高流量鼻导管在慢性呼吸系统疾病成人运动中的应用：系统评价和荟萃分析。
High-flow nasal cannula in adults with chronic respiratory diseases during physical exercise: a systematic review and meta-analysis.
机构信息
CardioREspirAtory Research Laboratory (CREAR Lab), Departamento de Kinesiología, Escuela de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
Programa Magister de Investigación en Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
出版信息
BMJ Open Respir Res. 2024 Oct 22;11(1):e002431. doi: 10.1136/bmjresp-2024-002431.
BACKGROUND
Chronic respiratory diseases (CRDs) affect at least 545 million people globally, leading to symptoms such as dyspnoea, fatigue and limited physical activity. Pulmonary rehabilitation (PR) programmes aim to improve the exercise capacity and quality of life of patients with CRD through exercise training. High-flow nasal cannula (HFNC) therapy shows potential as an adjunct treatment during exercise, but its effects on CRD populations are unclear. The purpose of this systematic review was to evaluate the effects of HFNC during exercise in people with CRD.
METHODS
A systematic review was conducted and eight databases and other resources were searched from inception (28 June 2022) to 4 April 2023. Studies that used adult patients with CRD and randomised controlled trial that compared the effect of HFNC versus standard care (conventional oxygen therapy or room air) during exercise were included. Two authors independently selected trials, extracted the data, assessed risks of bias and employed the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to judging the certainty of evidence. We pooled trials using random-effect models and inverse variance estimation.
RESULTS
Seventeen studies (n=8406) were included in the review (570 patients). The evidence suggests that HFNC increases exercise time after multiple training sessions (weighted mean difference (WMD)=160.58 s; 95% 95% CI=67.32-253.83, 2 studies) and increase after a single session (WMD=72.10 s; 95% CI=28.95-115.24, 11 studies). HFNC may result in little improvements in secondary outcomes (quality of life, dyspnoea, comfort, complications and adherence).
DISCUSSION
The evidence suggests that HFNC may increase functional exercise capacity and positively enhance secondary outcomes. Continued research is justified to elucidate the role of HFNC in PR during exercise training.
PROSPERO REGISTRATION NUMBER
CRD42022336263.
背景
慢性呼吸系统疾病（CRD）影响着全球至少 5.45 亿人，导致呼吸困难、疲劳和体力活动受限等症状。肺康复（PR）计划旨在通过运动训练提高 CRD 患者的运动能力和生活质量。高流量鼻导管（HFNC）治疗在运动期间作为辅助治疗具有潜力，但它对 CRD 人群的影响尚不清楚。本系统评价的目的是评估 HFNC 在 CRD 患者运动期间的作用。
方法
进行了系统评价，从 2022 年 6 月 28 日到 2023 年 4 月 4 日，检索了八个数据库和其他资源。纳入使用成年 CRD 患者并比较 HFNC 与标准治疗（常规氧疗或室内空气）在运动期间效果的随机对照试验。两名作者独立选择试验、提取数据、评估偏倚风险，并采用 GRADE（推荐评估、制定与评价）方法判断证据的确定性。我们使用随机效应模型和倒数方差估计对试验进行了汇总。
结果
综述纳入了 17 项研究（n=8406）（570 名患者）。证据表明，HFNC 可增加多次训练后的运动时间（加权均数差（WMD）=160.58 秒；95%CI=67.32-253.83，2 项研究）和单次训练后的运动时间（WMD=72.10 秒；95%CI=28.95-115.24，11 项研究）。HFNC 可能对次要结局（生活质量、呼吸困难、舒适度、并发症和依从性）的改善作用不大。
讨论
证据表明，HFNC 可能增加功能运动能力，并积极改善次要结局。有理由继续研究 HFNC 在运动训练期间 PR 中的作用。
PROSPERO 注册号：CRD42022336263。
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