吸气肌训练对脱机失败者脱机疗效的系统综述

doi:10.3969/j.issn.1006-9771.2025.03.007

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (3): 306-313.doi: 10.3969/j.issn.1006-9771.2025.03.007

吸气肌训练对脱机失败者脱机疗效的系统综述

蔡倩¹, 张溪¹, 苏海荣², 刘娜¹, 黄颖¹, 李际强¹, 夏金根³(), 郑德采¹()

1.广州中医药大学第二附属医院，广东广州市 510006
2.中国人民解放军第九医学中心，北京市 100101
3.中日友好医院呼吸与危重症医学科，北京市 100029

收稿日期:2024-11-07 修回日期:2024-12-16 出版日期:2025-03-25 发布日期:2025-03-25
通讯作者: 夏金根(1983-)，男，汉族，安徽怀宁县人，博士，副主任呼吸治疗师，主要研究方向：重症患者机械通气的精细化管理、气道管理等，E-mail：xiajingen_00632@163.com；郑德采(1980-)，男，汉族，广东丰顺县人，硕士，副主任康复治疗师，主要研究方向：运动康复、正骨推拿、保健康复等，E-mail：sandzheng@163.com。
作者简介:蔡倩(1988-)，女，汉族，四川武胜县人，硕士，主治医师，主要研究方向：慢性呼吸疾病的呼吸康复、呼吸治疗、心肺运动试验。
基金资助:
1.广东省中医药健康服务与产业发展研究中心项目(2024YBA04);2.广东省中医院中医康复人才培养项目(01020184);3.中日友好医院"菁英计划"人才培育工程骨干项目(ZRJY2023-GG21)

Inspiratory muscle training for weaning outcomes in patients with weaning failure: a systematic review

CAI Qian¹, ZHANG Xi¹, SU Hairong², LIU Na¹, HUANG Ying¹, LI Jiqiang¹, XIA Jin'gen³(), ZHENG Decai¹()

1. The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China
2. The Ninth Medical Center of the People's Liberation Army, Beijing 100101, China
3. Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China

Received:2024-11-07 Revised:2024-12-16 Published:2025-03-25 Online:2025-03-25
Contact: XIA Jin'gen, E-mail: xiajingen_00632@163.com; ZHENG Decai, E-mail: sandzheng@163.com
Supported by:
Guangdong Province Traditional Chinese Medicine Health Service and Industry Development Research Center Project(2024YBA04);Guangdong Provincial Hospital of Traditional Chinese Medicine Talent Training Project for Traditional Chinese Medicine Rehabilitation(01020184);Japan-China Friendship Hospital "Elite Program" Talent Cultivation Project Core Project(ZRJY2023-GG21)

摘要/Abstract

摘要：

目的系统评价吸气肌训练(IMT)对脱机失败者的脱机疗效。

方法检索PubMed、Cochrane Library、Web of Science、Embase、中国知网、维普、万方和中国生物医学文献数据库中有关IMT对机械通气脱机失败者效果的中、英文文献，检索时限自建库至2024年10月22日。利用物理治疗证据数据库(PEDro)量表对纳入文献进行方法学质量评价，提取相关数据进行系统综述。

结果最终纳入9篇随机对照试验，发表时间集中于2011年至2023年，来自巴西、中国、美国、伊朗和澳大利亚5个国家，共涉及499例患者。PEDro量表评分5~8分。研究对象包括延长脱机、困难脱机和气管切开者。IMT方式包括阈值负荷训练和锥形流阻训练。干预强度为30%~80%最大吸气压(MIP)，部分研究没有根据MIP设定训练强度，强度进阶的方式各研究间差异较大。干预频率为每组5~30次呼吸，组间休息至少1 min，每次2~6组，每天1~2次，每周5~7 d。干预持续至成功脱机，或脱机后1周，或拔管，或4 d~8周。干预疗效方面，IMT不能改善脱机失败者的机械通气时间和ICU住院时间，IMT对脱机失败者脱机成功率、脱机持续时间、MIP和病死率的效果，各项研究间结论不一致。

结论 IMT不能改善脱机失败者的机械通气时间和ICU住院时间，对脱机失败者脱机成功率、脱机持续时间、MIP和病死率的效果仍存在争议。

关键词: 吸气肌训练, 脱机失败, 通气机撤除法, 系统综述

Abstract:

Objective To systematically evaluate the effect of inspiratory muscle training (IMT) on weaning outcomes in patients with weaning failure.

Methods Literatures in Chinese and English were retrieved from databases such as PubMed, Cochrane Library, Web of Science, Embase, CNKI, VIP, Wanfang data and CBM for researches on the effect of IMT in mechanical ventilation weaning failure, from the inception of the databases to October 22, 2024. The methodological quality of the researches was evaluated with PEDro scale, and data were extracted for a systematic review.

