阈值吸气肌训练对肺癌术后患者肺康复影响的Meta分析

doi:10.3969/j.issn.1006-9771.2025.10.007

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (10): 1164-1171.doi: 10.3969/j.issn.1006-9771.2025.10.007

阈值吸气肌训练对肺癌术后患者肺康复影响的Meta分析

赵英楠¹, 郑鑫彤¹, 刘俊玲¹, 王紫丹¹, 吴泓悦¹, 李冰¹, 李燕²()

1.天津中医药大学，天津市 301617
2.天津医科大学肿瘤医院，天津市 300060

收稿日期:2025-08-06 修回日期:2025-09-10 出版日期:2025-10-25 发布日期:2025-11-10
通讯作者: 李燕(1972-)，女，汉族，天津市人，主任护师，硕士研究生导师，主要研究方向：肺癌术后肺康复，E-mail： liyan1@tjmuch.com
作者简介:赵英楠(1999-)，男，汉族，河北邯郸市人，硕士研究生，主要研究方向：肺癌术后肺康复。
基金资助:
1.天津市医学重点学科(专科)建设项目(TJYXZDXK-011A);2.天津医科大学医院管理创新研究项目(2023YG12)

Effect of threshold inspiratory muscle training on pulmonary rehabilitation in postoperative lung cancer patients: a meta-analysis

ZHAO Yingnan¹, ZHENG Xintong¹, LIU Junling¹, WANG Zidan¹, WU Hongyue¹, LI Bing¹, LI Yan²()

1. Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
2. Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China

Received:2025-08-06 Revised:2025-09-10 Published:2025-10-25 Online:2025-11-10
Contact: LI Yan, E-mail: liyan1@tjmuch.com
Supported by:
Construction Project of Tianjin Key Medical Disciplines (Specialties)(TJYXZDXK-011A);Hospital Management Innovation Research Project of Tianjin Medical University(2023YG12)

摘要/Abstract

摘要：

目的观察阈值吸气肌训练对肺癌术后患者肺康复的影响，重点探索不同干预模式下的效应差异。
方法检索PubMed、Cochrane Library、Embase、Web of Science、中国知网、万方数据库、维普数据库、中国生物医学数据库中公开发表的关于阈值吸气肌训练对肺癌术后患者肺康复影响的随机对照试验，同时检索ProQuest、clinicaltrials.gov中的灰色文献作为补充。检索时间为建库至2025年5月9日。采用Cochrane 5.1.0系统评价手册进行文献质量评价，采用RevMan 5.4进行Meta分析。
结果共纳入12篇文献，涉及701例患者，均为中、高质量文献。阈值吸气肌训练可降低肺部并发症(OR = 0.45, 95%CI 0.29~0.68, P < 0.001)，缩短术后住院时间(MD = -1.85, 95%CI -3.29~-0.42, P = 0.010)，提高肺癌术后患者吸气肌力量(MD = 5.84, 95%CI 0.96~10.71, P = 0.020)，提高患者运动耐力(SMD = 0.40, 95%CI 0.10~0.71, P = 0.010)，不会增加患者肺漏气风险(OR = 0.88, 95%CI 0.47~1.63, P = 0.680)。亚组分析显示，仅当阈值吸气肌训练联合有氧运动时，对住院时间的缩短(MD = -2.98，95%CI -5.87~-0.09, P = 0.040)和运动耐力的改善(SMD = 0.57, 95%CI 0.14~1.00, P = 0.009)效应显著，单独阈值吸气肌训练在此两项指标中效应不显著。
结论阈值吸气肌训练可有效减少肺癌术后患者肺部并发症，提高吸气肌力量，并且安全性良好；需联合有氧运动才能改善运动耐力，缩短住院时间。

关键词: 肺癌, 阈值吸气肌训练, 肺康复, Meta分析

Abstract:

Objective To systematically evaluate the effect of threshold inspiratory muscle training on pulmonary rehabilitation in postoperative lung cancer patients, with a focus on exploring the difference in efficacy under different intervention modes.
Methods Randomized controlled trials on the effect of threshold inspiratory muscle training on pulmonary rehabilitation in postoperative lung cancer patients were retrieved from PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang data, VIP and China Biomedical Literature Database. Meanwhile, gray literature from ProQuest and clinicaltrials.gov was searched as supplements. The retrieval period was from the establishment of each database to May 9, 2025. Cochrane 5.1.0 was used to evaluate the quality of literature, and a meta-analysis was performed using RevMan 5.4.
Results Twelve studies involving 701 patients were included, all of which were of moderate to high quality. Threshold inspiratory muscle training could reduce the pulmonary complications of postoperative lung cancer patients (OR = 0.45, 95%CI 0.29 to 0.68, P < 0.001), shorten the hospital stay (MD = -1.85, 95%CI -3.29 to -0.42, P = 0.010), improve the inspiratory muscle strength (MD = 5.84, 95%CI 0.96 to 10.71, P = 0.020), enhance their exercise endurance (SMD = 0.40, 95%CI 0.10 to 0.71, P = 0.010), and did not increase the risk of pulmonary air leakage (OR = 0.88, 95%CI 0.47 to 1.63, P = 0.680). Subgroup analysis revealed that shortening of hospital stay (MD = -2.98，95%CI -5.87 to -0.09, P = 0.040) and the improvement in exercise endurance (SMD = 0.57, 95%CI 0.14 to 1.00, P = 0.009) were significant only when threshold inspiratory muscle training was combined with aerobic exercise. However, standalone threshold inspiratory muscle training showed no statistical significance in these two outcomes.
Conclusion Threshold inspiratory muscle training can effectively reduce postoperative pulmonary complications and improve inspiratory muscle strength in postoperative lung cancer patients with good safety. Threshold inspiratory muscle training could shorten hospital stay and improve exercise endurance only when combining with aerobic exercise.

