急性失代偿性心力衰竭患者Ⅰ期运动康复效果的Meta分析

doi:10.3761/j.issn.2096-7446.2025.02.018

摘要/Abstract

摘要：

目的评价Ⅰ期运动康复对急性失代偿性心力衰竭（acute decompensated heart failure，ADHF）患者心脏康复的影响。方法由2名研究者独立检索并筛选PubMed、Web of Science、Embase、Cochrane Library、CINAHL、中国知网、维普数据库、万方数据库和中国生物医学文献数据库建库至2023年10月3日关于Ⅰ期运动康复对急性失代偿性心力衰竭患者心脏康复效果的随机对照研究。采用RevMan 5.3软件进行数据提取与分析。结果共纳入8项随机对照试验，总计681例患者。Meta分析结果显示，与常规护理相比，Ⅰ期运动康复可改善ADHF患者6分钟步行距离[MD=56.80，95%CI（20.82，92.78），P<0.01]、机体功能[MD=1.25，95%CI（0.61，1.89），P<0.01]，减少患者全因再住院率[OR=0.49，95%CI（0.26，0.91），P=0.03]，提升生活质量[MD=-15.74，95%CI（-20.03，-11.44），P<0.01]。但两组N末端脑钠肽前体[MD=-74.36，95%CI（-248.60，99.87），P=0.40]、3个月再住院率[OR=0.48，95%CI（0.16，1.50），P=0.21]差异无统计学意义。两组患者干预期间均未发生不良事件。结论 Ⅰ期运动康复有助于改善ADHF患者的运动耐量和生活质量，对改善6分钟步行距离、简易机体功能评分均有效，且具有安全性。但对于N末端脑钠肽前体水平和3个月再住院率仅有改善趋势，无统计学意义，仍需要大样本和高质量研究来评估其个体反应及长期影响。

关键词: 失代偿性, 急性心力衰竭, Ⅰ期康复, 运动康复, Meta分析, 循证护理学

Abstract:

Objective To evaluate the effect of phase I exercise rehabilitation on cardiac rehabilitation in patients with acute decompensated heart failure（ADHF）. Methods Two researchers independently searched and screened PubMed， Web of Science， Embase， Cochrane Library， CINAHL， CNKI， VIP， Wanfang Database and SinoMed for the randomized controlled study on the effect of phase I exercise rehabilitation on cardiac rehabilitation of patients with acute decompensated heart failure until October 2023. RevMan5.3 software was used for data extraction and analysis. Results A total of 8 RCTs involving 681 patients were included. Meta-analysis results showed that phase I exercise rehabilitation could improve the 6-minute walk distance[MD=56.80， 95%CI（20.82， 92.78）， P<0.01] and physical function [MD=1.25， 95%CI（0.61， 1.89）， P<0.01]， reduce all-cause readmission[OR=0.49， 95%CI（0.26， 0.91）， P=0.03]， improve quality of life[MD=-15.74， 95%CI（-20.03， -11.44）， P<0.01] of ADHF patients compared with routine care. However， there was no difference in NT-proBNP[MD=-74.36， 95%CI（-248.60， 99.87）， P=0.40] and 3-month rehospitalization[OR=0.48， 95%CI（0.16， 1.50）， P=0.21]. No adverse events occurred in the two groups during the intervention period. Conclusion Phase I exercise rehabilitation is helpful to improve the exercise tolerance and quality of life of patients with ADHF， and it is effective and safe to improve the 6-minute walk distance and short physical performance score. However， there was only an improvement trend in NT-proBNP level and 3-month rehospitalization rate， and there was no statistical power. Large sample and high-quality studies are still needed to evaluate its individual response and long-term effects.

Key words: Decompensated, Acute Heart Failure, Phase I Rehabilitation, Exercise Rehabilitation, Meta-Analysis, Evidence-Based Nursing

叶晶, 赵丽华, 郑一梅, 杨蕾. 急性失代偿性心力衰竭患者Ⅰ期运动康复效果的Meta分析[J]. 中华急危重症护理杂志, 2025, 6(2): 226-232.

YE Jing, ZHAO Lihua, ZHENG Yimei, YANG Lei. Effect of phase Ⅰ exercise rehabilitation on patients with acute decompensated heart failure：a meta-analysis[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(2): 226-232.

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