新冠肺炎康复后患者的肺康复效果：一项系统评价与Meta分析
Effect of Pulmonary Rehabilitation for Patients With Post-COVID-19: A Systematic Review and Meta-Analysis.
作者信息
Chen Huan, Shi Hangyu, Liu Xitong, Sun Tianheng, Wu Jiani, Liu Zhishun
机构信息
Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Tianjin University of Traditional Chinese Medicine, Tianjin, China.
出版信息
Front Med (Lausanne). 2022 Feb 21;9:837420. doi: 10.3389/fmed.2022.837420. eCollection 2022.
BACKGROUND
Evidence increasingly suggested that impaired respiratory function remained in about 40% of patients with coronavirus disease 2019 (COVID-19) after discharge, jeopardizing their activities of daily living and quality of life (QoL) in a long term. Pulmonary rehabilitation (PR) can improve exercise capacity and QoL in individuals with chronic lung disease; however, evidence on the effect of PR for patients with post-COIVD-19 was scarce. This study aimed to conduct a systematic review and meta-analysis to evaluate the effect of PR on lung impairment for patients with post-COVID-19.
METHODS
Five databases were searched for all the published trials of PR for patients with post-COVID-19 from 2019 to October 2021. Data were extracted using a standardized form. The risks of bias of included studies were assessed using the Cochrane risk of the bias assessment tool. Data were synthesized where possible; otherwise, qualitative analysis was done.
RESULTS
Among 6,000 retrieved studies, 3 studies with 233 patients after COVID-19 were included. The pooled estimate of PR effect on 6-min walk test (6-MWT) (50.41, 95% CI 34.34 to 66.48; < 0.0001) was in favor of the experiment group with clinical importance. It is found that PR could improve the symptom of dyspnea and QoL; however, its effect on pulmonary function test was inconsistent across studies. The risk of bias of included studies varied, with major concerns on the risk of blinding of participants and interventions performers.
CONCLUSION
The review showed that PR could improve exercise capacity measured by 6-MWT among patients with mild-to-moderate lung impairment after COVID-19. The interpretation of effects on lung function, dyspnea, and QoL should be cautious due to inadequate and conflicting data reported across studies.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021289562, identifier: CRD42021289562.
背景
越来越多的证据表明，2019冠状病毒病（COVID-19）患者出院后约40%仍存在呼吸功能受损，长期影响其日常生活活动和生活质量（QoL）。肺康复（PR）可以改善慢性肺病患者的运动能力和生活质量；然而，关于PR对COVID-19后患者影响的证据很少。本研究旨在进行系统评价和荟萃分析，以评估PR对COVID-19后患者肺损伤的影响。
方法
检索了五个数据库，以查找2019年至2021年10月期间所有已发表的关于PR治疗COVID-19后患者的试验。使用标准化表格提取数据。使用Cochrane偏倚风险评估工具评估纳入研究的偏倚风险。尽可能进行数据合成；否则，进行定性分析。
结果
在检索到的6000项研究中，纳入了3项研究，共233例COVID-19后患者。PR对6分钟步行试验（6-MWT）的综合估计效应（50.41，95%CI 34.34至66.48；<0.0001）有利于具有临床意义的实验组。研究发现，PR可以改善呼吸困难症状和生活质量；然而，其对肺功能测试的影响在各研究中并不一致。纳入研究的偏倚风险各不相同，主要关注参与者和干预实施者的盲法风险。
结论
该综述表明，PR可以改善COVID-19后轻度至中度肺损伤患者通过6-MWT测量的运动能力。由于各研究报告的数据不足且相互矛盾，对肺功能、呼吸困难和生活质量影响的解释应谨慎。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021289562，标识符：CRD42021289562。
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