老年肌少症患者血流限制训练的最佳证据总结

doi:10.3761/j.issn.0254-1769.2024.10.005

摘要/Abstract

摘要：

目的检索、评价及总结老年肌少症患者血流限制训练的相关证据，为护理人员指导老年患者开展血流限制训练、预防和治疗肌少症提供参考。方法系统检索国内外数据库、相关指南网站及专业网站中关于老年肌少症患者血流限制训练的指南、专家共识、专家意见、临床决策、系统评价、推荐实践和证据总结。检索时限为建库至2023年3月。由2名研究者独立进行文献质量评价、证据提取及整合。结果最终纳入14篇文献，其中指南1篇、系统评价12篇、专家意见1篇。从运动评估、运动方式、压力参数、运动参数、运动效果、运动安全和评价方法7个方面，共总结27条证据。结论该研究总结了老年肌少症患者血流限制训练的证据，建议护理人员在应用证据时充分考虑临床实际情况，根据老年患者的运动偏好和实际情况，制订个体化血流限制训练方案以预防及治疗肌少症。

关键词: 老年人, 肌少症, 血流限制训练, 循证护理学

Abstract:

Objective To search，evaluate，and summarize the relevant evidence of blood flow restriction training in elderly patients with sarcopenia，and provide references for medical staff to guide elderly patients to carry out blood flow restriction training to prevent and treat sarcopenia. Methods Computer systems were used to search domestic and foreign databases，relevant guide websites，and professional association websites for guidelines，expert consensuses，expert opinions，clinical decisions，system reviews，recommended practice，and evidence summaries on blood flow restriction training for elderly patients with sarcopenia. The retrieval period was from the inception of databases to March 2023. There were 2 researchers who independently conducted literature quality evaluation，evidence extraction，and integration. Results A total of 14 articles were finally included，including 1 guideline，12 systematic reviews，and 1 expert opinion. A total of 27 pieces of best evidence were summarized from 7 aspects：exercise assessment，exercise mode，pressure parameters，exercise parameters，exercise effects，exercise safety，and evaluation methods. Conclusion This study summarized the best evidence for blood flow restriction training in elderly patients with sarcopenia. It is recommended that medical staff fully consider clinical practice when applying evidence，and develop personalized blood flow restriction training programs based on the exercise preferences and actual situations of the elderly to prevent and treat sarcopenia.

Key words: Aged, Sarcopenia, Blood Flow Restriction Therapy, Evidence-Based Nursing

王鑫, 李诺, 梁诗雨, 李晨阳, 邵乐文. 老年肌少症患者血流限制训练的最佳证据总结[J]. 中华护理杂志, 2024, 59(10): 1187-1194.

WANG Xin, LI Nuo, LIANG Shiyu, LI Chenyang, SHAO Lewen. Evidence summary of blood flow restriction training for elder patients with sarcopenia[J]. Chinese Journal of Nursing, 2024, 59(10): 1187-1194.

图/表 4

图1 文献检索流程图注：JBI为乔安娜布里格斯研究所

Figure 1 Flow chart of literature search and screening

表1 纳入文献的一般特征（n=14）

Table 1 Characteristics of included studies（n=14）

表2 系统评价的方法学质量评价结果（n=12）

Table 2 Methodological quality evaluation results of included systematic reviews（n=12）

表3 老年肌少症患者血流限制训练的最佳证据总结

Table 3 Summary of best evidence of exercise intervention for sarcopenia in the elderly

