急性失代偿性心力衰竭患者脆弱期运动康复的疗效与安全性：一项系统评价和荟萃分析

Efficacy and safety of exercise rehabilitation in the vulnerable phase in patients with acute decompensated heart failure: A systematic review and meta-analysis.

作者信息

Zhao Lihua, Ye Jing, Zhao Zhuo, Yang Lei, Zheng Yimei

机构信息

Department of Cardiovascular Intensive Care Unit, Peaking University First Hospital, Beijing, China.

Department of Heart Rehabilitation Center, Peaking University First Hospital, Beijing, China.

出版信息

Int J Nurs Sci. 2025 Jun 16;12(4):408-414. doi: 10.1016/j.ijnss.2025.06.006. eCollection 2025 Jul.

DOI:10.1016/j.ijnss.2025.06.006

PMID:40786857

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12332430/

Abstract

OBJECTIVES

This study aimed to assess the impact of exercise rehabilitation during the vulnerable period on cardiac recovery (CR) outcomes in patients with acute decompensated heart failure (ADHF).

METHODS

Multiple databases including PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), Wanfang database, SinoMed, ClinicalTrials.gov, and American Heart Association (AHA) and European Society of Cardiology (ESC) were searched for RCTs on exercise rehabilitation in ADHF patients' vulnerable period from inception to April 2, 2025. The risk of bias was assessed with Cochrane Risk of Bias 2.0, and data were analyzed in RevMan 5.3.

RESULTS

A total of seven RCTs involving 946 patients were included. The results demonstrated that exercise rehabilitation training during the vulnerable period in patients with ADHF significantly increased the 6-min walk test distance (6-MWTD) ( = 0.37; 95 %: 0.09, 0.65; 0.01), short physical performance battery (SPPB) score ( = 1.26; 95 % 0.82, 1.70; < 0.001) and peak oxygen consumption (VOpeak) ( = 1.43; 95 % 0.53, 2.34; = 0.002), improved quality of life (QoL) ( = 0.85; 95 % 0.07, 1.64, = 0.03), reduced depression score ( = -0.73; 95 % 1.27, -0.18; = 0.009), frailty ( = -0.22; 95 % -0.48, 0.05; = 0.11), and decreased 6-month all-cause readmission ( = 0.67; 95 % 0.49, 0.91; = 0.01). However, no statistically significant differences were observed between the two groups in left ventricular ejection fraction (LVEF) ( = 0.96; 95 % -1.84, 3.77; = 0.50), 6-month heart failure (HF)-related readmission ( = 1.01; 95 % 0.66, 1.53; = 0.98), and all-cause mortality ( = 0.63; 95 % 0.18, 2.24; = 0.47). There were no adverse events reported.

CONCLUSIONS

Exercise rehabilitation during the vulnerable phase improves exercise tolerance, QoL, and depressive symptoms while reducing 6-month all-cause readmissions in ADHF patients, with no reported adverse events. Although trends toward improved LVEF, HF-related readmissions, and all-cause mortality were observed. Large-scale, high-quality studies are warranted to explore individualized responses and long-term outcomes.

摘要

目的

本研究旨在评估急性失代偿性心力衰竭（ADHF）患者在易损期进行运动康复对心脏恢复（CR）结局的影响。

方法

检索多个数据库，包括PubMed、Web of Science、Embase、Cochrane图书馆、CINAHL、中国知网（CNKI）、中文科技期刊数据库（VIP）、万方数据库、中国生物医学文献数据库（SinoMed）、ClinicalTrials.gov以及美国心脏协会（AHA）和欧洲心脏病学会（ESC），以查找自数据库建立至[具体日期]（这里原文有误，推测为2025年4月2日）关于ADHF患者易损期运动康复的随机对照试验（RCT）。采用Cochrane偏倚风险2.0评估偏倚风险，并使用RevMan 5.3进行数据分析。

结果

共纳入7项涉及946例患者的RCT。结果表明，ADHF患者在易损期进行运动康复训练显著增加了6分钟步行试验距离（6-MWTD）（平均差=0.37；95%置信区间：0.09，0.65；P=0.01）、简短体能状况量表（SPPB）评分（平均差=1.26；95%置信区间0.82，1.70；P<0.001）和峰值耗氧量（VOpeak）（平均差=1.43；95%置信区间0.53，2.34；P=0.002），改善了生活质量（QoL）（平均差=0.85；95%置信区间0.07，1.64；P=0.03），降低了抑郁评分（平均差=-0.73；95%置信区间-1.27，-0.18；P=0.009）、衰弱程度（平均差=-0.22；95%置信区间-0.48，0.05；P=0.11），并减少了6个月全因再入院率（平均差=0.67；95%置信区间0.49，0.91；P=0.01）。然而，两组在左心室射血分数（LVEF）（平均差=0.96；95%置信区间-1.84，3.77；P=0.50）、6个月心力衰竭（HF）相关再入院率（平均差=1.01；95%置信区间0.66，1.53；P=0.98）和全因死亡率（平均差=0.63；95%置信区间0.18，2.24；P=0.47）方面未观察到统计学显著差异。未报告不良事件。