阈值压力负荷吸气肌训练对哮喘患者肺康复及生活质量影响的Meta分析

doi:10.3761/j.issn.0254-1769.2021.07.007

摘要/Abstract

摘要：

目的通过Meta分析评价阈值压力负荷吸气肌训练对哮喘患者肺康复及生活质量的影响。方法计算机检索Cochrane Library、PubMed、Embase、Web of Science、万方、中国知网、维普及中国生物医学文献数据库中有关吸气肌训练对哮喘患者肺康复及生活质量影响的随机对照试验,检索时限为建库至2021年1月6日。经质量评价后,采用RevMan 5.3软件进行Meta分析。结果共纳入10篇文献,包括456例患者。Meta分析结果显示,阈值压力负荷吸气肌训练可改善患者的用力肺活量[SMD=0.90,95%CI（0.68,1.11）,P<0.001]、第1秒用力呼气容积[SMD=0.62,95%CI（0.41,0.83）,P<0.001]、呼气峰值流速[WMD=0.32,95%CI（0.01,0.62）,P=0.040]、最大自主通气量[WMD=11.89,95%CI（6.42,17.37）,P<0.001],增强患者的最大吸气压[SMD=29.76,95%CI（18.15,41.36）,P<0.001],减轻其呼吸困难程度[SMD=-0.51, 95%CI（-0.95,-0.06）,P<0.001],延长6 min步行距离[WMD=77.13,95%CI（24.58,129.67）,P=0.004],但在改善患者生活质量方面,差异无统计学意义[SMD=1.21,95%CI（-2.11,4.52）,P=0.480]。结论阈值压力负荷吸气肌训练可改善哮喘患者的多项肺功能指标,增强其呼吸肌肌力,减轻呼吸困难程度,延长患者6 min步行距离,但在改善生活质量方面效果不显著,后期需开展更多临床高质量研究进一步验证其有效性。

关键词: 阈值压力负荷, 抗阻训练, 哮喘, 肺康复, 生活质量, Meta分析, 护理

Abstract:

Objective To evaluate the effect of threshold-pressure inspiratory muscle training on pulmonary rehabilitation and quality of life in asthma patients by meta-analysis. Methods We searched the Cochrane Library,PubMed,Embase,Web of Science,Wanfang,CNKI,VIP,and CBM databases for randomized controlled trial studies on the effects of inspiratory muscle training on pulmonary rehabilitation and quality of life in patients with asthma. The search time is from the establishment of databases to January 6,2021. After the quality evaluation,meta-analysis was performed using RevMan 5.3 software. Results A total of 10 publications including 456 patients were included,and the meta-analysis showed that threshold-pressure inspiratory muscle training improved patients’ forced vital capacity[SMD=0.90,95%CI（0.68,1.11）,P<0.001],forced expiratory volume in a second[SMD=0.62,95%CI（0.41,0.83）,P<0.001],peak expiratory flow [WMD=0.32,95%CI（0.01,0.62）,P=0.040],maximum voluntary ventilation[WMD=11.89,95%CI（6.42,17.37）,P<0.001],and maximum inspiratory pressure[SMD=29.76,95%CI（18.15,41.36）,P<0.001],reduced their dyspnea[SMD=-0.51,95%CI（-0.95,-0.06）,P<0.001],and increased their 6-min walk distance[WMD=77.13,95%CI（24.58,129.67）,P=0.004]. However,the difference in improving their quality of life was not statistically significant[SMD=1.21,95%CI（-2.11,4.52）,P=0.480]. Conclusion Threshold-pressure inspiratory muscle training can significantly improve patients’ lung function indicators,enhance respiratory muscle strength,reduce dyspnea,and increase 6-min walking distance in asthmatic patients,but the effect in improving quality of life is not significant,and more clinical high-quality studies need to further verify its effectiveness.

Key words: Threshold-Pressure, Resistance Training, Asthma, Pulmonary Function, Quality of Life, Meta-Analysis, Nursing Care

伊默,贾元敏,赵宝生,王海霞,李一章,陈欧. 阈值压力负荷吸气肌训练对哮喘患者肺康复及生活质量影响的Meta分析[J]. 中华护理杂志, 2021, 56(7): 1001-1007.

YI Mo,JIA Yuanmin,ZHAO Baosheng,WANG Haixia,LI Yizhang,CHEN Ou. Effect of threshold-pressure inspiratory muscle training on pulmonary rehabilitation and quality of life in patients with asthma：a meta-analysis[J]. Chinese Journal of Nursing, 2021, 56(7): 1001-1007.

