阈值负荷吸气肌训练对慢性阻塞性肺疾病患者呼吸功能、运动功能及生活质量影响的Meta分析

doi:10.3969/j.issn.1006-9771.2022.09.004

Abstract

Abstract:

Objective To systematically evaluate the effects of threshold inspiratory muscle training (TIMT) on respiratory function, motor function and quality of life in patients with chronic obstructive pulmonary disease (COPD).
Methods Randomized controlled trials (RCT) about the effects of TIMT on dyspnea, quality of life, motor function and inspiratory muscle strength for COPD patients were retrieved from PubMed, EBSCO, Web of Science, Ovid, Cochrane Library, SinoMed, CNKI, VIP, since establishment to September, 2020. Two researchers independently screened literatures, extracted data and evaluated the methodological quality. A meta-analysis was performed using RevMan 5.3.
Results A total of 30 RCTs involving 2 060 patients were included. TIMT could obviously improve the maximum inspiratory pressure (MD = 10.68, 95%CI 7.43 to 13.92, P< 0.001), optimize the results of 6-minute Walking Test (MD = 24.62, 95%CI 9.09 to 40.15, P= 0.002), the St George's Respiratory Questionnaire (MD = -3.08, 95%CI -5.84 to -0.33, P= 0.03), the modified Medical Research Council Dyspnea Scale (MD = -0.30, 95%CI -0.52 to -0.07, P= 0.01) and Borg score (MD = -0.84, 95%CI -1.24 to -0.44, P< 0.001). TIMT could also improve the forced expiratory volume in one second (MD = 0.11, 95%CI 0.04 to 0.19, P= 0.003) and the forced expiratory volume in one second in predicted (MD = 3.72, 95%CI 2.62 to 4.82, P< 0.001). There was no significant difference in the COPD Assessment Test (MD = -1.14, 95%CI -2.32 to 0.03, P= 0.06) or forced vital capacity (MD = 0.07, 95%CI -0.12 to 0.25, P= 0.49).
Conclusion TIMT can improve the inspiratory muscle strength, alleviate the symptoms of dyspnea, and improve the lung function and the quality of life for COPD patients.

Key words: threshold inspiratory muscle training, chronic obstructive pulmonary disease, randomized controlled trial, meta-analysis

CLC Number:

R563.3

PENG Juan,WANG Jieping,HUANG Wei,FAN Bishuang,YU Jihua,ZENG Jin,HUANG Liheng,AN Lijuan,XU Fangyuan. Effects of threshold inspiratory muscle training on respiratory function, motor function and quality of life for patients with chronic obstructive pulmonary disease: a meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(9): 1022-1031.

