Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University Hospitals Geneva, and.
Institute of Sport Sciences, Synathlon, Uni-Centre, Lausanne, Switzerland.
Ann Am Thorac Soc. 2021 Apr;18(4):678-688. doi: 10.1513/AnnalsATS.202002-183OC.
Poor preoperative physical fitness and respiratory muscle weakness are associated with postoperative pulmonary complications (PPCs) that result in prolonged hospital length of stay and increased mortality. To examine the effect of preoperative exercise training on the risk of PPCs across different surgical settings. We searched MEDLINE, Web of Science, Embase, the Physiotherapy Evidence Database, and the Cochrane Central Register, without language restrictions, for studies from inception to July 2020. We included randomized controlled trials that compared patients receiving exercise training with those receiving usual care or sham training before cardiac, lung, esophageal, or abdominal surgery. PPCs were the main outcome; secondary outcomes were preoperative functional changes and postoperative mortality, cardiovascular complications, and hospital length of stay. The study was registered with PROSPERO (International Prospective Register of Systematic Reviews). From 29 studies, 2,070 patients were pooled for meta-analysis. Compared with the control condition, preoperative exercise training was associated with a lower incidence of PPCs (23 studies, 1,864 patients; relative risk, 0.52; 95% confidence interval [CI], 0.41 to 0.66; grading of evidence, moderate); Trial Sequential Analysis confirmed effectiveness, and there was no evidence of difference of effect across surgeries, type of training (respiratory muscles, endurance or combined), or preoperative duration of training. At the end of the preoperative period, exercise training resulted in increased peak oxygen uptake (weighted mean difference [WMD], +2 ml/kg/min; 99% CI, 0.3 to 3.7) and higher maximal inspiratory pressure (WMD, +12.2 cm HO; 99% CI, 6.3 to 18.2). Hospital length of stay was shortened (WMD, -2.3 d; 99% CI, -3.82 to -0.75) in the intervention group, whereas no difference was found in postoperative mortality. Preoperative exercise training improves physical fitness and reduces the risk of developing PPCs while minimizing hospital resources use, regardless of the type of intervention and surgery performed.Systematic review registered with https://www.crd.york.ac.uk/prospero/ (CRD 42018096956).
术前身体状况不佳和呼吸肌无力与术后肺部并发症（PPCs）有关，这会导致住院时间延长和死亡率增加。本研究旨在探讨不同手术环境下术前运动训练对 PPCs 风险的影响。我们检索了 MEDLINE、Web of Science、Embase、物理治疗证据数据库和 Cochrane 中央注册，检索时间截至 2020 年 7 月，无语言限制，纳入比较心脏、肺、食管或腹部手术后接受运动训练与接受常规护理或假训练的患者的随机对照试验。PPCs 是主要结局；次要结局为术前功能变化和术后死亡率、心血管并发症以及住院时间。本研究已在 PROSPERO（国际系统评价前瞻性登记库）上注册。从 29 项研究中，共纳入 2070 例患者进行荟萃分析。与对照组相比，术前运动训练与 PPCs 发生率降低相关（23 项研究，1864 例患者；相对风险，0.52；95%置信区间 [CI]，0.41 至 0.66；证据分级，中）；Trial Sequential Analysis 证实了有效性，且手术类型、训练类型（呼吸肌、耐力或联合）或术前训练持续时间均无效果差异。在术前阶段结束时，运动训练可使峰值摄氧量增加（加权均数差 [WMD]，+2 ml/kg/min；99%CI，0.3 至 3.7）和最大吸气压力升高（WMD，+12.2 cm H2O；99%CI，6.3 至 18.2）。干预组的住院时间缩短（WMD，-2.3 天；99%CI，-3.82 至 -0.75），但术后死亡率无差异。术前运动训练可改善身体状况，降低 PPCs 的发生风险，同时最大限度地减少医院资源的使用，无论干预类型和手术类型如何。系统评价注册于 https://www.crd.york.ac.uk/prospero/（CRD42018096956）。
