肺康复训练对中重度慢性阻塞性肺疾病效果的Meta分析

doi:10.3969/j.issn.1006-9771.2026.10.002

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (10): 1133-1142.doi: 10.3969/j.issn.1006-9771.2026.10.002

肺康复训练对中重度慢性阻塞性肺疾病效果的Meta分析

成对霞, 何娟(), 潘蕾

空军军医大学唐都医院呼吸与危重症医学科，陕西西安市 710038

收稿日期:2026-05-26 修回日期:2026-09-17 接受日期:2026-09-29 出版日期:2026-10-25 发布日期:2026-10-23
通讯作者: 何娟(1983-)，女，汉族，陕西西安市人，主管护师，主要研究方向：急危重症护理学。E-mail： 412017093@qq.com
作者简介:成对霞(1993-)，女，汉族，陕西西安市人，硕士，主要研究方向：急危重症护理学。
基金资助:
陕西省重点研发项目(2024SF-YBXM-092);空军军医大学临床研究项目(2022LC2256)

Effect of pulmonary rehabilitation on moderate-to-severe chronic obstructive pulmonary disease： a meta-analysis

Cheng Duixia, He Juan(), Pan Lei

Department of Respiratory and Critical Care Medicine, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, China

Received:2026-05-26 Revised:2026-09-17 Accepted:2026-09-29 Published:2026-10-25 Online:2026-10-23
Supported by:
Shaanxi Provincial Key R&D Program(2024SF-YBXM-092);Clinical Research Project of Air Force Medical University(2022LC2256)

摘要/Abstract

摘要：

目的系统评价肺康复训练对中重度慢性阻塞性肺疾病患者的效果。

方法检索中国知网、维普、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library、EMbase和Web of Science中关于中重度慢性阻塞性肺疾病患者行肺康复治疗的随机对照试验，检索时限建库至2026年1月30日。采用Cochrane偏倚风险评估工具和PEDro量表对纳入文献进行质量评价，采用RevMan 5.4进行Meta分析。

结果最终纳入15项研究，涉及1 259例患者。纳入研究PEDro量表评分7~10分。Meta分析显示，肺康复训练能够改善患者6分钟步行试验(6MWT)距离(MD = 39.48, 95%CI 32.65~46.32, P< 0.001)和用力肺活量(MD = 0.16, 95%CI 0.00~0.31, P= 0.04)，降低改良版英国医学研究委员会呼吸困难量表评分(MD = -0.36, 95%CI -0.48~-0.23, P< 0.001)、慢性阻塞性肺疾病评估测试评分(MD = -4.72, 95%CI -6.71~-2.74, P< 0.001)和圣乔治呼吸问卷评分(MD = -4.34, 95%CI -6.73~-1.94, P< 0.001)。亚组分析显示，≥ 3个月与< 3个月肺康复训练均能显著增加6MWT距离，肺康复训练组第1秒用力呼气容积占用力肺活量的百分比改善。

结论肺康复训练能够提高中重度慢性阻塞性肺疾病患者运动能力和生活质量，改善呼吸困难症状和肺功能。

关键词: 慢性阻塞性肺疾病, 中重度, 肺康复, Meta分析

Abstract:

Objective To systematically evaluate the effect of pulmonary rehabilitation training on moderate-to-severe chronic obstructive pulmonary disease (COPD).

Methods Randomized controlled trials on pulmonary rehabilitation for patients with moderate-to-severe COPD were retrieved from CNKI, VIP, Wanfang data, SinoMed, PubMed, Cochrane Library, Embase and Web of Science, from inception to January 30, 2026. The Cochrane risk-of-bias tool and the PEDro scale were used to assess the quality of the included literatures, and RevMan 5.4 was used for meta-analysis.

