收稿日期: 2024-03-19
网络出版日期: 2025-01-22
Effect of phase Ⅰ exercise rehabilitation on patients with acute decompensated heart failure：a meta-analysis
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。
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 . DOI: 10.3761/j.issn.2096-7446.2025.02.018
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.
| [1] | 唐婷婷, 廖玉华. 2023 ESC急性和慢性心力衰竭诊断和治疗指南更新要点解读[J]. 临床心血管病杂志, 2023, 39(10):749-752. |
| Tang TT, Liao YH. Interpretation of the 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. J Clin Cardiol, 2023, 39(10):749-752. | |
| [2] | Emmons-Bell S, Johnson C, Roth G. Prevalence,incidence and survival of heart failure:a systematic review[J]. Heart, 2022, 108(17):1351-1360. |
| [3] | 国家心血管病中心《中西医结合Ⅰ期心脏康复专家共识》专家委员会. 中西医结合Ⅰ期心脏康复共识[J]. 中华高血压杂志, 2017, 25(12):1140-1148. |
| Expert Committee of the Consensus on Integrated Traditional Chinese and Western Medicine for Phase Ⅰ Cardiac Rehabi-litation of National Cardiovascular Disease Center. Consensus of integrated traditional Chinese and western medicine in the first stage of cardiac rehabilitation[J]. Chin J Hypertens, 2017, 25(12):1140-1148. | |
| [4] | Maddocks S, Cobbing S. Patients’ experiences of and pers-pectives on phase 1 cardiac rehabilitation after coronary artery bypass graft surgery[J]. Physiother Can, 2017, 69(4):333-340. |
| [5] | McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guide-lines for the diagnosis and treatment of acute and chronic heart failure:developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC). With the special contri-bution of the Heart Failure Association(HFA) of the ESC[J]. Eur J Heart Fail, 2022, 24(1):4-131. |
| [6] | Patti A, Merlo L, Ambrosetti M, et al. Exercise-based cardiac rehabilitation programs in heart failure patients[J]. Heart Fail Clin, 2021, 17(2):263-271. |
| [7] | Sterne JAC, Savovi? J, Page MJ, et al. RoB 2:a revised tool for assessing risk of bias in randomised trials[J]. BMJ, 2019, 366:l4898. |
| [8] | Ahmad AM, Elshenawy AI, Abdelghany M, et al. Effects of early mobilisation program on functional capacity,daily living activities,and N-terminal prohormone brain natriuretic peptide in patients hospitalised for acute heart failure. A randomised controlled trial[J]. Wu Li Chih Liao, 2023, 43(1):19-31. |
| [9] | Tanaka S, Kamiya K, Matsue Y, et al. Efficacy and safety of acute phase intensive electrical muscle stimulation in frail older patients with acute heart failure:results from the ACTIVE-EMS trial[J]. J Cardiovasc Dev Dis, 2022, 9(4):99. |
| [10] | Poltavskaya M, Sviridenko V, Giverts I, et al. In-hospital elec-trical muscle stimulation for patients early after heart failure decompensation:results from a prospective randomised con-trolled pilot trial[J]. Open Heart, 2022, 9(2):e001965. |
| [11] | Delgado B, Novo A, Lopes I, et al. The effects of early rehabi-litation on functional exercise tolerance in decompensated heart failure patients:results of a multicenter randomized controlled trial(ERIC-HF study)[J]. Clin Rehabil, 2022, 36(6):813-821. |
| [12] | Nakaya Y, Akamatsu M, Ogimoto A, et al. Early cardiac reha-bilitation for acute decompensated heart failure safely impro-ves physical function(PEARL study):a randomized controlled trial[J]. Eur J Phys Rehabil Med, 2021, 57(6):985-993. |
| [13] | 钟惠, 朱正芬, 张小红. 过渡期康复训练对急性失代偿性心力衰竭老年患者的影响研究[J]. 中国实用护理杂志, 2021, 37(21):1628-1634. |
| Zhong H, Zhu ZF, Zhang XH. The intervention effect of transitional rehabilitation training on the clinical outcome of elderly patients with ADHF based on physical function evaluation[J]. Chin J Pract Nurs, 2021, 37(21):1628-1634. | |
