外周动脉疾病患者运动训练的最佳证据总结

doi:10.3761/j.issn.0254-1769.2022.21.016

摘要/Abstract

摘要：

目的检索、汇总外周动脉疾病（peripheral arterial disease，PAD）患者运动训练的最佳证据，为临床外周动脉疾病患者运动训练干预提供循证依据。方法检索UpToDate、美国血管外科学会网站、欧洲血管外科学会网站、Cochrane Library、PubMed、Springer Link、Embase、CINAHL、医脉通、中华医学会血管外科分会网站、超星期刊数据库、中国知网、万方数据库、中文科技期刊数据库针对PAD患者进行运动训练的证据。证据来源包括临床指南、证据总结、专家共识、系统评价及荟萃分析等。文献检索时限为建库至2021年7月1日。此外，由2名研究者对所纳入的文献质量进行评价和提取所需资料。结果共纳入14篇文献。从运动安全、运动时机、运动方式、运动强度、运动时间、效果评价、注意事项7个方面，共提取20条最佳证据。结论运动训练可以提高PAD患者的步行能力，改善生活质量，建议在保证安全的前提下应进行运动训练干预。该研究证据总结过程严谨、内容全面。在实际临床工作中，医护人员在应用证据时需考虑到实际的应用环境和患者的个体情况。

关键词: 外周动脉疾病, 运动训练, 证据总结, 循证护理学

Abstract:

Objective To search，summarize and evaluate the best evidence of exercise training in patients with peripheral arterial disease（PAD），which could further provide evidence-based medical bases for clinical exercise training intervention in patients with PAD. Methods All evidence on exercise training in patients with PAD were retrieved from UpToDate，Society for Vascular Surgery（SVS） website，European Society for Vascular Surgery（ESVS） website，Cochrane Library，PubMed，Springer Link，Embase，Cumulative Index to Nursing and Allied Health Literature（CINAHL），Med-live website，Chinese Society of Vascular Surgery，the Chao-Xing journal database，China National Knowledge Infrastructure（CNKI），Wan-Fang database，and other Chinese and foreign technological journal databases. Evidence was obtained from guidelines，clinical decisions，expert consensuses，evidence summaries，systematic evaluation，and meta-analysis. The retrieval time limit was from the establishment of databases until July 1，2021. There were 2 researchers who evaluated the literature quality and extracted the data. Results A total of 14 articles were included in the present analysis. A total of 20 pieces of best evidence were extracted from 7 aspects，including exercise safety，exercise timing，exercise mode，exercise intensity，exercise time，effect evaluation，and tips. Conclusion The exercise training could improve the walking ability and the quality of life of PAD patients. Thereby，it is recommended that exercise training intervention should be conducted while ensuring safety. The evidence summary process of this study is rigorous and comprehensive. In clinical practice，the medical staff should consider the actual application environment and individual situation of patients when using the evidence.

Key words: Peripheral Artery Disease, Exercise Training, Summary of Evidence, Evidence-Based Nursing

杨琴, 赵玉明, 黄妍, 许文香, 苏欣, 庄晖, 陈媛. 外周动脉疾病患者运动训练的最佳证据总结[J]. 中华护理杂志, 2022, 57(21): 2661-2667.

YANG Qin, ZHAO Yuming, HUANG Yan, XU Wenxiang, SU Xin, ZHUANG Hui, CHEN Yuan. Summary of the best evidence for exercise training in patients with peripheral artery disease[J]. Chinese Journal of Nursing, 2022, 57(21): 2661-2667.

图/表 5

图1 文献筛选流程图

Figure 1 Literature screening process

表1 纳入文献的一般特征（n=14）

Table 1 General characteristics of included literature（n=14）

表2 纳入指南的质量评价结果（n=3）

Table 2 Standardization percentage of each dimension and 2 comprehensive evaluation results（n=3）

表3 系统评价的方法学质量评价结果（n=13）

Table 3 Quality evaluation results of included systematic review methodology（n=13）

表4 外周动脉疾病患者运动方案的最佳证据总结

Table 4 Summary of best evidence on exercise program in patient with peripheral arterial diseases