Results Nine randomized controlled trials were included, published between 2011 and 2023, from Brazil, China, the United States, Iran and Australia, with a total of 499 patients. The scores of the PEDro scale ranged five to eight. The population included patients with prolonged weaning, difficult weaning and tracheostomy. The IMT methods included threshold load training and tapered flow resistance training. The training intensity was 30% to 80% of maximal inspiratory pressure (MIP), and some researches did not set the training intensity based on MIP. The progression of intensity varied widely across researches. The intervention frequency ranged from five to 30 breaths per set, with at least one minute rest between sets, two to six sets per session, one to two sessions per day, and five to seven days per week. The duration of the intervention ranged from successful weaning, one week after weaning, extubation, or four days to eight weeks. Regarding the efficacy of the intervention, IMT was not beneficial for the duration of mechanical ventilation and intensive care unit (ICU) length of stay on weaning failure patients. However, the effect of IMT on weaning successful rates, duration of weaning, MIP and mortality was inconsistent.

Conclusion IMT can not improve the duration of mechanical ventilation and ICU length of stay for weaning failure patients, and there is still debate regarding its effect on successful rate of weaning, duration of weaning, MIP and mortality.

Key words: inspiratory muscle training, weaning failure, ventilator weaning, systematic review

中图分类号:

R563.8

蔡倩, 张溪, 苏海荣, 刘娜, 黄颖, 李际强, 夏金根, 郑德采. 吸气肌训练对脱机失败者脱机疗效的系统综述[J]. 《中国康复理论与实践》, 2025, 31(3): 306-313.

CAI Qian, ZHANG Xi, SU Hairong, LIU Na, HUANG Ying, LI Jiqiang, XIA Jin'gen, ZHENG Decai. Inspiratory muscle training for weaning outcomes in patients with weaning failure: a systematic review[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(3): 306-313.

图/表 4

表1

图1

表2

表3

纳入文献基本特征"

纳入文献	国家	研究对象特征	n(对照组/试验组)	年龄/岁		对照组	试验组吸气肌训练处方				结局指标
纳入文献	国家	研究对象特征	n(对照组/试验组)	对照组	试验组	对照组	方式	持续时间	训练频率	强度及进阶	结局指标
Martin等^[17](2011)	美国	气管切开	34/35	65.1±10.7	65.6±11.7	假治疗	a	成功脱机或28 d	每组6~10次呼吸，组间休息2 min，每次4组，每天1次，每周5 d	4~20 cmH₂O	①②③④
Shimizu等^[18](2014)	巴西	脱机失败者	8/5	62.37±14.41	65.40±10.88	T管	a	4 d	每组10次呼吸，组间休息1 min，每次3组，每天2次	50%MIP	③④⑤
Tonella等^[19](2017)	巴西	气管切开	11/8	46.5	58	常规治疗	b	至脱机	每组10次呼吸，组间休息1 min，每次3组，每天2次	30%MIP起，每天增加10%MIP	②③④⑤
林静静等^[20](2021)	中国	气管切开	13/14	49.38±14.80	53.14±16.15	常规治疗	a	8周	每次15 min，每天1次，每周5 d	30%~50%MIP	④
Da Silva Guimarães等^[21](2021)	巴西	气管切开	53/48	69±16	63±16	T管	b	成功脱机或60 d	每组30次呼吸，组间休息2~3 min，每次2组，每天1次，每周5 d	40%~80%MIP，每周根据MIP调整1次目标负荷	①②④
Roceto Ratti等^[22](2022)	巴西	气管切开	44/34	56.00±18.29	41.64±39.43	T管	b	持续至脱机	每组10次呼吸，组间休息1 min，每次3组，每天2次，每周7 d	30% MIP起，每日增加10%MIP	①②③④⑤⑥
胡正永^[23] (2022)	中国	气管切开	15/28	59.93±12.80	59.97±11.68	常规治疗	a,b	2周	每组5次呼吸，组间休息1 min，每次6组，每天1次，每周6 d	30%MIP起，1~2 d增加1~2 cmH₂O	①④⑤
Khodabandeloo等 ^[24](2023)	伊朗	MV1周	39/40	67.4±13.8	64.6±15.3	常规治疗	a	持续至拔管	每组6次呼吸，组间休息1 min，每次5组，每天1次	50%MIP起，每天增加10%MIP	①②③④⑤
Bissett等^[25](2023)	澳大利亚	MV> 1周	37/33	59±15	60±17	常规治疗	a	脱机后1周	每组6次呼吸，组间休息几分钟，每次5组，每天1次，每周5 d	> 50%MIP	②③④⑥

表3

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纳入文献	资格标准	随机分配	分配隐藏	基线相似	被试施盲	治疗师施盲	评估者施盲	退出率≤ 15%	意向性分析	组间统计比较	点测量和变异量值	总分	质量
Martin等^[17](2011)	√	√	√	√	√				√	√	√	7	高
Shimizu等^[18] (2014)	√	√	√	√				√		√	√	6	高
Tonella等^[19](2017)	√	√	√	√				√		√	√	6	高
林静静等^[20](2021)	√	√		√				√		√	√	5	中等
Da Silva Guimarães等^[21](2021)	√	√		√				√		√	√	5	中等
Roceto Ratti等^[22](2022)	√	√	√	√						√	√	5	中等
胡正永^[23](2022)	√	√		√				√		√	√	5	中等
Khodabandeloo等 ^[24](2023)	√	√		√	√		√	√	√	√	√	8	高
Bissett等^[25](2023)	√	√	√	√		√	√		√	√	√	8	高

吸气肌训练对脱机失败者脱机疗效的系统综述

Inspiratory muscle training for weaning outcomes in patients with weaning failure: a systematic review

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