Portex Unit, UCL Institute of Child Health, London, UK.
Br J Anaesth. 2013 May;110(5):679-89. doi: 10.1093/bja/aes514. Epub 2013 Feb 7.
Reduced physical fitness is associated with increased risk of complications after intra-cavity surgery. Aerobic exercise training interventions improve physical fitness in clinical populations. However, it is unclear whether implementing a preoperative aerobic exercise training intervention improves outcome after intra-cavity surgery. We conducted a systematic review (Embase and PubMed, to April 2011) to address the question: does preoperative aerobic exercise training in intra-cavity surgery result in improved postoperative clinical outcomes? Secondary objectives were to describe the effect of such an intervention on physical fitness and health-related quality of life (HRQL) and report feasibility, safety, and cost-effectiveness. Ten studies were identified from 2443 candidate abstracts. Eight studies were small (<100 patients) and all were single centre. Seven studies reported clinical outcomes. Two studies were controlled trials and two used a sham intervention group. One study in cardiac surgery demonstrated reduced postoperative hospital and intensive care length of stay in the intervention group. Eight studies showed improvement in ≥ 1 measure of physical fitness after the intervention. HRQL was reported in five studies; three showed improved HRQL after the intervention. The frequency, duration, and intensities of the exercise interventions varied across the studies. Adherence to exercise interventions was good. Two exercise-related adverse events (transient hypotension) were reported. Evidence for improved postoperative clinical outcome after preoperative aerobic exercise training interventions is limited. However, preoperative aerobic exercise training seems to be generally effective in improving physical fitness in patients awaiting intra-cavity surgery and appears to be feasible and safe.
体力活动减少与腔镜手术后并发症风险增加相关。有氧运动训练干预可改善临床人群的身体适应性。但是否实施术前有氧运动训练干预能改善腔镜手术后的结局还不清楚。我们进行了系统评价（检索了 Embase 和 PubMed，截至 2011 年 4 月）以回答以下问题：腔镜手术前的有氧运动训练是否能改善术后临床结局？次要目标是描述该干预对身体适应性和健康相关生活质量（HRQL）的影响，并报告可行性、安全性和成本效益。从 2443 篇候选摘要中确定了 10 项研究。8 项研究规模较小（<100 例患者），且均为单中心研究。7 项研究报告了临床结局。2 项为对照试验，2 项采用了模拟干预组。1 项心脏手术研究显示干预组的术后住院时间和 ICU 住院时间缩短。8 项研究显示干预后至少有 1 项身体适应性指标得到改善。5 项研究报告了 HRQL，其中 3 项显示干预后 HRQL 得到改善。研究间的运动干预频率、持续时间和强度存在差异。运动干预的依从性良好。报告了 2 例与运动相关的不良事件（短暂性低血压）。术前有氧运动训练干预对改善术后临床结局的证据有限。但是，术前有氧运动训练似乎能有效改善腔镜手术患者的身体适应性，且似乎可行和安全。