Results A total of 15 studies involving 1 259 patients were included. The PEDro scores of the included studies ranged from seven to ten. Meta-analysis showed that pulmonary rehabilitation training improved the distance of 6 Minute Walk Test (6MWT) (MD = 39.48, 95%CI 32.65 to 46.32, P < 0.001) and forced vital capacity (MD = 0.16, 95%CI 0.00 to 0.31, P = 0.04), reduced the scores of modified Medical Research Council (MD = -0.36, 95%CI -0.48 to -0.23, P < 0.001), COPD Assessment Test (MD = -4.72, 95%CI -6.71 to -2.74, P < 0.001) and St. Georges Respiratory Questionnaire (MD = -4.34, 95%CI -6.73 to -1.94, P < 0.001). Subgroup analysis showed that pulmonary rehabilitation training lasting ≥ 3 months and < 3 months both increased the distance of 6MWT, and the pulmonary rehabilitation group improved the percentage of forced expiratory volume in the first second to forced vital capacity.

Conclusion Pulmonary rehabilitation training can improve exercise capacity and quality of life, and alleviate dyspnea and improve pulmonary function in patients with moderate-to-severe COPD.

Key words: chronic obstructive pulmonary disease, moderate to severe, pulmonary rehabilitation, meta-analysis

中图分类号:

R563.9

成对霞, 何娟, 潘蕾. 肺康复训练对中重度慢性阻塞性肺疾病效果的Meta分析[J]. 《中国康复理论与实践》, 2026, 32(10): 1133-1142.

Cheng Duixia, He Juan, Pan Lei. Effect of pulmonary rehabilitation on moderate-to-severe chronic obstructive pulmonary disease： a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(10): 1133-1142.

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纳入文献	纳入与排除标准	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%	意向治疗分析	组间统计比较	点测量和差异值	总分
杜红^[15](2022)	√			√		√	√	√	√	√	√	7
赵凌燕等^[16](2024)	√	√	√	√	√	√	√	√	√	√	√	10
房颖等^[17](2023)	√	√	√	√	√	√		√	√	√	√	9
蒋胜华等^[18](2017)	√			√		√	√	√	√	√	√	7
黄斐斐等^[19](2018)	√	√	√	√		√	√	√	√	√	√	9
方晓明等^[20](2019)	√	√	√	√	√	√	√	√	√	√	√	10
杨霞等^[21](2019)	√	√	√	√	√	√	√	√	√	√	√	10
袁泉等^[22](2024)	√	√	√	√	√	√	√	√	√	√	√	10
Florian等^[23](2024)	√	√	√	√	√	√		√	√	√	√	9
Güell等^[24](2017)	√	√	√	√	√	√	√	√	√	√	√	10
Keniş-Coşkun^[25](2022)	√	√	√	√	√	√	√	√	√	√	√	10
Luo等^[26](2023)	√	√	√	√	√	√	√	√	√	√	√	10
Miki等^[27](2023)	√	√	√	√	√	√		√	√	√	√	9
Phantayuth等^[28](2024)	√	√	√	√	√	√	√	√	√	√	√	10
Tounsi等^[29](2021)	√	√	√	√	√	√	√	√	√	√	√	10

