华西医学

华西医学

肺康复训练对脑卒中患者肺功能影响的 Meta 分析

查看全文

目的 评价肺康复训练改善脑卒中患者肺功能的效果。 方法 系统检索 Cochrane Library、PubMed、ProQuest、Embase、中国知网、万方数据库、中国生物医学文献数据库和维普中文期刊全文数据库,收集肺康复训练对脑卒中患者肺功能影响的随机对照研究,检索期限为建库至 2018 年 9 月。试验组采用肺康复训练,训练内容包括呼吸肌肌力训练、胸式呼吸或腹式呼吸训练,训练方式可采用或不采用呼吸训练器进行;对照组采用常规的脑卒中康复训练。结局指标采用用力肺活量(forced vital capacity,FVC)、第 1 秒用力呼气容积(forced expiratory volume in one second,FEV1)、FEV1 占预计值百分比(FEV1% 预计值)、FEV1/FVC、呼气峰值流速、最大吸气压、最大呼气压、活动耐力和生存质量。由 2 名研究人员单独进行文献检索和数据提取,同时采用物理治疗证据数据库量表和 Cochrane 系统评价手册标准进行文献质量评价。若遇分歧,咨询专家后共同作出决策。使用 RevMan 5.3 软件进行数据处理。 结果 共纳入 11 篇文献、500 例脑卒中患者,其中试验组 274 例,对照组 226 例。Meta 分析结果显示,与对照组相比,试验患者的 FVC 值[均数差(mean difference,MD)=0.30 L,95% 置信区间(confidence interval,CI)(0.26,0.34)L,P<0.000 01]、FEV1 值[MD=0.28 L,95%CI(0.25,0.32)L,P<0.000 01]和 6 min 步行测试[MD=43.43 m,95%CI(7.92,78.95)m,P=0.02]在干预后更高,最大吸气压的提高更多[MD=6.49 cm H2O(1 cm H2O=0.098 kPa),95%CI(3.67,9.32) cm H2O,P<0.000 1]。在改善脑卒中患者的 FEV1/FVC 和 FEV1% 预计值方面,尚未发现肺康复训练的优势(P>0.05)。 结论 实施以呼吸肌训练为主的肺康复训练结合常规卒中康复治疗可以提高患者肺功能指标中的 FVC 和 FEV1、吸气肌肌力和 6 min 步行距离。肺康复训练对脑卒中患者的长期疗效、不同处方的呼吸肌训练模式、对活动耐力和生存质量的影响尚需进一步研究。

Objective To examine the effects of pulmonary rehabilitation training on pulmonary function in patients post-stroke. Methods We searched Cochrane Library, PubMed, ProQuest, Embase, China National Knowledge Infrastructure, Wangfang Database, Chinese Biomedical Database, and VIP Chinese Science and Technology Journal Database for randomized controlled trials of investigating the effects of pulmonary rehabilitation training on pulmonary function in stroke patients published before September 2018. The patients in the training group were treated with pulmonary rehabilitation, including respiratory muscle training, chest breathing, or abdominal breathing training, with or without respiratory training device. The patients in the control group received conventional stroke rehabilitation. The outcome indicators included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1 percentage predicted (FEV1%pred), peak expiratory flow rate, maximal inspiratory pressure (PImax), maximal expiratory pressure, exercise endurance, and quality of life. Two researchers independently carried out literature retrieval and data extraction, using Physiotherapy Evidence Database scale, and standard data extraction forms adapted from Cochrane Collaboration model to evaluate the studies quality. The Meta-analysis was performed using Review Manager Version 5.3. Results Eleven studies met the study criteria with a total of 500 stroke patients, including 274 patients in the training group and 226 patients in the control group, respectively. The Meta-analysis showed that after pulmonary rehabilitation training, the values of FVC [mean difference (MD)=0.30 L, 95% confidence interval (CI)(0.26, 0.34) L, P<0.000 01], FEV1 [MD=0.28 L, 95%CI (0.25, 0.32) L, P<0.000 01], and 6-minute walking test [MD=43.43 m, 95%CI (7.92, 78.95) m, P=0.02] in the training group were significantly higher than those in the control group, as well as the change of PImax [MD=6.49 cm H2O (1 cm H2O=0.098 kPa), 95%CI (3.67, 9.32) cm H2O, P<0.000 1]. The advantages of pulmonary rehabilitation training had not been found in improving FEV1/FVC and FEV1%pred (P>0.05). Conclusions The implementation of pulmonary rehabilitation training in the way of respiratory muscle training combined with conventional rehabilitation therapy could improve two kinds of indicators of pulmonary function referring to FVC and FEV1, inspiratory muscle strength and 6-minute waking distance. The long-term effect of pulmonary rehabilitation training on stroke patients, the respiratory training mode of different prescriptions, the endurance of exercise and the quality of life need further study.