Key words: lung cancer, threshold inspiratory muscle training, pulmonary rehabilitation, meta-analysis

中图分类号:

R734.2

赵英楠, 郑鑫彤, 刘俊玲, 王紫丹, 吴泓悦, 李冰, 李燕. 阈值吸气肌训练对肺癌术后患者肺康复影响的Meta分析[J]. 《中国康复理论与实践》, 2025, 31(10): 1164-1171.

ZHAO Yingnan, ZHENG Xintong, LIU Junling, WANG Zidan, WU Hongyue, LI Bing, LI Yan. Effect of threshold inspiratory muscle training on pulmonary rehabilitation in postoperative lung cancer patients: a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(10): 1164-1171.

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纳入文献	国家	n(T/C)	年龄(T/C)/岁	干预措施		干预频率	阈值初始阻力	干预时长	结局指标
纳入文献	国家	n(T/C)	年龄(T/C)/岁	T	C	干预频率	阈值初始阻力	干预时长	结局指标
Brocki等^[17](2015)	丹麦	34/34	69.7±7.9/70.5±7.5	TIMT	深呼吸训练	每组30次，每天2组	15% MIP	术后2周	①②③④⑤
Liu等^[11](2021)	中国	32/31	64.2±5.9/66.3±7.9	TIMT+有氧运动	常规呼吸训练	每组30次，每天2组	30% MIP	术后6周	①③④⑤
Lähteenmäki等^[12](2021)	芬兰	22/23	59±11/58±15	TIMT	水瓶正压呼气	每天1次	20% MIP	术前和术后前2 d	②③④⑤
Ha等^[18](2023)	美国	14/14	68.3±6.4/70.3±7.4	TIMT+有氧运动	常规健康教育	每天10~15 min	最大耐受压力	术后12周	④⑤
赵蕾^[19](2023)	中国	44/44	69.3±6.2/70±7.4	TIMT	深呼吸训练	每组30次，每天1组	30% MIP	术前3 d至出院	①
Lähteenmäki等^[20](2020)	芬兰	22/20	67±6/68±9	TIMT	水瓶正压呼气	每天1次	20% MIP	术前和术后前2 d	②③④⑤
Taşkin等^[21](2020)	土耳其	20/20	53.3±10/57.1±8.7	TIMT+有氧运动	胸部理疗	每天6组，每组30次	15% MIP	术后1周	③④⑤
Weiner等^[22](1997)	以色列	17/15	59.8±10/63.3±8.9	TIMT	常规呼吸训练	每天1 h	15% MIP	术前2周至术后3个月	①③
Benzo等^[23](2011)	美国	9/8	70.2±8.6/72.0±6.7	TIMT+有氧运动	深呼吸训练	每天10~15 min	最大耐受压力	术前1周	①②
Morano等^[24](2013)	美国	12/12	64.8±8/68.8±7.3	TIMT+有氧运动	常规呼吸训练	每天10~30 min	20% MIP	术前4周	①②③④⑤
Huang等^[25](2017)	中国	30/30	64.1±5.3/63.6±6.5	TIMT+有氧运动	常规呼吸训练	每次15~20 min，每天2~3次	最大耐受压力	术前1周	①②④⑤
Han等^[26](2025)	中国	94/100	64±8.9/63.5±8.9	TIMT+有氧运动	常规健康教育	每组10~20次，每天10组	—	术前3 d	①②④⑤

阈值吸气肌训练对肺癌术后患者肺康复影响的Meta分析

Effect of threshold inspiratory muscle training on pulmonary rehabilitation in postoperative lung cancer patients: a meta-analysis

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结局指标	亚组分析	纳入研究数/n	异质性检验结果		效应模型	Meta分析结果
结局指标	亚组分析	纳入研究数/n	P值	I²/%	效应模型	合并效应量	95%CI	P值
肺部并发症		8^{[11,17,19,22-26]}	0.390	5	固定	OR = 0.45	0.29~0.68	< 0.001
术后住院时间		7^{[12,17,20,23-26]}	< 0.001	80	随机	MD = -1.85	-3.29~-0.42	0.010
	TIMT	3^[12,17,20]	0.900	0	随机	MD = -0.72	-1.78~0.33	0.180
	TIMT+有氧运动	4^[23-26]	< 0.001	90	随机	MD = -2.98	-5.87~-0.09	0.040
MIP		7^{[12,17,20,23-26]}	0.600	0	固定	MD = 5.84	0.96~10.71	0.020
运动耐力		9^{[11-12,17-18,20-21,24-26]}	0.004	65	随机	SMD = 0.40	0.10~0.71	0.010
	TIMT	3^[12,17,20]	0.860	0	随机	SMD = 0.12	-0.20~0.43	0.460
	TIMT+有氧运动	6^{[11,18,21,24-26]}	0.003	72	随机	SMD = 0.57	0.14~1.00	0.009
肺漏气		5^{[11-12,17,19-20]}	0.200	33	固定	OR = 0.88	0.47~1.63	0.680

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