纳入文献	国家	n(C/T)	性别(男/女)/n	年龄(C/T)/岁	干预措施		干预时间	结局指标
纳入文献	国家	n(C/T)	性别(男/女)/n	年龄(C/T)/岁	C	T	干预时间	结局指标
杜红^[15](2022)	中国	40/40	56/24	(66.35±7.17)/(65.89±9.11)	常规治疗	肺康复干预	6个月	①②③④⑤
赵凌燕等^[16](2024)	中国	31/32	51/12	(66±8.89)/(70±8.15)	常规治疗	肺康复干预	6个月	①②④⑥⑦
房颖等^[17](2023)	中国	55/55	73/37	(65.37±4.36)/(65.28±4.25)	常规治疗	肺康复干预	8周	①③⑤⑦
蒋胜华等^[18](2017)	中国	26/26	42/10	(60.07±18.76)/(60.07±18.76)	常规治疗	肺康复干预	6个月	①⑥
黄斐斐等^[19](2018)	中国	53/43	57/39	(77.7±5.5)/(79.0±6.1)	常规治疗	肺康复干预	6个月	①②④⑤⑥
方晓明等^[20](2019)	中国	43/43	62/24	(66.2±7.1)/(65.1±6.7)	常规治疗	肺康复干预	6个月	①②⑤⑥⑦
杨霞等^[21](2019)	中国	49/49	62/36	(71.2±4.2)/(71.4±4.3)	常规治疗	肺康复干预	1个月	①⑥⑦
袁泉等^[22](2024)	中国	72/73	85/60	(75.2±5.9)/(74.6±6.1)	常规治疗	肺康复干预	3个月	①⑦
Florian等^[23](2024)	罗马尼亚	33/32	-	(64.43±4.48)/(65.03±5.08)	常规治疗	肺康复干预	3周	①
Güell等^[24](2017)	西班牙	70/68	123/15	(64.6±8)/(64.6±9)	常规治疗	肺康复干预	12个月	①
Keniş-Coşkun等^[25](2022)	土耳其	12/12	22/2	(60.7±6.7)/(65.6±7.3)	常规治疗	肺康复干预	6个月	①②③
Luo等^[26](2023)	中国	106/100	150/56	(67.43±7.34)/(68.03±6.58)	常规治疗	太极	12个月	③⑤⑦
Miki等^[27](2023)	美国	20/20	35/5	(74±5.93)/(74±5)	常规治疗	压力负荷训练	3个月	③
Phantayuth等^[28](2024)	泰国	12/12	24/0	(70±4)/(70±6)	常规治疗	太极+瑜伽	12周	④⑤⑦
Tounsi等^[29](2021)	法国	16/16	-	(63±4)/(62±5)	常规治疗	吸气肌训练+全身耐力训练	8周	①

结局指标	纳入文献数	异质性检验		效应模型	Meta分析结果
结局指标	纳入文献数	I²值	P值	效应模型	MD(95%CI)	P值
6MWT	12^[15-25,29]	76%	< 0.001	随机	39.48(32.65~46.32)	< 0.001
mMRC	5^[16,18-21]	43%	0.150	固定	-0.36(-0.48~-0.23)	< 0.001
CAT	5^{[15-16,19-20,25]}	63%	0.030	随机	-4.72(-6.71~-2.74)	< 0.001
SGRQ	5^{[15,17,25-27]}	0%	0.610	固定	-4.34(-6.73~-1.94)	< 0.001
FEV₁	4^{[15-16,19,28]}	83%	< 0.001	随机	0.10(-0.06~0.27)	0.220
FVC	6^{[15,17,19-20,26,28]}	89%	< 0.001	随机	0.16(0.00~0.31)	0.040
(FEV₁/FVC)/%	7^{[16-17,20-22,26,28]}	96%	< 0.001	随机	0.90(-3.08~4.88)	0.660

结局指标	亚组		纳入研究数/n	异质性检验		Meta分析
结局指标	亚组		纳入研究数/n	I²值	P值	MD(95%CI)	P值
6MWT	干预周期	≥ 3个月	8^{[15-16,18-20,22,24-25]}	51	0.040	40.35(32.22~48.48)	< 0.001
6MWT	干预周期	< 3个月	4^{[17,21,23,29]}	91	< 0.001	35.57(23.27~47.87)	< 0.001
(FEV₁/FVC)/%	训练方式	肺康复	5^{[16-17,20-22]}	85	< 0.001	3.38(0.97~5.80)	0.006
(FEV₁/FVC)/%	训练方式	身心训练	2^[26,28]	95	< 0.001	-5.35(-14.04~3.34)	0.230

肺康复训练对中重度慢性阻塞性肺疾病效果的Meta分析

Effect of pulmonary rehabilitation on moderate-to-severe chronic obstructive pulmonary disease： a meta-analysis

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