冠心病患者基于运动的康复治疗：随机对照试验的系统评价与荟萃分析
Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials.
作者信息
Taylor Rod S, Brown Allan, Ebrahim Shah, Jolliffe Judith, Noorani Hussein, Rees Karen, Skidmore Becky, Stone James A, Thompson David R, Oldridge Neil
机构信息
Department of Epidemiology and Public Health, University of Birmingham, Birmingham, United Kingdom.
出版信息
Am J Med. 2004 May 15;116(10):682-92. doi: 10.1016/j.amjmed.2004.01.009.
PURPOSE
To review the effectiveness of exercise-based cardiac rehabilitation in patients with coronary heart disease.
METHODS
A systematic review and meta-analysis of randomized controlled trials was undertaken. Databases such as MEDLINE, EMBASE, and the Cochrane Library were searched up to March 2003. Trials with 6 or more months of follow-up were included if they assessed the effects of exercise training alone or in combination with psychological or educational interventions.
RESULTS
We included 48 trials with a total of 8940 patients. Compared with usual care, cardiac rehabilitation was associated with reduced all-cause mortality (odds ratio [OR] = 0.80; 95% confidence interval [CI]: 0.68 to 0.93) and cardiac mortality (OR = 0.74; 95% CI: 0.61 to 0.96); greater reductions in total cholesterol level (weighted mean difference, -0.37 mmol/L [-14.3 mg/dL]; 95% CI: -0.63 to -0.11 mmol/L [-24.3 to -4.2 mg/dL]), triglyceride level (weighted mean difference, -0.23 mmol/L [-20.4 mg/dL]; 95% CI: -0.39 to -0.07 mmol/L [-34.5 to -6.2 mg/dL]), and systolic blood pressure (weighted mean difference, -3.2 mm Hg; 95% CI: -5.4 to -0.9 mm Hg); and lower rates of self-reported smoking (OR = 0.64; 95% CI: 0.50 to 0.83). There were no significant differences in the rates of nonfatal myocardial infarction and revascularization, and changes in high- and low-density lipoprotein cholesterol levels and diastolic pressure. Health-related quality of life improved to similar levels with cardiac rehabilitation and usual care. The effect of cardiac rehabilitation on total mortality was independent of coronary heart disease diagnosis, type of cardiac rehabilitation, dose of exercise intervention, length of follow-up, trial quality, and trial publication date.
CONCLUSION
This review confirms the benefits of exercise-based cardiac rehabilitation within the context of today's cardiovascular service provision.
目的
回顾基于运动的心脏康复对冠心病患者的有效性。
方法
进行了一项随机对照试验的系统评价和荟萃分析。检索了MEDLINE、EMBASE和Cochrane图书馆等数据库，检索截止至2003年3月。纳入随访6个月或更长时间的试验，这些试验评估了单独运动训练或与心理或教育干预相结合的效果。
结果
我们纳入了48项试验，共8940例患者。与常规治疗相比，心脏康复与全因死亡率降低相关（比值比[OR]=0.80；95%置信区间[CI]：0.68至0.93）以及心脏死亡率降低（OR=0.74；95%CI：0.61至0.96）；总胆固醇水平（加权平均差，-0.37 mmol/L[-14.3 mg/dL]；95%CI：-0.63至-0.11 mmol/L[-24.3至-4.2 mg/dL]）、甘油三酯水平（加权平均差，-0.23 mmol/L[-20.4 mg/dL]；95%CI：-0.39至-0.07 mmol/L[-34.5至-6.2 mg/dL]）和收缩压（加权平均差，-3.2 mmHg；95%CI：-5.4至-0.9 mmHg）有更大幅度的降低；自我报告的吸烟率更低（OR=0.64；95%CI：0.50至0.83）。非致命性心肌梗死和血运重建率、高密度和低密度脂蛋白胆固醇水平以及舒张压的变化没有显著差异。心脏康复和常规治疗使与健康相关的生活质量提高到相似水平。心脏康复对总死亡率的影响独立于冠心病诊断、心脏康复类型、运动干预剂量、随访时间、试验质量和试验发表日期。
结论
本综述证实了在当今心血管服务提供背景下基于运动的心脏康复的益处。
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