Figures/Tables 10

纳入研究	国家/地区	研究对象/n	年龄/岁	性别 (男/女)/n	肺功能分级	干预时间	干预措施	评定时间	结局指标	PEDro 评分	文献质量
郑江南等^[7](2019)	中国	T:25 C:25	T:64.76±5.51 C:65.56±5.79	T:16/9 C:15/10	未提及	30次呼吸/组,休息2 min/15次呼吸,2组/天,每周5 d,共48周	T:TIMT+支气管扩张剂/糖皮质激素 C:空白对照+支气管扩张剂/糖皮质激素	训练前训练48周后	(1)(2)(3)(4)(5)(6)	6	高
黄玉霞等^[8](2018)	中国	T:21 C:20	未提及	T:16/5 C:14/6	未提及	每次锻炼3 min,休息2 min,8次/组,共8周	T:TIMT+常规药物 C:空白对照+常规药物	训练前训练8周后	(1)(3)(5)(7)(8)	7	高
黄元萍等^[9](2019)	中国	T:40 C:40	T:64.37±11.35 C:66.69±10.46	T:28/12 C:24/16	未提及	每次锻炼3 min,休息5 min,每组8次,共8周	T:TIMT+常规药物 C:空白对照+常规药物	训练前训练8周后	(2)(3)(4)(5)(8)(9)	6	高
闫立娟等^[10](2019)	中国	T:68 C:68	T:63.85±2.5 C:63.46±2.37	T:40/28 C:42/26	Ⅱ~Ⅳ级	每次20 min,每天2次,共5周	T:TIMT+常规药物 C:呼吸操+常规药物	训练前训练5周后	(1)(2)(3)(4)(9)(10)	6	高
徐建红等^[11](2014)	中国	T:23 C:22	T:65.30±3.41 C:66.78±3.52	T:15/8 C:16/6	I~II级	每次15 min,每天1次,共24周	T:有氧训练+TIMT C:有氧训练+假性干预	训练前训练24周后	(1)(3)(10)	6	高
陈长芳等^[12](2016)	中国	T:32 C:31	T:68.95±7.93 C:67.33±7.86	未提及	未提及	每次15 min,每天2次,每周6 d,共48周	T:支气管扩张剂/糖皮质激素+TIMT C:支气管扩张剂/糖皮质激素+假性干预	训练前训练48周后	(2)(3)(4)(7)(9)	6	高
Xu等^[13](2018)	中国	T:23 C:23	T:67.49±6.17 C:69.43±6.44	未提及	Ⅱ~Ⅳ级	每天48 min,每周7 d,共8周	T:TIMT+常规药物 C:假性干预+常规药物	训练前训练8周后	(1)(7)(8)(5)(3)(2)(9)(4)(11)(12)	7	高
Wu等^[14](2017)	中国	T:21 C:19	T:62.24±7.36 C:60.30±6.55	未提及	未提及	每次15 min,每天2次,共8周	T:TIMT+常规药物 C:空白对照+常规药物	训练前训练8周后	(3)(13)(14)(15)	7	高
Weiner等^[15](1992)	以色列	T:12 C:12	T:67.2 ±2.6 C:64.4 ±3.0	T:6/6 C:7/5	稳定型	每次60 min,每周3次,共24周	T:TIMT+一般训练 C:假性干预+一般训练	训练前训练24周后	(2)(3)(8)(9)(16)	6	高
Wang等^[16](2017)	中国	T:28 C:27	T:70.8±4.5 C:70.0±6.3	未提及	未提及	每次30 min CET训练+14 min TIMT,每周3次,共8周	T:TIMT+循环呼吸训练 C:空白对照+循环呼吸训练	训练前训练8周后	(1)(2)(3)(4)(5)(7)(8)(9)(11)(12)(17)(18)	9	极高
Schultz等^[17](2018)	德国	T:300 C:302	T:57.7±8.2 C:57.9±6.6	T:188/112 C:201/101	II~IV级	每天21 min,每周7 d,共3周	T:肺康复计划+TIMT C:肺康复计划+假性干预	训练前训练3周后	(1)(7)(3)(2)(5)(14)(19)(20)	6	高
Sánchez等^[18](2001)	西班牙	T:10 C:10	T:67±4 C:67.6±5	T:9/1 C:9/1	未提及	每次20 min,每天2次,每周6 d,共24周	T:TIMT+常规药物 C:假性干预+常规药物	训练前训练24周后	(3)(10)(14)(15)(21)(22)(23)(24)(25)	8	高
Margaret等^[19](2001)	美国	T:12 C:15	T:65±6 C:67±10	未提及	严重型	每天30 min,每周5 d,共16周	T:TIMT+健康教育 C:空白对照+健康教育	训练前训练16周后	(3)(15)(26)	8	高
Hsiao等^[20] (2003)	中国	T:10 C:10	T:68.2±6.5 C:71.1±3.9	T:10/0 C:8/2	中到重度	每天15 min,每周5 d,共8周	T:TIMT C:假性干预	训练前训练8周后	(1)(3)(27)	6	高
Beckerman等^[21](2005)	以色列	T:21 C:21	T:67.7±3.6 C:66.9±3.3	T:17/4 C:15/6	未提及	每次15 min,每天2次,每周6 d, 共48周	T:TIMT C:假性干预	训练前训练12周、24周、36周、48周后	(1)(3)(7)(10)(28)(29)(30)	8	高