参考文献 39

[1]	沈晨阳, 李伟浩. 《美国血管外科学会无症状性和间歇性跛行下肢动脉硬化闭塞症诊治指南》解读[J]. 中华外科杂志, 2016, 54(2):81-83.
	Shen CY, Li WH. Interpretation of the guidelines for the diagnosis and treatment of asymptomatic and intermittent limp arteriosclerosis occlusion in the American Society of Vascular Surgery[J]. Chin J Surg, 2016, 54(2):81-83.
[2]	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2020概要[J]. 中国循环杂志, 2021, 36(6):221-244.
	China Cardiovascular Health and Disease Report Writing Group. Summary of China cardiovascular health and disease report 2020[J]. Chin J Circ, 2021, 36(6):221-244.
[3]	Parvar SL, Fitridge R, Dawson J, et al. Medical and lifestyle ma-nagement of peripheral arterial disease[J]. J Vasc Surg, 2018, 68(5):1595-1606. DOI PMID
[4]	Biswas MP, Capell WH, McDermott MM, et al. Exercise training and revascularization in the management of symptomatic peripheral artery disease[J]. JACC Basic Transl Sci, 2021, 6(2):174-188. DOI PMID
[5]	骆雷鸣. 外周动脉疾病的研究进展与前景[J]. 中华老年心脑血管病杂志, 2018, 20(5):449-453.
	Luo LM. Progress and prospects of peripheral arterial disease[J]. Chin J Geriatr Heart Brain Vessel Dis, 2018, 20(5):449-453.
[6]	Treat-Jacobson D, McDermott MM, Beckman JA, et al. Implemen-tation of supervised exercise therapy for patients with symptomatic peripheral artery disease:a science advisory from the American Heart Association[J]. Circulation, 2019, 140(13):e700-e710. DOI
[7]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018:45-50.
	Hu Y, Hao YF. Evidence-based nursing science[M]. 2nd ed. Beijing: People’s Health Publishing House, 2018:45-50.
[8]	Foster MJ, Shurtz S. Making the critical appraisal for summa-ries of evidence(CASE) for evidence-based medicine (EBM):critical appraisal of summaries of evidence[J]. J Med Libr Assoc, 2013, 101(3):192-198. DOI URL
[9]	Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ:advan-cing guideline development,reporting,and evaluation in health care[J]. Prev Med, 2010, 51(5):421-424. DOI PMID
[10]	周芬, 郝玉芳, 丛雪, 等. 指南研究与评价工具AGREE Ⅱ及各领域分值的补充解释及思考[J]. 护理学报, 2018, 25(18):56-58.
	Zhou F, Hao YF, Cong X, et al. Supplementary interpretation and thinking of the guideline research and evaluation tool AGREEⅡ and various field scores[J]. J Nurs, 2018, 25(18):56-58.
[11]	朱政, 胡雁, 周英凤, 等. 推动证据向临床转化(五)证据临床转化研究中的文献质量评价[J]. 护士进修杂志, 2020, 35(11):996-1000.
	Zhu Z, Hu Y, Zhou YF, et al. Promoting evidence to clinical transformation(V) literature quality evaluation in the clinical transformation research of evidence[J]. J Nurses Train, 2020, 35(11):996-1000.
[12]	Mark GD, Denis LC, John FE, et al. Treatment of lameness due to peripheral artery disease[EB/OL].(2021-04-28)[2021-06-30]. https://www.uptodate.cn/contents/zh-Hans/management-of-claudi-cation-due-to-peripheral-artery-disease?source=related_link]H40.
[13]	Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases,in collaboration with the European Society for Vascular Surgery(ESVS)[J]. Eur Heart J, 2018, 39(9):763-816. DOI PMID
[14]	Frank U, Nikol S, Belch J, et al. ESVM guideline on peripheral arterial disease[J]. VASA, 2019, 48(102):1-79.
[15]	Lin E, Nguyen CH, Thomas SG. Completion and adherence rates to exercise interventions in intermittent claudication:traditional exercise versus alternative exercise-a systematic review[J]. Eur J Prev Cardiol, 2019, 26(15):1625-1633. DOI URL
[16]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-grading and evidence recommendation level system (2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[17]	Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease:a report of the American College of Cardiology/American Heart Association Task Force on clinical Practice Guidelines[J]. Circulation, 2017, 135(12):e726-e779.
[18]	Treat-Jacobson D, McDermott MM, Bronas UG, et al. Optimal exercise programs for patients with peripheral artery disease:a scientific statement from the American Heart Association[J]. Circulation, 2019, 139(4):e10-e33. DOI
[19]	Abola MTB, Golledge J, Miyata T, et al. Asia-Pacific consensus statement on the management of peripheral artery disease:a report from the Asian Pacific Society of Atherosclerosis and Vascular Disease Asia-Pacific Peripheral Artery Disease Con-sensus Statement Project Committee[J]. J Atheroscler Thromb, 2020, 27(8):809-907. DOI URL
