目的：系统评价社区心脏康复训练对冠心病患者康复疗效的影响。 方法：计算机检索Cochrane Library、PubMed、Web of Science、Embase、中国生物医学文献数据库、中国学术期刊全文数据库中有关冠心病患者社区心脏康复训练的随机对照试验，采用RevMan 5.3软件进行Meta分析。结果：最终纳入14篇文献，共2 645例患者。 Meta分析结果显示，社区心脏康复训练能有效改善冠心病患者的峰值摄氧量(MD=1.17，95%CI 0.41~1.92，P=0.003)、左心室射血分数(MD=7.43，95%CI 6.59~8.28，P＜0.001)、收缩压(MD=-4.97，95%CI-7.93~-2.01，P=0.001)、舒张压(MD=-2.27，95%CI-3.38~-1.15，P＜0.001)、6 min步行距离(MD=102.70，95%CI 88.51~116.88，P＜0.001)，帮助患者戒烟(OR=1.40，95%CI 1.12~1.76，P=0.003)，降低体质量指数(MD=-1.32，95%CI-2.26~-0.37，P=0.006)、心脏不良事件发生率(OR=0.17，95%CI 0.07~0.39，P＜0.001)，提高生活质量(MD=6.81，95%CI 4.77~8.84，P＜0.001)，差异均有统计学意义。结论：社区心脏康复训练能有效改善冠心病患者心肺功能、运动能力和心脏射血能力，降低收缩压、体质量指数和心脏不良事件发生率，帮助患者戒烟，从而提高患者生活质量。

[1] 中国心血管健康与疾病报告编写组.中国心血管健康与疾病报告2019概要[J].中国循环杂志,2020,35(9):833-854.
[2] JIMENEZ-NAVARRO M F,LOPEZ-JIMENEZ F,PEREZ-BELMONTE L M,et al.Benefits of cardiac rehabilitation on cardiovascular outcomes in patients with diabetes mellitus after percutaneous coronary intervention[J].J Am Heart Assoc,2017,6(10):e006404.
[3] 杜若飞,王盼盼,田丽,等.冠心病患者心脏康复依从性的研究进展[J].中华护理杂志,2017,52(10):1246-1251.
[4] HARRIS D E,RECORD N B.Cardiac rehabilitation in community settings[J].J Cardiopulm Rehabil,2003,23(4):250-259.
[5] BAEK S,HA Y,MOK J,et al.Community-based cardiac rehabilitation conducted in a public health center in South Korea:a preliminary study[J].Ann Rehabil Med,2020,44(6):481-492.
[6] HIGGINS J P,ALTMAN D G,GOTZSCHE P C,et al.The Cochrane Collaboration's tool for assessing risk of bias in randomised trials[J].BMJ,2011,18(343):d5928.
[7] LENNON O,CAREY A,GAFFNEY N,et al.A pilot randomized controlled trial to evaluate the benefit of the cardiac rehabilitation paradigm for the non-acute ischaemic stroke population[J].Clin Rehabil,2008,22(2):125-133.
[8] ZHANG Y,CAO H,JIANG P,et al.Cardiac rehabilitation in acute myocardial infarction patients after percutaneous coronary intervention:a community-based study[J].Medicine(Baltimore),2018,97(8):e9785.
[9] MINNEBOO M,LACHMAN S,SNATERSE M,et al.Community-based lifestyle intervention in patients with coronary artery disease:the RESPONSE-2 trial[J].J Am Coll Cardiol,2017,70(3):318-327.
[10] XAVIER D,GUPTA R,KAMATH D,et al.Community health worker-based intervention for adherence to drugs and lifestyle change after acute coronary syndrome:a multicentre,open,randomised controlled trial[J].Lancet Diabetes Endocrinol,2016,4(3):244-253.
[11] 周召锋,吴春阳,施亚明,等.冠心病PCI术后病人实施社区中西医结合心脏康复的效果观察[J].中西医结合心脑血管病杂志,2020,18(10):1555-1557.
[12] 兰永青,陈丹,蒋萍.冠心病患者社区运动康复训练的可行性及效果分析[J].川北医学院学报,2019,34(3):452-455.
[13] BETHELL H J,MULLEE M A.A controlled trial of community based coronary reh-abilitation[J].Br Heart J,1990,64(6):370-375.
[14] 陈碧华,王青青,陈俊玲,等.社区心脏康复路径对冠心病患者的影响[J].临床内科杂志,2020,37(3):191-193.