参考文献 35

[1]	Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia:revised European consensus on definition and diagnosis[J]. Age Ageing, 2019, 48(4):601. DOI PMID
[2]	刘娟, 丁清清, 周白瑜, 等. 中国老年人肌少症诊疗专家共识(2021)[J]. 中华老年医学杂志, 2021, 40(8):943-952.
	Liu J, Ding QQ, Zhou BY, et al. Chinese expert consensus on diagnosis and treatment for elderly with sarcopenia(2021)[J]. Chin J Geriatr, 2021, 40(8):943-952.
[3]	马旭, 李青科, 何立芳. 结直肠癌患者肌少症的发生率及其对术后感染和住院时间的影响[J]. 现代肿瘤医学, 2022, 30(13):2400-2404.
	Ma X, Li QK, He LF. Characteristics of sarcopenia in patients with colorectal cancer and its influence on postoperative infection and hospital stay[J]. J Mod Oncol, 2022, 30(13):2400-2404.
[4]	韩婷, 钱绪芬, 王庆芳, 等. 基于Logistic回归和决策树模型的老年住院患者肌少症风险的影响因素分析[J]. 护理学报, 2022, 29(12):56-62.
	Han T, Qian XF, Wang QF, et al. Analysis of risk factors of sarcopenia in elderly inpatients based on Logistic regression and decision tree model[J]. J Nurs(China), 2022, 29(12):56-62.
[5]	于普林, 高超, 周白瑜, 等. 预防老年人肌少症核心信息中国专家共识(2021)[J]. 中华老年医学杂志, 2021, 40(8):953-954.
	Yu PL, Gao C, Zhou BY, et al. Chinese expert consensus on core information for sarcopenia prevention in the elderly[J]. Chin J Geriatr, 2021, 40(8):953-954.
[6]	沈睿, 王茜茜, 徐霓影, 等. 老年肌少症患者运动干预的最佳证据总结[J]. 中华护理杂志, 2021, 56(10):1560-1566. DOI
	Shen R, Wang XX, Xu NY, et al. Evidence summary of exercise intervention for elderly patients with sarcopenia[J]. Chin J Nurs, 2021, 56(10):1560-1566. DOI
[7]	李燕, 黄丽华. 老年人平衡能力评估及干预的研究进展[J]. 中华护理杂志, 2019, 54(4):603-608. DOI
	Li Y, Huang LH. Current status of research on balance assessment and intervention in the elderly[J]. Chin J Nurs, 2019, 54(4):603-608.
[8]	Papa EV, Dong XY, Hassan M. Skeletal muscle function deficits in the elderly:current perspectives on resistance training[J]. J Nat Sci, 2017, 3(1):e272.
[9]	Centner C, Zdzieblik D, Roberts L, et al. Effects of blood flow restriction training with protein supplementation on muscle mass and strength in older men[J]. J Sports Sci Med, 2019, 18(3):471-478.
[10]	潘玮敏, 王兵, 韩亚兵, 等. 血流限制训练对老年人肌肉力量、质量和躯体能力改变影响的Meta分析[J]. 中国组织工程研究, 2023, 27(5):805-812.
	Pan WM, Wang B, Han YB, et al. Effects of blood flow restriction training on muscle strength,muscle mass and physical performance in older adults:a Meta-analysis[J]. Chin J Tissue Eng Res, 2023, 27(5):805-812.
[11]	谢恩礼, 陶慧敏. 血流限制训练在临床康复医学中的应用趋势[J]. 中国组织工程研究, 2024, 28(2):258-262.
	Xie EL, Tao HM. Application trends of blood flow restriction training in clinical rehabilitation[J]. Chin J Tissue Eng Res, 2024, 28(2):258-262.
[12]	Cahalin LP, Formiga MF, Anderson B, et al. A call to action for blood flow restriction training in older adults with or susceptible to sarcopenia:a systematic review and meta-analysis[J]. Front Physiol, 2022, 13:924614.
[13]	Zhang TQ, Tian GX, Wang X. Effects of low-load blood flow restriction training on hemodynamic responses and vascular function in older adults:a meta-analysis[J]. Int J Environ Res Public Health, 2022, 19(11):6750.
[14]	彭通, 赵大业, 丁淑平, 等. 血流限制训练在老年人群中应用的安全性系统评价[J]. 护理研究, 2022, 36(22):3994-4001.
	Peng T, Zhao DY, Ding SP, et al. Safety of blood flow restriction training in the elderly:a meta-analysis[J]. Chin Nurs Res, 2022, 36(22):3994-4001.
[15]	Shimizu R, Hotta K, Yamamoto S, et al. Low-intensity resistance training with blood flow restriction improves vascular endothelial function and peripheral blood circulation in healthy elderly people[J]. Eur J Appl Physiol, 2016, 116(4):749-757.
	Pinto RR, Karabulut M, Poton R, et al. Acute resistance exercise with blood flow restriction in elderly hypertensive wo-men:haemodynamic,rating of perceived exertion and blood lactate[J]. Clin Physiol Funct Imaging,2018, 38(1):17-24.
[17]	Agree Next Steps Consortium. The agree Ⅱ instructions[EB/OL]. (2017-12-30)[2023-04-10]. https://www.agreetrust.org/resource-centre/agree-ii/agree-ii-instructions/.
[18]	McArthur A, Klugárová J, Yan H, et al. Innovations in the systematic review of text and opinion[J]. Int J Evid Based Healthc, 2015, 13(3):188-195.
