神经肌肉电刺激对机械通气 COPD 患者的疗效：系统评价和荟萃分析。
Effectiveness of neuromuscular electrostimulation in COPD subjects on mechanical ventilation. A systematic review and meta-analysis.
机构信息
Physical Medicine and Rehabilitation Service, Critical Care Unit, Instituto Nacional del Tórax, Santiago, Chile; Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile.
Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile; Departamento Ciencias de la Salud, Carrera de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
出版信息
Clinics (Sao Paulo). 2022 Sep 24;77:100108. doi: 10.1016/j.clinsp.2022.100108. eCollection 2022.
OBJECTIVE
To estimate the effectiveness of Neuromuscular Electrostimulation (NMES) in adults with COPD undergoing MV.
METHOD
A sensitive search was performed in MEDLINE, Embase, CENTRAL, CINAHL and other resources. Randomized Controlled Clinical Trials (RCTs) or non-RCTs that enrolled adults with COPD on MV due to an exacerbation of their disease were included. Two independent reviewers screened, extracted information, and assessed the risk of bias (RoB 2 tool) and the certainty of evidence (GRADE approach) from the included studies.
RESULTS
Four RCTs (144 participants) were included. Subjects who underwent NMES were able to move from bed to chair independently in less time (MD = 4.98 days less; 95% CI -8.55 to -1.47; 2 RCTs; low certainty of the evidence) and they were fewer days on MV (MD = 2.89 days less; 95% CI -4.58 to -1.21); 3 RCTs; low certainty of the evidence) than the control group. However, the effect of NMES on muscle strength is unclear (very low certainty of the evidence).
CONCLUSIONS
NMES may improve functional independence and decrease MV time in adults with COPD; however, its effectiveness on muscle strength is uncertain. More and better RCTs are needed to determine with greater certainty the effectiveness of NMES in this population.
目的
评估神经肌肉电刺激（NMES）在机械通气（MV）治疗的 COPD 成人中的有效性。
方法
在 MEDLINE、Embase、CENTRAL、CINAHL 和其他资源中进行了敏感检索。纳入了因疾病加重而接受 MV 的 COPD 成年患者的随机对照临床试验（RCT）或非 RCT。两名独立评审员筛选、提取信息，并对纳入研究的偏倚风险（RoB 2 工具）和证据确定性（GRADE 方法）进行评估。
结果
共纳入 4 项 RCT（144 名参与者）。接受 NMES 的受试者能够更快地从床上转移到椅子上（MD = 少 4.98 天；95%CI-8.55 至-1.47；2 项 RCT；证据确定性为低），并且他们接受 MV 的天数更少（MD = 少 2.89 天；95%CI-4.58 至-1.21；3 项 RCT；证据确定性为低）。然而，NMES 对肌肉力量的影响尚不清楚（证据确定性非常低）。
结论
NMES 可能改善 COPD 成人的功能独立性并减少 MV 时间；然而，其对肌肉力量的有效性尚不确定。需要更多和更好的 RCT 来更确定地确定 NMES 在该人群中的有效性。
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