阈值负荷吸气肌训练对呼吸肌功能影响的Meta分析

doi:10.3969/j.issn.1006-9771.2019.10.007

摘要/Abstract

摘要： 目的系统评价阈值负荷吸气肌训练(TIMP)对危重机械通气患者呼吸肌功能的影响。方法检索Cochrane Library、PubMed、Embase、Web of Science、中国生物医学文献数据库、万方数据库、中国知网全文数据库和维普数据库相关随机对照试验(RCT)，截止日期2018年7月1日。由2名研究员对文献质量进行严格评价和资料提取，对符合纳入标准的文献进行Meta分析。结果共纳入14项RCT，共计650例患者，其中试验组323例，对照组327例。与对照组比较，试验组最大吸气压(MIP)增加(MD = -6.65, 95%CI -8.27~-5.03, P < 0.001)，呼吸肌肌力增加(MD = -5.04, 95%CI -7.68~-2.04, P = 0.0002)，撤机时间缩短(MD = -1.01, 95%CI -1.65~-0.37, P = 0.002)，机械通气时间缩短(MD= -2.24, 95%CI -4.33~-0.15, P = 0.04)，ICU住院时间缩短(MD= -3.41, 95%CI -6.06~-0.76, P= 0.01)。两组间最大呼气压(MEP) (MD= 1.22, 95%CI -6.55~9.00, P = 0.76)、再次插管/气管切开发生率(RR = 0.99, 95%CI 0.56~1.73, P = 0.96)、死亡率(RR= 1.05, 95%CI 0.53~2.06, P = 0.89)无显著性差异。结论 TIMP可以改善危重机械通气患者MIP、呼吸肌肌力，缩短机械通气时间、撤机时间和ICU住院时间，提高撤机的成功率。

关键词: 阈值负荷吸气肌训练, 机械通气, 撤机, 呼吸肌肌力, Meta分析

Abstract: Objective To evaluate the effect of threshold inspiratory muscle training (TIMT) on respiratory muscle strength and clinical outcomes for machinery ventilates patients. Methods The Cochrane Library, PubMed, Embase, Web of Science, CBM, Wanfang Database, CNKI and VIP were searched for the randomized controlled trials (RCT) about the effect of TIMT on respiratory muscle strength and clinical outcomes from establishment to July 1st, 2018. Two researchers strictly evaluated literature quality and extracted information, and then a Meta-analysis was carried out. Results A total of 14 literatures were included with 650 patients, 323 cases in the experimental group and 327 cases in the control group. Compared with the control group, the massive inspiratory pressure (MIP) increased (MD = -6.65, 95%CI -8.27~-5.03, P < 0.001), the respiratory muscle strength increased (MD = -5.04, 95%CI -7.68~-2.04, P = 0.0002), the weaning time reduced (MD = -1.01, 95%CI -1.65~-0.37, P = 0.002), the mechanical ventilation time shortened (MD= -2.24, 95%CI -4.33~-0.15, P = 0.04), as well as the intensive care unit (ICU) length of stay (MD= -3.41, 95%CI -6.06~-0.76, P= 0.01). There was no significant difference in maximum expiratory pressure (MEP) (MD= 1.22, 95%CI -6.55~9.00, P = 0.76), the rate of reintubation/tracheotomy (RR = 0.99, 95%CI 0.56~1.73, P = 0.96) and mortality (RR= 1.05, 95%CI 0.53~2.06, P = 0.89) between two groups. Conclusion TIMP could improve MIP and respiratory muscle strength of patients with mechanical ventilation, shorten the weaning time, the mechanical ventilation time and the ICU length of stay, and then reduce the incidence of weaning failure.

Key words: threshold inspiratory muscle training, mechanical ventilation, weaning, respiratory muscle strength, meta-analysis

中图分类号:

R332

吴雨晨, 丁楠楠, 姜变通, 张志刚, 张彩云, 岳伟岗, 田金徽. 阈值负荷吸气肌训练对呼吸肌功能影响的Meta分析[J]. 《中国康复理论与实践》, 2019, 25(10): 1150-1161.

WU Yu-chen, DING Nan-nan, JIANG Bian-tong, ZHANG Zhi-gang, ZHANG Cai-yun, YUE Wei-gang, TIAN Jin-hui. Effect of Threshold Inspiratory Muscle Training on Respiratory Muscle Function: A Meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2019, 25(10): 1150-1161.

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