Xiang Yuping, Zhao Qin, Luo Tinahui, Zeng Ling
Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.
Front Cardiovasc Med. 2023 Jul 24;10:1223619. doi: 10.3389/fcvm.2023.1223619. eCollection 2023.
Pulmonary complications occur in a substantial proportion of patients who undergo coronary artery bypass grafting. Inspiratory muscle training (IMT), a simple, well-tolerated physical therapy, has been proposed to reduce the risk of complications, but its efficacy remains controversial.
Randomized controlled trials (RCTs) examining the influence of IMT on the risk of pulmonary complications after coronary artery bypass grafting were identified from PubMed, Embase, CENTRAL, CINAL, and Web of Science through March 2023. Data were meta-analyzed for the primary outcomes of pulmonary complications, defined as pneumonia, pleural effusion, and atelectasis; and in terms of the secondary outcomes of maximum inspiratory pressure, maximum expiratory pressure, length of hospitalization, 6 min walk test, and peak expiratory flow and other outcomes. Risk of bias and quality of evidence assessments were carried out using the RoB 2.0 and Grading of Recommendations Assessment, Development and Evaluation (GRADE) applied to primary outcomes of pulmonary complications.
Data from eight RCTs involving 755 patients were meta-analyzed. IMT was associated with a significantly lower risk of postoperative pneumonia [relative risk (RR) 0.39, 95% confidence interval (CI) 0.25-0.62, < 0.0001] and atelectasis (RR 0.43, 95% CI 0.27-0.67, = 0.0002), but not pleural effusion (RR 1.09, 95% CI 0.62-1.93, = 0.76). IMT was associated with significantly better maximum inspiratory pressure (preoperative: mean difference (MD) 16.55 cmHO, 95% CI 13.86-19.24, < 0.00001; postoperative: mean difference (MD) 8.99 cmHO, 95% CI 2.39-15.60, = 0.008) and maximum expiratory pressure (MD 7.15 cmHO, 95% CI: 1.52-12.79, = 0.01), and with significantly shorter hospitalization (MD -1.71 days, 95% CI -2.56 to -0.87, < 0.001). IMT did not significantly affect peak expiratory flow or distance traveled during the 6 min walk test.
The available evidence from medium and high quality trials suggests that IMT can significantly decrease the risk of pneumonia and atelectasis after coronary artery bypass grafting while shortening hospitalization and improving the strength of respiratory muscles.
https://www.crd.york.ac.uk/prospero/, identifier: CRD42023415817.
相当一部分接受冠状动脉旁路移植术的患者会出现肺部并发症。吸气肌训练（IMT）是一种简单且耐受性良好的物理治疗方法，已被提议用于降低并发症风险，但其疗效仍存在争议。
通过检索截至2023年3月的PubMed、Embase、CENTRAL、CINAL和Web of Science数据库，识别出考察IMT对冠状动脉旁路移植术后肺部并发症风险影响的随机对照试验（RCT）。对肺部并发症的主要结局（定义为肺炎、胸腔积液和肺不张）以及最大吸气压力、最大呼气压力、住院时间、6分钟步行试验、呼气峰值流速等次要结局和其他结局进行荟萃分析。使用RoB 2.0和推荐分级评估、制定与评价（GRADE）对肺部并发症的主要结局进行偏倚风险和证据质量评估。
对八项RCT（涉及755例患者）的数据进行了荟萃分析。IMT与术后肺炎风险显著降低相关[相对风险（RR）0.39，95%置信区间（CI）0.25 - 0.62，<0.0001]以及肺不张风险降低相关（RR 0.43，95% CI 0.27 - 0.67，=0.0002），但与胸腔积液无关（RR 1.09，95% CI 0.62 - 1.93，=0.76）。IMT与显著更好的最大吸气压力相关（术前：平均差（MD）16.55 cmH₂O，95% CI 13.86 - 19.24，<0.00001；术后：平均差（MD）8.99 cmH₂O，95% CI 2.39 - 15.60，=0.008）和最大呼气压力相关（MD 7.15 cmH₂O，95% CI：1.52 - 12.79，=0.01），并且与住院时间显著缩短相关（MD -1.71天，95% CI -2.56至-0.87，<0.001）。IMT对呼气峰值流速或6分钟步行试验中的行走距离没有显著影响。
来自中高质量试验的现有证据表明，IMT可显著降低冠状动脉旁路移植术后肺炎和肺不张的风险，同时缩短住院时间并提高呼吸肌力量。
