慢性阻塞性肺疾病患者呼吸肌训练的最佳证据总结

doi:10.3761/j.issn.0254-1769.2022.01.007

摘要/Abstract

摘要：

目的提炼并总结慢性阻塞性肺疾病 (chronic obstructive pulmonary disease,COPD) 患者呼吸肌训练的最佳证据,为临床干预提供循证依据。方法系统检索UpToDate、BMJ最佳临床实践、乔安娜布里格斯研究所循证卫生保健中心数据库、Cochrane Library、英国国家卫生与临床优化研究所指南库、加拿大安大略注册护士协会网、医脉通、英国胸科协会网站、加拿大胸科学会网站、美国胸科学会网站、澳大利亚和新西兰胸科学会网站、Web of Science、PubMed、Embase、万方数据库、中国知网、中国生物医学文献服务网中与COPD患者呼吸肌训练相关的文献,包括指南、专家共识、临床决策、证据总结、系统评价及随机对照研究,检索时限为建库至2020年10月31日。由2名研究者独立对文献质量进行评价并提取资料。结果共纳入12篇文献,包括指南2篇、专家共识2篇、临床决策2篇、系统评价6篇。总结的最佳证据包括训练目的、训练对象、训练地点、训练计划、训练方式、质量控制和效果评价7个方面,共21条。结论该研究总结了COPD患者呼吸肌训练的最佳证据。建议医护人员在应用证据时,充分考虑临床实际情况,结合患者的需要和偏好制订个性化的训练方案。

关键词: 肺疾病,慢性阻塞性, 呼吸肌, 呼吸训练, 循证护理学

Abstract:

Objective Through systematic evidence retrieval and literature quality evaluation,the best evidence for respiratory muscle training in patients with chronic obstructive pulmonary disease (COPD) was extracted and summarized,so as to provide research-based evidence for respiratory muscle training in the clinical settings. Methods The evidence search was performed across 17 databases and official websites systematically,including UpToDate,BMJ Best Practice,Joanna Briggs Institute Library,Cochrane Library,British National Institute for Health and Care Excellence,Registered Nurses’ Association of Ontario,Canada,British Thoracic Society,Canadian Thoracic Society,American Thoracic Society,Thoracic Society of Australia and New Zealand,Web of Science,PubMed,Embase,Sinomed,CNKI,and Wanfang Database. The guidelines,expert consensuses,evidence summaries,systematic reviews,and randomized controlled trials were included. The retrieval timeframe was ranged from the establishment date of the databases or websites to October 31,2020. All literature was independently evaluated by 2 researchers,and they determined whether the literature met the standards and then extracted the data. Results A total of 12 pieces of literature were eligible for inclusion. They were 2 guidelines,2 expert consensuses,2 evidence summaries,and 6 systematic reviews. There were 21 pieces of best evidence with 7 dimensions being summarized,namely training purposes,training subjects,training places,training plans,training methods,quality control,and effectiveness evaluation. Conclusion The best evidence of respiratory muscle training in patients with COPD was summarized. It is recommended that health care professionals should fully consider the allocation of medical resources when they apply the evidence and formulate individualized and feasible training programs based on the needs and preferences of patients.

Key words: Pulmonary Disease,Chronic Obstructive, Respiratory Muscles, Breathing Exercises, Evidence-Based Nursing

杨雪凝, 李雪儿, 王松, 方紫妍, 柳静, Akimana Sandra, 张静. 慢性阻塞性肺疾病患者呼吸肌训练的最佳证据总结[J]. 中华护理杂志, 2022, 57(1): 49-55.

YANG Xuening, LI Xue’er, WANG Song, FANG Ziyan, LIU Jing, Akimana Sandra, ZHANG Jing. Summary of best evidence of respiratory muscle training in patients with chronic obstructive pulmonary disease[J]. Chinese Journal of Nursing, 2022, 57(1): 49-55.

图/表 4

图1 文献筛选流程图注：BTS为英国胸科协会;CTS为加拿大胸科学会;ATS为美国胸科学会;TSANZ为澳大利亚和新西兰胸科学会;JBI为乔安娜布里格斯研究所;NICE为英国国家卫生与临床优化研究所指南库;RNAO为加拿大安大略注册护士协会网。

Figure 1 Flow chart of literature

表1 纳入文献的基本情况

Table 1 Characteristics of included studies

表2 指南的质量评价结果

Table 2 Quality evaluation of guidelines

表3 慢性阻塞性肺疾病患者呼吸肌训练的最佳证据总结

Table 3 Best evidence of respiratory muscle training in patients with chronic obstructive pulmonary disease

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