早期肺康复对慢性阻塞性肺疾病急性加重期患者干预效果的系统评价  

Early pulmonary rehabilitation in acute exacerbation of chronic obstructive pulmonary disease:a systematic review

作　　者：牛济慈 师晨曦 贾燕瑞[2] Niu Jici;Shi Chenxi;Jia Yanrui(School of Nursing,Capital Medical University,Beijing 100069,China;Department of Nursing,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China;Department of Respiratory and Critical Care Medicine,Beijing Institute of Respiratory Diseases and Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学护理学院,北京100069 [2]首都医科大学附属北京朝阳医院护理部,北京100020 [3]首都医科大学附属北京朝阳医院-北京市呼吸疾病研究所呼吸与危重症医学科,北京100020

出　　处：《中国中西医结合急救杂志》2024年第6期676-683,共8页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：首都卫生发展科研专项(2022-2-1063);北京市医管局“登峰”人才计划项目(DFL20240302)。

摘　　要：目的系统评价早期肺康复在慢性阻塞性肺疾病急性加重期(AECOPD)患者中的应用效果。方法计算机检索中国生物医学文献数据库、中国知网、万方数据库、维普数据库、Cochrane图书馆、美国国立医学图书馆PubMed数据库、科学网(Web of Science)、Ebsco、Scopus、荷兰医学文摘Embase数据库以及中国临床试验注册中心建库至2024年8月发表的关于早期肺康复在AECOPD患者中应用的相关文献。由2名研究者独立进行文献筛选、提取资料及文献质量评价后,采用Meta分析评估早期肺康复对AECOPD患者肺功能水平、运动能力、症状严重程度、生活质量及预后的影响,并绘制漏斗图分析纳入文献的发表偏倚。结果共纳入10篇文献,包括1155例患者。Meta分析结果显示,与病情稳定后进行的肺康复对照组比较,早期肺康复有助于改善AECOPD患者的肺功能水平:第1秒用力呼气容积〔FEV1,均数差(MD)=0.12,95%可信区间(95%CI)为0.07~0.17,P<0.00001〕、FEV1占预计值的百分比(FEV1%,MD=6.11,95%CI为1.85~10.38,P=0.005)、FEV1/用力肺活量(FVC)比值(MD=7.99,95%CI为4.88~11.11,P<0.00001)均明显增加,提升AECOPD患者的运动功能:6 min步行距离(6MWD)增加(MD=26.62,95%CI为12.87~40.37,P=0.0001),同时缓解症状,改善生活质量:改良英国医学研究委员会呼吸困难量表(mMRC)评分(MD=-0.41,95%CI为-0.60~-0.23,P<0.0001)和COPD评估测试(CAT)评分(MD=-1.73,95%CI为-2.73~-0.73,P=0.0007)均明显降低,但病死率明显提高〔优势比(OR)=1.65,95%CI为1.06~2.57,P=0.03〕。针对纳入文献总数最多的总有效率(即早期肺康复组与对照组相比的FEV1值)绘制漏斗图,结果显示,漏斗图呈大致对称分布,提示纳入文献存在发表偏倚的可能性较小。结论实施包含运动训练在内的早期肺康复能提升AECOPD患者的肺功能水平和运动功能,在缓解症状的同时能改善患者生活质量。Objective To evaluate the effectiveness of early pulmonary rehabilitation for patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)through systematic review.Methods Chinese biomedical literature database,China National Knowledge Infrastructure(CNKI),Wanfang database,VIP database,Cochrane Library,PubMed database of the National Library of Medicine,Web of Science(WOS),Ebsco,Scopus,Embase and Chinese Clinical Trial Registry database were searched for relevant literatures on the application of early pulmonary rehabilitation in patients with AECOPD published from the establishment of the database to August 2024.After literature screening,data extraction and literature quality evaluation by two researchers independently,Meta-analysis was used to evaluate the effects of early pulmonary rehabilitation on lung function,exercise capacity,symptom severity,quality of life and prognosis in patients with AECOPD,and the funnel plot was drawn.Results A total of 10 studies involving 1155 patients were included.The results of meta-analysis showed that compared with the control group of pulmonary rehabilitation after the condition was stable,early pulmonary rehabilitation helped to improve the lung function level of AECOPD patients:forced expiratory volume in 1 second[FEV1,mean difference(MD)=0.12,95%confidence interval(95%CI)was 0.07-0.17,P<0.00001],FEV1 as a percentage of predicted value(FEV1%,MD=6.11,95%CI was 1.85-10.38,P=0.005),FEV1/forced vital capacity(FVC)ratio(MD=7.99,95%CI was 4.88-11.11,P<0.00001).Early pulmonary rehabilitation significantly improved exercise capacity as measured by 6-minute walk distance(6MWD,MD=26.62,95%CI was 12.87-40.37,P=0.0001),and reduced both mMRC dyspnea scale(MD=-0.41,95%CI was-0.60 to-0.23,P<0.0001)and COPD assessment test(CAT)scores(MD=-1.73,95%CI was-2.73 to-0.73,P=0.0007).However,the mortality rate was significantly increased[odds ratio(OR)=1.65,95%CI was 1.06-2.57,P=0.03].The funnel plot was drawn for the total effective rate(FEV1 in the early pulmonary rehabili

关 键 词：慢性阻塞性肺疾病 慢性阻塞性肺疾病急性加重期 肺康复 循证护理 

分 类 号：R56[医药卫生—呼吸系统]