关键词: 肺康复; 脑卒中; 肺功能; Meta 分析

Key words: Pulmonary rehabilitation; Stroke; Pulmonary function; Meta-analysis

引用本文: 陈彦, 吴霜. 肺康复训练对脑卒中患者肺功能影响的 Meta 分析. 华西医学, 2018, 33(10): 1277-1286. doi: 10.7507/1002-0179.201805162 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Kulnik ST, Rafferty GF, Birring SS, et al. A pilot study of respiratory muscle training to improve cough effectiveness and reduce the incidence of pneumonia in acute stroke: study protocol for a randomized controlled trial. Trials, 2014, 15: 123.
2. Liu DD, Chu SF, Chen C, et al. Research progress in stroke-induced immunodepression syndrome (SIDS) and stroke-associated pneumonia (SAP). Neurochem Int, 2018, 114: 42-54.
3. Sutbeyaz ST, Koseoglu F, Inan L, et al. Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke: a randomized controlled trial. Clin Rehabil, 2010, 24(3): 240-250.
4. Ezeugwu XE, Olaogun M, Mbada CE, et al. Comparative lung function performance of stroke survivors and age-matched and sex-matched controls. Physiother Res Int, 2013, 18(4): 212-219.
5. Lista Paz A, González Doniz L, Ortigueira García S, et al. Respiratory muscle strength in chronic stroke survivors and its relation with the 6-minute walk test. Arch Phys Med Rehabil, 2016, 97(2): 266-272.
6. Kim J, Park JH, Yim J. Effects of respiratory muscle and endurance training using an individualized training device on the pulmonary function and exercise capacity in stroke patients. Med Sci Monit, 2014, 20: 2543-2549.
7. Britto RR, Rezende NR, Marinho KC, et al. Inspiratory muscular training in chronic stroke survivors: a randomized controlled trial. Arch Phys Med Rehabil, 2011, 92(2): 184-190.
8. Lee DK, Kim SH. The effect of respiratory exercise on trunk control, pulmonary function, and trunk muscle activity in chronic stroke patients. J Phys Ther Sci, 2018, 30(5): 700-703.
9. 俞长君, 李雪萍, 林强, 等. 呼吸肌训练对亚急性期脑卒中患者呼吸功能的影响. 中华物理医学与康复杂志, 2016, 38(10): 735-739.
10. 马艳, 王小云, 岳翔, 等. 膈肌训练对脑卒中后疲劳患者日常生活活动的影响. 中华物理医学与康复杂志, 2016, 38(8): 587-590.
11. 中华医学会神经病学分会, 中华医学会神经病学分会神经康复学组, 中华医学会神经病学分会脑血管病学组. 中国脑卒中早期康复治疗指南. 中华神经科杂志, 2017, 50(6): 405-412.
12. 时惠, 刘玲, 祖菲娅·吐尔迪. 阈值压力负荷呼吸肌训练对脑卒中患者康复疗效的 Meta 分析. 中国康复理论与实践, 2016, 22(9): 1069-1074.
13. Gomes-Neto M, Saquetto MB, Silva CM, et al. Effects of respiratory muscle training on respiratory function, respiratory muscle strength, and exercise tolerance in patients poststroke: a systematic review with Meta-analysis. Arch Phys Med Rehabil, 2016, 97(11): 1994-2001.
14. Gungen BD, Tunc A, Aras YG, et al. Predictors of intensive care unit admission and mortality in patients with ischemic stroke: investigating the effects of a pulmonary rehabilitation program. BMC Neurol, 2017, 17(1): 132.
15. Hegland KW, Davenport PW, Brandimore AE, et al. Rehabilitation of swallowing and cough functions following stroke: an expiratory muscle strength training trial. Arch Phys Med Rehabil, 2016, 97(8): 1345-1351.
16. Jung KM, Bang DH. Effect of inspiratory muscle training on respiratory capacity and walking ability with subacute stroke patients: a randomized controlled pilot trial. J Phys Ther Sci, 2017, 29(2): 336-339.