| [14] | Forestieri P, Bolzan DW, Santos VB, et al. Neuromuscular elec-trical stimulation improves exercise tolerance in patients with advanced heart failure on continuous intravenous inotropic support use-randomized controlled trial[J]. Clin Rehabil, 2018, 32(1):66-74. |
| [15] | Groehs RV, Antunes-Correa LM, Nobre TS, et al. Muscle elec-trical stimulation improves neurovascular control and exercise tolerance in hospitalised advanced heart failure patients[J]. Eur J Prev Cardiol, 2016, 23(15):1599-1608. |
| [16] | Yoshimura KP, Urabe YP, Maeda NP, et al. Dynamics of car-diorespiratory response during and after the six-minute walk test in patients with heart failure[J]. Physiother Theory Pract, 2020, 36(4):476-487. |
| [17] | Taylor RS, Walker S, Smart NA, et al. Impact of exercise re-habilitation on exercise capacity and quality-of-life in heart failure:individual participant meta-analysis[J]. J Am Coll Cardiol, 2019, 73(12):1430-1443. |
| [18] | Keteyian SJ, Michaels A. Heart failure in cardiac rehabili-tation:a review and practical considerations[J]. J Cardiopulm Rehabil Prev, 2022, 42(5):296-303. |
| [19] | 姚彦蓉, 刘娜, 郑栋莲, 等. 个性化早期活动方案对机械通气患者肌力的影响[J]. 中华急危重症护理杂志, 2020, 1(6):500-505. |
| Yao YR, Liu N, Zheng DL, et al. Influence of personalized early mobilization intervention program on muscle strength of patients with mechanical ventilation[J]. Chin J Emerg Crit Care Nurs, 2020, 1(6):500-505. | |
| [20] | 马昊哲, 赵良渊, 张晓红. 中国老年人简易机体功能评估结果及其影响因素分析[J]. 护理研究, 2022, 36(14):2491-2496. |
| Ma HZ, Zhao LY, Zhang XH. Analysis of evaluation result and influencing factors of Short Physical Performance Battery of elderly in China[J]. Chin Nurs Res, 2022, 36(14):2491-2496. | |
| [21] | Tamura S, Miyata K, Igarashi T, et al. Minimal clinically im-portant difference of the short physical performance battery and comfortable walking speed in old-old adults with acute cardiovascular disease:a multicenter,prospective,observational study[J]. Disabil Rehabil, 2023, 45(6):1079-1086. |
| [22] | Djordjevic T, Arena R, Guazzi M, et al. Prognostic value of NT-pro brain natriuretic peptide during exercise recovery in ischemic heart failure of reduced,midrange,and preserved ejection fraction[J]. J Cardiopulm Rehabil Prev, 2021, 41(4):282-287. |
| [23] | Stienen S, Salah K, Moons AH, et al. NT-proBNP (N-Terminal pro-B-Type Natriuretic Peptide):guided therapy in acute decompensated heart failure:PRIMA Ⅱ randomized con-trolled trial(can NT-ProBNP-guided therapy during hospital admission for acute decompensated heart failure reduce mortality and readmissions?)[J]. Circulation, 2018, 137(16):1671-1683. |
| [24] | Tegegne TK, Rawstorn JC, Nourse RA, et al. Effects of exer-cise-based cardiac rehabilitation delivery modes on exercise capacity and health-related quality of life in heart failure:a systematic review and network meta-analysis[J]. Open Heart, 2022, 9(1):e001949. |
| [25] | Fukuta H, Goto T, Wakami K, et al. Effects of exercise train-ing on cardiac function,exercise capacity,and quality of life in heart failure with preserved ejection fraction:a meta-analysis of randomized controlled trials[J]. Heart Fail Rev, 2019, 24(4):535-547. |
| [26] | Long LD, Mordi IR, Bridges C, et al. Exercise-based cardiac rehabilitation for adults with heart failure[J]. Cochrane Data-base Syst Rev, 2019, 1(1):CD003331. |
| [27] | Meng YT, Zhuge W, Huang HJ, et al. The effects of early exercise on car-diac rehabilitation-related outcome in acute heart failure patients:a syste-matic review and meta-analysis[J]. Int J Nurs Stud, 2022, 130:104237. |
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