呼吸肌训练对神经肌肉疾病患者呼吸功能的影响：一项随机对照试验的系统评价和荟萃分析

The impact of respiratory muscle training on respiratory function in patients with neuromuscular disease: a systematic review and meta-analysis of randomized controlled trials.

作者信息

Ortiz-Garcia Nancy Yesenia, Rueda-Capristran Diego Eduardo, Kumar Ajay, Herrera Domenica Alejandra, Alonso-Ramírez Angie Carolina, Othón-Martínez Diana, Reyes-Rivera Jonathan, Mejia Frances Marie, Martinez-Illan Jonathan David, Durazo Carla Isabella Miret, Perez-Moreno Elda Janette, Cruz Camila Sánchez, Martinez Ernesto Calderon

机构信息

Universidad Juárez del Estado de Durango, Durango, México.

Universidad Nacional Autónoma de México, Ciudad de México, México.

出版信息

BMC Sports Sci Med Rehabil. 2025 Jul 2;17(1):168. doi: 10.1186/s13102-025-01198-z.

DOI:10.1186/s13102-025-01198-z

PMID:40605068

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12220649/

Abstract

BACKGROUND

Neuromuscular diseases (NMDs) can impair respiratory muscle function, leading to increased morbidity and mortality. Respiratory muscle training (RMT) is widely used to manage these respiratory complications, but its efficacy across different NMDs remains unclear. This systematic review and meta-analysis evaluated the impact of physiotherapy interventions, specifically RMT, on respiratory muscle function in NMD patients.

METHODS

A systematic search of multiple databases, including MEDLINE, EMBASE, Web of Science, Cochrane, CRS-Web, PEDro, LILACS, ICTPR, the China National Knowledge Infrastructure database, and ClinicalTrials.gov, was conducted up to February 2025. Randomized controlled trials (RCTs) and cohort studies evaluating RMT's effect on lung volumes and respiratory muscle strength in NMD patients were included. Risk of bias assessment was performed using Cochrane Risk of bias tool for RCTs and Newcastle-Ottawa Scale for cohorts. Meta-analyses were performed using a random-effects model, and heterogeneity was assessed with I² statistics.

RESULTS

Sixteen studies were analyzed from 9,626 screened articles. The meta-analysis demonstrated significant improvements in respiratory muscle strength, particularly in maximal inspiratory pressure (MD: 6.83 cmH₂O, 95% CI: 2.08 to 11.58, p < 0.01, I² = 3.8%) and maximal expiratory pressure (MD: 13.05 cmH₂O, 95% CI: 3.65to 22.42, p < 0.01, I² = 43%). No significant improvements were observed in forced vital capacity (MD: 3.13%, 95% CI: -8.06 to 14.34, p = 0.58), sniff nasal inspiratory pressure (MD: 1.47 cmH₂O, 95% CI: -15.45 to 18.39, p = 0.86), forced expiratory volume in one second (MD: -0.02 L, 95% CI: -0.17 to 0.13, p = 0.78), and vital capacity (MD: -0.10 L, 95% CI: -0.31 to 0.11, p = 0.33).

CONCLUSION

This review supports the role of respiratory muscle training in improving inspiratory and expiratory muscle strength in patients with neuromuscular diseases. However, variability in study methodologies and patient populations limits the statistical significance of some respiratory parameters. Future studies should aim to standardize interventions and outcome measures to provide more conclusive evidence on the efficacy of RMT.

摘要

背景

神经肌肉疾病（NMDs）可损害呼吸肌功能，导致发病率和死亡率增加。呼吸肌训练（RMT）被广泛用于管理这些呼吸并发症，但其在不同神经肌肉疾病中的疗效仍不明确。本系统评价和荟萃分析评估了物理治疗干预，特别是呼吸肌训练，对神经肌肉疾病患者呼吸肌功能的影响。

方法

截至2025年2月，对多个数据库进行了系统检索，包括MEDLINE、EMBASE、科学网、Cochrane、CRS-Web、PEDro、LILACS、ICTPR、中国知网数据库和ClinicalTrials.gov。纳入评估呼吸肌训练对神经肌肉疾病患者肺容量和呼吸肌力量影响的随机对照试验（RCTs）和队列研究。使用Cochrane随机对照试验偏倚风险工具和队列研究的纽卡斯尔-渥太华量表进行偏倚风险评估。采用随机效应模型进行荟萃分析，并用I²统计量评估异质性。

结果

从9626篇筛选文章中分析了16项研究。荟萃分析表明呼吸肌力量有显著改善，尤其是最大吸气压力（MD：6.83 cmH₂O，95%CI：2.08至11.58，p<0.01，I² = 3.8%）和最大呼气压力（MD：13.05 cmH₂O，95%CI：3.65至22.42，p<0.01，I² = 43%）。在用力肺活量（MD：3.13%，95%CI：-8.06至14.34，p = 0.58）、嗅鼻吸气压力（MD：1.47 cmH₂O，95%CI：-15.45至18.39，p = 0.86）、一秒用力呼气量（MD：-0.02 L，95%CI：-0.17至0.13，p = 0.78）和肺活量（MD：-0.10 L，95%CI：-0.31至0.11，p = 0.33）方面未观察到显著改善。