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

Abstract

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

CLC Number:

R563.8

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.

Figures/Tables 4

Table 1

Figure 1

Table 2

Table 3

Characteristics of included literatures"

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

Table 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

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

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