Langer等^[22] (2018)	加拿大	T:10 C:10	T: 73±4 C:67±8	T:4/6 C:3/7	中到重度	每组4~5 min,每天2~3组,每周7 d,共8周	T:TIMT C:假性干预	训练前训练8周后	(3)(10)(8)(13)(14)	9	极高
Abedi等^[23](2019)	伊朗	T:16 C:15	T:51.88±9.05 C:55.67±11.08	T:7/9 C:7/8	中到重度	每天15 min,每周2 d,共8周	T:TIMT+常规药物 C:空白对照+常规药物	训练前训练4周、8周后	(7)	5	中
Kim等^[24] (1993)	美国	T:41 C:26	T:66±7 C:63±8	未提及	中到重度	每天30 min,共24周	T:TIMT C:假性干预	训练前训练12周、24周后	(3)(16)	7	高
Lisboa等^[25](1997)	智利	T:10 C:10	T:61±2 C:64±2	T:6/4 C:7/3	未提及	每天30 min,每周6 d,共10周	T:TIMT C:假性干预	训练前训练10周后	(1)(2)(3)(9)(10)(14)(25)	8	高
Basso-Vanelli等^[26](2016)	巴西	T:13 C:12	T:67±12.8 C:66±7.6	T:11/2 C:9/3	中到重度	每天21 min,每周3 d,共16周	T:体能训练+TIMT C:体能训练+健美操呼吸训练	训练前训练16周后	(1)(2)(3)(4)(8)(9)(14)(17)(31)	6	高
Bavarsad等^[27](2015)	伊朗	T:15 C:15	T:58.8±6.82 C:54.2±8.09	T:13/2 C:14/1	中到重度	每天15 min,每周6 d,共8周	T: TIMT+常规药物 C: 空白对照+常规药物	训练前训练8周后	(1)(2)(4)(9)(10)	5	中
Beaumont等^[28](2018)	法国	T:74 C:75	T:62.2±8.0 C:65.9±8.9	T:30/44 C:25/50	重度	每天15 min,每周5 d,共4周	T: 肺康复计划+TIMT C: 肺康复计划+空白对照	训练前训练4周后	(1)(2)(3)(7)(8)(10)(32)(33)	8	高
Beaumont等^[29](2015)	法国	T:16 C:18	T:62±10 C:61±7	T:4/12 C:7/11	中到重度	每组15 min,每天2组,每周5 d,共3周	T: 肺康复计划+TIMT C: 肺康复计划+空白对照	训练前训练3周后	(1)(3)(10)(31)(32)(34)	7	高
Charususin等^[30](2018)	比利时	T:89 C:85	T:66±8 C:65±7	未提及	未提及	每次3~5 min,每天2次,共8周	T: 肺康复计划+TIMT C: 肺康复计划+假性干预	训练前训练8周后	(1)(3)(17)(18)(22)(35)	8	高
Chuang等^[31](2017)	中国	T:27 C:28	T:66.22±12.76 C:66.04±10.99	T:17/10 C:19/9	中到重度	每天21~30 min,每周5 d,共8周	T:TIMT+常规药物及护理 C:空白对照+常规药物及护理	训练前训练4周、8周后	(1)(3)(13)(27)	5	中
Cutrim等^[32](2019)	巴西	T:11 C:11	T:70±8 C:66±8.5	T:9/2 C:8/3	未提及	每周3 d,共12周	T:TIMT C:空白对照	训练前训练12周后	(1)(2)(3)(9)(18)	8	高
Hill等^[33] (2006)	澳大利亚	T:16 C:17	T:69.4±7.2 C:66.6±9.8	T:11/5 C:11/6	中到重度	每天21 min,每周3 d,共8周	T:TIMT C:假性干预	训练前训练8周后	(1)(2)(3)(4)(9)(15)(18)(33)	7	高
Nikoletou等^[34](2016)	英国	T:22 C:19	T:70.1±8.4 C:71.1±9.6	T:13/9 C:11/8	中到重度	每天2次,每周6 d,共7周	T:TIMT C:空白对照	训练前训练7周后	(3)(11)(15)(21)(27)(36)(37)	7	高
Weiner等^[35] (2006)	以色列	T:14 C:14	未提及	T:8/6 C:8/6	中到重度	每天60 min,每周6 d,共8周	T:TIMT C:假性干预	训练前训练8周后	(3)(38)	8	高
Elmorsi等^[36](2016)	埃及	T:20 C:20	T:57.20±5.08 C:55.70±6.12	未提及	中到重度	每天3 min,每周6 d,共8周	T:TIMT+常规药物 C:空白对照+常规药物	训练前训练4周、8周后	(1)(3)(7)(8)(22)	5	中

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Effects of threshold inspiratory muscle training on respiratory function, motor function and quality of life for patients with chronic obstructive pulmonary disease: a meta-analysis

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