17. 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. Top Stroke Rehabil, 2018, 25(1): 37-43.
18. 中华神经科学会, 中华神经外科学会. 各类脑血管疾病诊断要点. 中华神经科杂志, 1996, 29(6): 379-380.
19. Bhogal SK, Teasell RW, Foley NC, et al. The PEDro scale provides a more comprehensive measure of methodological quality than the Jadad scale in stroke rehabilitation literature. J Clin Epidemiol, 2005, 58(7): 668-673.
20. Higgins JP, Green S. Cochrane handbook for systemic reviews of interventions version 5.1.0[updated March 2011] . The Cochrane Collaboration, 2011.
21. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
22. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
23. Joo S, Shin D, Song C. The effects of game-based breathing exercise on pulmonary function in stroke patients: a preliminary study. Med Sci Monit, 2015, 21: 1806-1811.
24. 吴红琴, 张兰香, 王速敏, 等. 呼吸训练器对脑卒中患者肺功能及日常生活自理能力的影响. 江苏医药, 2015, 41(19): 2328-2329.
25. Kim CY, Lee JS, Kim HD, et al. Effects of the combination of respiratory muscle training and abdominal drawing-in maneuver on respiratory muscle activity in patients with post-stroke hemiplegia: a pilot randomized controlled trial. Top Stroke Rehabil, 2015, 22(4): 262-270.
26. Kulnik ST, Birring SS, Moxham J, et al. Does respiratory muscle training improve cough flow in acute stroke? Pilot randomized controlled trial. Stroke, 2015, 46(2): 447-453.
27. Messaggi-Sartor M, Guillen-Solà A, Depolo M, et al. Inspiratory and expiratory muscle training in subacute stroke: a randomized clinical trial. Neurology, 2015, 85(7): 564-572.
28. Kumar S, Selim MH, Caplan LR. Medical complications after stroke. Lancet Neurol, 2010, 9(1): 105-118.
29. Šedý J, Kuneš J, Zicha J. Pathogenetic mechanisms of neurogenic pulmonary edema. J Neurotrauma, 2015, 32(15): 1135-1145.
30. Wu W, GuanL, Zhang X, et al. Effect of two types of equal-intensity inspiratory muscle training in stable patients with chronic obstructive pulmonary disease: a randomised controlled trail. Respir Med, 2017, 132: 84-91.
31. Rochester CL, Vogiatzis I, Holland AE, et al. An official American Thoracic Society/European Respiratory Society policy statement: enhancing implementation, use, and delivery of pulmonary rehabilitation. Am J Respir Crit Care Med, 2015, 192(11): 1373-1386.
32. Fry DK, Pfalzer LA, Chokshi AR, et al. Randomized control trial of effects of 110-week inspiratory muscle training program on measures of pulmonary function in persons with multiple sclerosis. J Neurol Phys Ther, 2007, 31(4): 162-172.
33. Inzelberg R, Peleg N, Nisipeanu P, et al. Inspiratory muscle training and the perception of dyspnea in Parkinson’s disease. Can J Neurol Sci, 2005, 32(2): 213-217.
34. Young RP, Hopkins R, Eaton TE. Forced expiratory volume in one second: not just a lung function test but a marker of premature death from all causes. Eur Respir J, 2007, 30(4): 616-622.
35. Beckerman M, Magadle R, Weiner M, et al. The effects of 1 year of specific inspiratory muscle training in patients with COPD. Chest, 2005, 128(5): 3177-3182.
36. Ward K, Seymour J, Steier J, et al. Acute ischaemic hemispheric stroke is associated with impairment of reflex in addition to voluntary cough. Eur Respir J, 2010, 36(6): 1383-1390.