图/表 2

参考文献 34

[1]	Huang K, Yang T, Xu J, et al. Prevalence,risk factors,and management of asthma in China:a national cross-sectional study[J]. Lancet, 2019, 394(10196):407-418. DOI PMID
[2]	张芬, 殷勇, 沈南平, 等. 儿童哮喘门诊规范化管理的实践[J]. 中华护理杂志, 2018, 53(11):1347-1352.
	Zhang F, Yin Y, Sheng NP, et al. Application of standardized asthma clinic for asthma management in children[J]. Chin J Nurs, 2018, 53(11):1347-1352.
[3]	Keles MN, Elbasan B, Apaydin U, et al. Effects of inspiratory muscle training in children with cerebral palsy:a randomized controlled trial[J]. Braz J Phys Ther, 2018, 22(6):493-501. DOI URL
[4]	Liu W, Mu X, Wang X, et al. Effects of comprehensive pulmonary rehabilitation therapy on pulmonary functions and blood gas indexes of patients with severe pneumonia[J]. Exp Ther Med, 2018, 16(3):1953-1957.
[5]	段俊滔, 刘聪颖, 于桂香, 等. 吸气肌训练对经皮冠状动脉介入治疗术后患者的影响研究[J]. 中华护理杂志, 2020, 55(4):519-523.
	Duan JT, Liu CY, Yu GX, et al. Effects of inspiratory muscle training on cardiopulmonary function and exercise capacity of patients after percutaneous coronary intervention[J]. Chin J Nurs, 2020, 55(4):519-523.
[6]	Cho JE, Lee HJ, Kim MK, et al. The improvement in respiratory function by inspiratory muscle training is due to structural muscle changes in patients with stroke:a randomized controlled pilot trial[J]. Top Stroke Rehabil, 2018, 25(1):37-43. DOI URL
[7]	Boswell-Ruys CL, Lewis CR, Gandevia SC, et al. Respiratory muscle training may improve respiratory function and obstructive sleep apnoea in people with cervical spinal cord injury[J]. Spinal Cord Ser Cases, 2015, 1:15010. DOI PMID
[8]	王翠, 张楠, 郭敏, 等. 慢性心力衰竭患者吸气肌训练效果的Meta分析[J]. 中华护理杂志, 2018, 53(8):932-938.
	Wang C, Zhang N, Guo M, et al. Effectiveness of inspiratory muscle training in chronic heart failure patients:a meta-analysis[J]. Chin J Nurs, 2018, 53(8):932-938.
[9]	Mauer Y, Taliercio RM. Managing adult asthma:the 2019 GINA guidelines[J]. Cleve Clin J Med, 2020, 87(9):569-575. DOI URL
[10]	Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews：a new edition of the Cochrane Handbook for Systematic Reviews of Interventions[J]. Cochrane Database Syst Rev, 2019, 10:ED000142.
[11]	Lage SM, Pereira DAG, Corradi Magalhães Nepomuceno AL, et al. Efficacy of inspiratory muscle training on inspiratory muscle function,functional capacity,and quality of life in patients with asthma：a randomized controlled trial[DB/OL]. ( 2020- 12- 15)[2020- 12- 27]. https://pubmed.ncbi.nlm.nih.gov/33406892/
[12]	Ebrahim G, Refaye E, Farid H, et al. Comparative study of inspiratory muscle strength training and incentive spirometer on ventilatory function in postmenopausal asthmatic women[J]. Int J Appl Exerc Physiol, 2020, 9(11):2322-3537.
[13]	Elnaggar RK. A randomized placebo-controlled study investigating the efficacy of inspiratory muscle training in the treatment of children with bronchial asthma[J]. J Asthma, 2020(9):1-12.
[14]	刘晓梅, 汪启银. 阈值压力负荷呼吸肌训练对支气管哮喘慢性持续期患者运动耐力及肺功能的影响[J]. 河南医学研究, 2020, 29(28):5267-5268.
	Liu XM, Wang QY. Effect of threshold pressure loading respiratory muscle training on exercise tolerance and pulmonary function in patients with chronic persistent bronchial asthma[J]. Henan Med Res, 2020, 29(28):5267-5268.
[15]	López-de-Uralde-Villanueva I, Candelas-Fernández P, de-Diego-Cano B, et al. The effectiveness of combining inspiratory muscle training with manual therapy and a therapeutic exercise program on maximum inspiratory pressure in adults with asthma:a randomized clinical trial[J]. Clin Rehabil, 2018, 32(6):752-765. DOI PMID
[16]	Duruturk N, Acar M, Do ğrul MI. Effect of inspiratory muscle training in the management of patients with asthma:a randomized controlled trial[J]. J Cardiopulm Rehabil Prev, 2018, 38(3):198-203. DOI URL
