吸气肌训练对慢性心力衰竭患者影响的系统评价再评价

doi:10.3761/j.issn.0254-1769.2023.20.013

摘要/Abstract

摘要：

目的将吸气肌训练对慢性心力衰竭患者临床结局影响的系统评价进行再评价。方法计算机检索PubMed、Embase、CINAHL、 Cochrane Library、中国知网、万方数据库、中国生物医学文献数据库、维普数据库，查找关于吸气肌训练对慢性心力衰竭患者干预效果的系统评价/Meta分析，检索时限为建库至2023年1月。由2名接受过循证护理学系统培训的研究人员独立进行文献筛选和资料提取，并应用系统评价方法学质量评价工具2（assessment of mutiple system reviews 2，AMSTAR 2）进行方法学质量评价后，采用推荐分级的评估、制订与评价（grades of recom-mendations assessment，development and evaluation，GRADE）系统进行证据的汇总与分级。结果共纳入14篇系统评价，AMSTAR 2评价结果显示，高等及中等质量文献各有1篇，其余12篇为低质量或极低质量。采用GRADE系统对14篇系统评价的40条结局指标的证据质量评价结果显示，3条证据为中等质量，31条证据为低质量，6条证据为极低质量。重新Meta分析结果显示，吸气肌训练有助于改善慢性心力衰竭患者最大吸气压、6 min步行距离、峰值摄氧量及呼吸困难（P<0.05），但对生活质量的干预效果仍需进一步证实。结论吸气肌训练对慢性心力衰竭患者的临床结局起到积极作用，但考虑到目前纳入系统评价的整体研究质量和结局指标证据质量普遍偏低，未来仍需严格、规范开展高质量的随机对照试验为慢性心力衰竭患者的吸气肌训练效果提供更有力的证据支持。

关键词: 吸气肌训练, 慢性心力衰竭, 临床结局, 系统评价再评价, 护理

Abstract:

Objective To evaluate the systematic reviews of the effect of inspiratory muscle training on clinical outcome of patients with chronic heart failure. Methods PubMed，Embase，CINAHL，Cochrane Library，CNKI，Wanfang Database，Chinese Biomedical Literature Database，and VIP Database were searched by computer to find systematic reviews/meta analysis on the effect of inspiratory muscle training on patients with chronic heart failure. The search time limit was from the establishment of the database to January 2023. 2 researchers who were trained in evidence-based knowledge system independently screened the literature and extracted the data. AMSTAR 2 scale was used to evaluate methodological quality，and GRADE system was used to summarize and grade the evidence. Results A total of 14 systematic reviews were included. AMSTAR 2 evaluation results showed that there were 1 paper of high quality and 1 paper of medium quality，and the other 12 papers were of low quality or very low quality. The evidence quality evaluation results of 40 outcome indicators in 14 systematic reviews using GRADE system showed that 3 pieces of evidence were of medium quality，and 31 pieces of evidence were of low quality，and 6 pieces of evidence were of very low quality. The meta-analysis results showed that inspiratory muscle training can improve the maximum inspiratory pressure，6 min walking distance，peak oxygen uptake and dyspnea in patients with chronic heart failure（P<0.05），but the intervention effect on quality of life needs further confirmation. Conclusion Inspiratory muscle training plays a positive role in the clinical outcomes of patients with chronic heart failure. However，considering the overall research quality and the quality of evidence of outcome indicators included in the current systematic reviews are generally low，it is still necessary to further conduct strict，standardized and comprehensive high-quality randomized controlled trials to provide stronger evidence support for the effect of inspiratory muscle training in patients with chronic heart failure in the future.

Key words: Inspiratory Muscle Training, Chronic Heart Failure, Clinical Outcome, Overview of Systematic Reviews, Nursing Care

王乾沙, 明玥, 谢玉生, 黄蓉蓉, 杨倩, 郑晓香, 邹杨. 吸气肌训练对慢性心力衰竭患者影响的系统评价再评价[J]. 中华护理杂志, 2023, 58(20): 2521-2529.

WANG Qiansha, MING Yue, XIE Yusheng, HUANG Rongrong, YANG Qian, ZHENG Xiaoxiang, ZOU Yang. Effect of inspiratory muscle training on clinical outcome of patients with chronic heart failure：an overview of systematic reviews[J]. Chinese Journal of Nursing, 2023, 58(20): 2521-2529.

图/表 5

图1 PubMed检索策略

Figure 1 PubMed search strategies

图2 文献筛选流程

Figure 2 Literature screening process

表1 纳入文献的基本特征（n=14）

Table 1 Basic characteristics of included studies（n=14）

表2 系统评价方法学质量评价工具2的评价结果（n=14）

Table 2 Assessment list of multiple system reviews 2（n=14）

表3 推荐分级的评估、制订与评价系统证据质量评价结果（n=14）

Table 3 GRADE evidence quality of outcomes included in the literature（n=14）

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