述 

分 类 号：R563.8[医药卫生—呼吸系统]