[20]	Lin E, Nguyen CH, Thomas SG. Completion and adherence rates to exercise interventions in intermittent claudication:traditional exercise versus alternative exercise-a systematic review[J]. Eur J Prev Cardiol, 2019, 26(15):1625-1633. DOI URL
[21]	Lane R, Harwood A, Watson L, et al. Exercise for intermittent claudication[J]. Cochrane Database Syst Rev, 2017, 12(12):CD000990.
[22]	Hageman D, Fokkenrood HJ, Gommans LN, et al. Supervised exercise therapy versus home-based exercise therapy versus walking advice for intermittent claudication[J]. Cochrane Data-base Syst Rev, 2018, 4(4):CD005263.
[23]	Golledge J, Singh TP, Alahakoon C, et al. Meta-analysis of cli-nical trials examining the benefit of structured home exercise in patients with peripheral artery disease[J]. Br J Surg, 2019, 106(4):319-331. DOI PMID
[24]	Machado I, Sousa N, Paredes H, et al. Combined aerobic and resistance exercisein walking performance of patients with intermittent claudication:systematic review[J]. Front Physiol, 2020, 10:1538. DOI URL
[25]	Parmenter BJ, Mavros Y, Ritti Dias R, et al. Resistance training as a treatment for older persons with peripheral artery disease:a systematic review and meta-analysis[J]. Br J Sports Med, 2020, 54(8):452-461.
[26]	王怡, 白姣姣, 臧娴. 持杖行走训练对老年周围血管病变病人干预效果的Meta分析[J]. 循证护理, 2018, 4(1):6-12.
	Wang Y, Bai JJ, Zang X. Meta-analysis of the intervention effects of stick-holding walking training in elderly patients with peripheral vascular lesions[J]. Evidence-based Care, 2018, 4(1):6-12.
[27]	Pymer S, Palmer J, Harwood AE, et al. A systematic review of high-intensity interval training as an exercise intervention for intermittent claudication[J]. J Vasc Surg, 2019, 70(6):2076-2087. DOI PMID
[28]	Treat-Jacobson D, McDermott MM, Beckman JA, et al. Implementation of supervised exercise therapy for patients with symptomatic peripheral artery disease:a science advisory from the American Heart Association[J]. Circulation, 2019, 140(13):e700-e710. DOI
[29]	McDermott MM. Exercise training for intermittent claudication[J]. J Vasc Surg, 2017, 66(5):1612-1620. DOI PMID
[30]	Cornelis N, Nassen J, Buys R, et al. The impact of supervised exercise training on traditional cardiovascular risk factors in patients with intermittent claudication:a systematic review and meta-analysis[J]. Eur J Vasc Endovasc Surg, 2019, 58(1):75-87. DOI URL
[31]	Abaraogu UO, Abaraogu OD, Dall PM, et al. Exercise therapy in routine management of peripheral arterial disease and intermittent claudication:a scoping review[J]. Ther Adv Cardio-vasc Dis, 2020, 14:1753944720924270.
[32]	McDermott MM. Medical management of functional impairment in peripheral artery disease:a review[J]. Prog Cardiovasc Dis, 2018, 60(6):586-592. DOI PMID
[33]	Polonsky TS, McDermott MM. Lower extremity peripheral artery disease without chronic limb-threatening ischemia:a review[J]. JAMA, 2021, 325(21):2188-2198. DOI PMID
[34]	谷雨擎, 朱丽丽, 李庆印, 等. 急诊经皮冠状动脉介入治疗患者早期心脏康复护理方案的构建[J]. 中华护理杂志, 2021, 56(4):502-508. DOI
	Gu YQ, Zhu LL, Li QY, et al. Construction of an early cardiac rehabilitation nursing practice program for patients after emer-gency percutaneous coronary intervention[J]. Chin J Nurs, 2021, 56(4):502-508.
[35]	Gommans LN, Fokkenrood HJ, van Dalen HC, et al. Safety of supervised exercise therapy in patients with intermittent claudication[J]. J Vasc Surg, 2015, 61(2):512-518.e2. DOI PMID
[36]	Cornelis N, Buys R, Dewit T, et al. Satisfaction and acceptability of telemonitored home-based exercise in patients with intermittent claudication:pragmatic observational pilot study[J]. JMIR Rehabil Assist Technol, 2021, 8(1):e18739. DOI URL
[37]	Abaraogu U, Ezenwankwo E, Dall P, et al. Barriers and enab-lers to walking in individuals with intermittent claudication:a systematic review to conceptualize a relevant and patient-centered program[J]. PLoS One, 2018, 13(7):e0201095. DOI URL
[38]	朱金凤, 张远星, 王芳, 等. 脑卒中患者远程康复运动管理有效性及安全性的系统评价再评价[J]. 中华护理杂志, 2022, 57(12):1447-1455. DOI
	Zhu JF, Zhang YX, Wang F, et al. The effectiveness and safety of telerehabilitation management in stroke patients:an overview of systematic reviews[J]. Chin J Nurs, 2022, 57(12):1447-1455.
[39]	张洁, 刘欣梅, 赵芳, 等. 信息化多元运动方案在衰弱前期老年患者中的应用研究[J]. 中华护理杂志, 2022, 57(16):1925-1930. DOI
	Zhang J, Liu XM, Zhao F, et al. Application of a multi-component exercise intervention based on Wechat applet in the pre-frailty elderly[J]. Chin J Nurs, 2022, 57(16):1925-1930. DOI