阈值负荷吸气肌训练对慢性阻塞性肺疾病患者呼吸功能、运动功能及生活质量影响的Meta分析

目的 系统分析阈值负荷吸气肌训练(TIMT)对慢性阻塞性肺疾病(COPD)患者呼吸、运动功能及生活质量的影响。 方法 从PubMed、EBSCO、Web of Science、Ovid、Cochrane Library、中国生物医学文献数据库、中国知网和维普数据库检索自建库至2020年9月关于TIMT对COPD患者呼吸、运动功能及生活质量影响的随机对照试验(RCT)。由两名研究者独立进行文献筛选、资料提取和质量评价,采用RevMan 5.3软件进行Meta分析。 结果 共纳入30个RCT,2 060例患者。TIMT能显著增加最大吸气压(MD = 10.68, 95%CI 7.43~13.92, P < 0.001),改善6分钟步行试验结果(MD = 24.62, 95%CI 9.09~40.15, P = 0.002)、圣乔治呼吸疾病问卷评分(MD = -3.08, 95%CI -5.84~-0.33, P = 0.03)、改良英国医学会研究协会呼吸困难量表评分(MD = -0.30, 95%CI -0.52~-0.07, P = 0.01)和Borg评分(MD = -0.84, 95%CI -1.24~-0.44, P < 0.001)。TIMT能改善第1秒用力最大呼气容积(MD = 0.11, 95%CI 0.04~0.19, P = 0.003)和第1秒钟用力呼气容积占预计值百分比(MD = 3.72, 95%CI 2.62~4.82, P < 0.001)。TIMT对COPD评估测试评分(MD = -1.14, 95%CI -2.32~0.03, P = 0.06)和用力肺活量(MD = 0.07, 95%CI -0.12~0.25, P = 0.49)无显著改善作用。 结论 TIMT能够提升COPD患者吸气肌肌力,缓解呼吸困难,提升患者肺功能、生活质量及运动能力。

Effects of threshold inspiratory muscle training on respiratory function,motor function and quality of life for patients with chronic obstructive pulmonary disease: a meta-analysis

Objective To systematically evaluate the effects of threshold inspiratory muscle training (TIMT) on respiratory function, motor function and quality of life in patients with chronic obstructive pulmonary disease (COPD). Methods Randomized controlled trials (RCT) about the effects of TIMT on dyspnea, quality of life, motor function and inspiratory muscle strength for COPD patients were retrieved from PubMed, EBSCO, Web of Science, Ovid, Cochrane Library, SinoMed, CNKI, VIP, since establishment to September, 2020. Two researchers independently screened literatures, extracted data and evaluated the methodological quality. A meta-analysis was performed using RevMan 5.3. Results A total of 30 RCTs involving 2 060 patients were included. TIMT could obviously improve the maximum inspiratory pressure (MD = 10.68, 95%CI 7.43 to 13.92, P< 0.001), optimize the results of 6-minute Walking Test (MD = 24.62, 95%CI 9.09 to 40.15, P= 0.002), the St George's Respiratory Questionnaire (MD = -3.08, 95%CI -5.84 to -0.33, P= 0.03), the modified Medical Research Council Dyspnea Scale (MD = -0.30, 95%CI -0.52 to -0.07, P= 0.01) and Borg score (MD = -0.84, 95%CI -1.24 to -0.44, P< 0.001). TIMT could also improve the forced expiratory volume in one second (MD = 0.11, 95%CI 0.04 to 0.19, P= 0.003) and the forced expiratory volume in one second in predicted (MD = 3.72, 95%CI 2.62 to 4.82, P< 0.001). There was no significant difference in the COPD Assessment Test (MD = -1.14, 95%CI -2.32 to 0.03, P= 0.06) or forced vital capacity (MD = 0.07, 95%CI -0.12 to 0.25, P= 0.49). Conclusion TIMT can improve the inspiratory muscle strength, alleviate the symptoms of dyspnea, and improve the lung function and the quality of life for COPD patients.