[19]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具——系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):701-703.
	Gu Y, Zhang HW, Zhou YF, et al. JBI evidence-based health center’s quality assessment tool for different types of research——the quality evaluation of diagnostic and economic evaluation[J]. J Nurses Train, 2018, 33(8):701-703.
[20]	Lorenz DS, Bailey L, Wilk KE, et al. Blood flow restriction training[J]. J Athl Train, 2021, 56(9):937-944.
[21]	Cognetti DJ, Sheean AJ, Owens JG. Blood flow restriction thera-py and its use for rehabilitation and return to sport:physio-logy,application,and guidelines for implementation[J]. Arthrosc Sports Med Rehabil, 2022, 4(1):e71-e76.
[22]	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-classification and evidence rank system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[23]	陈蓉, 曾庆, 巩泽, 等. 不同模式下血流限制治疗老年性肌肉减少症的效果与安全因素[J]. 中国组织工程研究, 2021, 25(32):5215-5221.
	Chen R, Zeng Q, Gong Z, et al. Different modes of blood flow restriction in the treatment of senile sarcopenia:therapeutic effects and safety factors[J]. Chin J Tissue Eng Res, 2021, 25(32):5215-5221.
[24]	Minniti MC, Statkevich AP, Kelly RL, et al. The safety of blood flow restriction training as a therapeutic intervention for patients with musculoskeletal disorders:a systematic review[J]. Am J Sports Med, 2020, 48(7):1773-1785.
[25]	Baker BS, Stannard MS, Duren DL, et al. Does blood flow re-striction therapy in patients older than age 50 result in mus-cle hypertrophy,increased strength,or greater physical func-tion? A systematic review[J]. Clin Orthop Relat Res, 2020, 478(3):593-606.
[26]	Beckwée D, Delaere A, Aelbrecht S, et al. Exercise interventions for the prevention and treatment of sarcopenia. A systematic umbrella review[J]. J Nutr Health Aging, 2019, 23(6):494-502. DOI PMID
[27]	Fabero-Garrido R, Gragera-Vela M, Del Corral T, et al. Effects of low-load blood flow restriction resistance training on muscle strength and hypertrophy compared with traditional resistance training in healthy adults older than 60 years:systematic review and meta-analysis[J]. J Clin Med, 2022, 11(24):7389.
[28]	Labata-Lezaun N, Llurda-Almuzara L, González-Rueda V, et al. Effectiveness of blood flow restriction training on muscle strength and physical performance in older adults:a systematic review and meta-analysis[J]. Arch Phys Med Rehabil, 2022,103(9):1848-1857.
[29]	Zhang TQ, Wang X, Wang J. Effect of blood flow restriction combined with low-intensity training on the lower limbs muscle strength and function in older adults:a meta-analysis[J]. Exp Gerontol, 2022, 164:111827.
[30]	余诗琦, 王瑛, 杨丹. 不同抗阻训练方式对老年人股四头肌围度和膝关节屈伸力量影响的Meta分析[J]. 辽宁体育科技, 2020, 42(1):57-64.
	Yu SQ, Wang Y, Yang D. A meta analysis on influence of different resistance exercise to old people’s quadriceps femoris dimension and knee-joints’ bend and stretch strength[J]. Liaoning Sport Sci Technol, 2020, 42(1):57-64.
[31]	Centner C, Wiegel P, Gollhofer A, et al. Effects of blood flow restriction training on muscular strength and hypertrophy in older individuals:a systematic review and meta-analysis[J]. Sports Med, 2019, 49(1):95-108.
[32]	Hughes L, Paton B, Rosenblatt B, et al. Blood flow restriction training in clinical musculoskeletal rehabilitation:a systematic review and meta-analysis[J]. Br J Sports Med, 2017, 51(13):1003-1011.
[33]	Clarkson MJ, Brumby C, Fraser SF, et al. Hemodynamic and perceptual responses to blood flow-restricted exercise among patients undergoing dialysis[J]. Am J Physiol Renal Physiol, 2020, 318(3):F843-F850.
[34]	Wooten SV, Declan Fleming RYD, Wolf JS Jr, et al. Prehabilitation program composed of blood flow restriction training and sports nutrition improves physical functions in abdominal cancer patients awaiting surgery[J]. Eur J Surg Oncol, 2021, 47(11):2952-2958. DOI PMID
[35]	蒋琪霞, 唐永利, 洪艳燕, 等. 50所医院老年患者皮肤损伤现状及危险因素分析[J]. 中华护理杂志, 2022, 57(9):1105-1112. DOI
	Jiang QX, Tang YL, Hong YY, et al. Analysis on the prevalence and risk factors of skin injuries in the elderly in 50 hospitals in China[J]. Chin J Nurs, 2022, 57(9):1105-1112. DOI