[17]	Turner LA, Mickleborough TD, Mcconnell AK, et al. Effect of inspiratory muscle training on exercise tolerance in asthmatic individuals[J]. Med Sci Sport Exer, 2011, 43(11):2031-2038. DOI URL
[18]	Shaw BS, Shaw I. Pulmonary functionand abdominaland thoracic kinematic changes following aerobic and inspiratory resistive diaphragmatic breathing training in asthmatics[J]. Lung, 2011, 189(2):131-139. DOI URL
[19]	Lima EV, Lima WL, Nobre A, et al. Inspiratory muscle training and respiratory exercises in children with asthma[J]. J Bras Pneumol, 2008, 34(8):552-558. DOI URL
[20]	Weiner P, Magadle R, Beckerman M, et al. The relationship among inspiratory muscle strength,the perception of dyspnea and inhaled beta2-agonist use in patients with asthma[J]. Can Respir J, 2002, 9(5):307-312. DOI URL
[21]	Silva IS, Fregonezi GAF, Dias FAL, et al. Inspiratory muscle training for asthma[J]. Cochrane Database Syst Rev, 2013(9):CD003792.
[22]	Gershon AS, Victor JC, Guan J, et al. Pulmonary function testing in the diagnosis of asthma:a population study[J]. Chest, 2012, 141(5):1190-1196. DOI PMID
[23]	Almeida VP, Guimarães FS, Moço VJ, et al. Correlation between pulmonary function,posture,and body composition in patients with asthma[J]. Rev Port Pneumol, 2013, 19(5):204-210. DOI PMID
[24]	郭佳宝, 朱毅. 吸气肌训练的临床研究进展[J]. 中国康复医学杂志, 2014, 29(9):888-892.
	Guo JB, Zhu Y. Progress of clinical research on inspiratory muscle training[J]. China J Rehabil Med, 2014, 29(9):888-892.
[25]	McDonald T, Stiller K. Inspiratory muscle training is feasible and safe for patients with acute spinal cord injury[J]. J Spinal Cord Med, 2019, 42(2):220-227. DOI PMID
[26]	Ferreira JB, Plentz RD, Stein C, et al. Inspiratory muscle training reduces blood pressure and sympathetic activity in hypertensive patients:a randomized controlled trial[J]. Int J Cardiol, 2013, 166(1):61-67. DOI URL
[27]	Cutrim ALC, Duarte AAM, Silva-Filho AC, et al. Inspiratory muscle training improves autonomic modulation and exercise tolerance in chronic obstructive pulmonary disease subjects:a randomized-controlled trial[J]. Respir Physiol Neurobiol, 2019, 263:31-37. DOI URL
[28]	Chiappa GR, Roseguini BT, Vieira PJ, et al. Inspiratory muscle training improves blood flow to resting and exercising limbs in patients with chronic heart failure[J]. J Am Coll Cardiol, 2008, 51(17):1663-1671. DOI PMID
[29]	Cordeiro AL, de Melo TA, Neves D, et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery[J]. Braz J Cardiovasc Surg, 2016, 31(2):140-144.
[30]	Chen XY, Hou L, Zhang YY, et al. The effects of five days of intensive preoperative inspiratory muscle training on postoperative complications and outcome in patients having cardiac surgery:a randomized controlled trial[J]. Clin Rehabil, 2019, 33(5):913-922. DOI URL
[31]	Smith BK, Gabrielli A, Davenport PW, et al. Effect of training on inspiratory load compensation in weaned and unweaned mechanically ventilated ICU patients[J]. Respir Care, 2014, 59(1):22-31. DOI URL
[32]	Majd S, Apps L, Chantrell S, et al. A feasibility study of a randomized controlled trial of asthma-tailored pulmonary rehabilitation compared with usual care in adults with severe asthma[J]. J Allergy Clin Immunol Pract, 2020, 8(10):3418-3427. DOI URL
[33]	郑红颖, 胡嘉乐, 董柏君, 等. 医护患共享决策相关理论模式的研究进展[J]. 中国护理管理, 2018, 18(11):1575-1580.
	Zheng HY, Hu JL, Dong BJ, et al. Research progress on the theoretical models of shared decision making among physicians,nurses and patients[J]. Chin Nurs mang, 2018, 18(11):1575-1580.
[34]	Smith BK, Gabrielli A, Davenport PW, et al. Effect of training on inspiratory load compensation in weaned and unweaned mechanically ventilated ICU patients[J]. Respir Care, 2014, 59(1):22-31. DOI URL