[15] 马江莲.社区康复指导模式对冠心病患者预后的影响[J].大家健康(学术版),2016,10(6):97-98.
[16] 苏媛媛,张伟宏,宋晓月,等.心脏康复教育对社区老年冠心病患者自我管理行为及生活质量的影响[J].中国老年学杂志,2019,39(20):5105-5108.
[17] 蔡泽坤,徐琳,马骏,等.早期心脏康复程序对急性心肌梗死患者经皮冠状动脉介入术后心脏收缩功能的影响[J].中国康复医学杂志,2017,32(4):391-395.
[18] XIAO M,LI Y,GUAN X.Community-based physical rehabilitation after percutaneous coronary intervention for acute myocardial infarction[J].Tex Heart Inst J,2021,48(2):e197103.
[19] 蒋旭侃,张伟明,马杨,等.基于三级康复网络的冠心病社区康复管理模式对社区冠心病患者的效果分析[J].中国康复医学杂志,2021,36(7):827-831.
[20] 杨树鹏,申云,郝楠,等.社区心脏康复对急性非ST段抬高型心肌梗死患者经皮冠状动脉介入术后康复的影响[J].中国医药,2021,16(7):991-994.
[21] HA J W,CHOI D,PARK S,et al.Determinants of exercise-induced pulmonary hypertension in patients with normal left ventricular ejection fraction[J].Heart,2009,95(6):490-494.
[22] SEINO Y,STANILOFF H,SHELL W A,et al.Evaluation of a QRS scoring system in acutemyocardial infarction:relation to infarct size,early stage left ventricular ejecti-on fraction,and exercise performance[J].Am J Cardiol,1983,1(52):37-42.
[23] HAYKOWSKY M,SCOTT J,ESCH B,et al.A Meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction:start early and go longer for greatest exercise benefits on remodeling[J].Trials,2011,12:92.
[24] 朱秀华,袁玉芹,李松,等.有氧康复运动训练联合心理治疗对PCI术后患者精神心理障碍的调节作用[J].广东医学,2014,35(23):3676-3678.
[25] 高真真,季鹏,夏月清,等.不同强度有氧运动对经皮冠状动脉介入治疗术后患者心功能及运动耐力的影响[J].中国康复医学杂志,2015,30(4):344-348.
[26] 孔雪,高方明.急性心肌梗死患者急诊行经皮冠状动脉介入术后早期康复治疗对心脏射血分数的影响[J].中国康复医学杂志,2015,30(8):843-844,849.
[27] 曲凯.心脏康复治疗对冠脉支架术后患者心脏功能及生化指标的影响[D].长春：吉林大学,2017.
[28] 中国高血压防治指南修订委员会,高血压联盟(中国),中华医学会心血管病学分会,等.中国高血压防治指南(2018年修订版)[J].中国心血管杂志,2019,24(1):24-56.
[29] KUBILIUS R,JASIUKEVICIENE L,GRIZAS V,et al.The impact of complex cardi-ac rehabilitation on manifestation of risk factors in patients with coronary heart disea-se[J].Medicina(Kaunas),2012,48(3):166-173.
[30] MOHAMMED H G,SHABANA A M.Effect of cardiac rehabilitation on cardiovascular risk factors inchronic heart failure patients[J].Egypt Heart J,2018,70(2):77-82.
[31] JIANG X,SIT J W,WONG T K.A nurse-led cardiac rehabilitation programme impr-oves health behaviours and cardiac physiological risk parameters:evidence from Chengdu,China[J].J Clin Nurs,2007,16(10):1886-1897.
[32] 叶常英,杨丽娟,马力,等.运动康复训练对老年冠心病慢性心力衰竭患者心功能及预后的影响[J].护理实践与研究,2014,11(7):8-10.
[33] MEHTA L,DEVHN W,MCCUFLOUGH P A,et al.Impact of body mass index on outcomes after percutaneous coronary intervention in patients with acute myocardial infarction[J].Am J Cardiol,2007,99(7):906-910.
[34] SHIRAISHI J,KOHNO Y,SAWADA T,et al.Pathogenesis of acute myocardial infarction in young male adults with or without obesity[J].J Cardiol,2007,49(1):13-21.
[35] JING L,BINKLEY C M,SUEVER J D,et al.Cardiac remodeling and dysfunction in childhood obesity:acardiovascularmagnetic resonance study[J].J Cardiovasc Magn Reson,2016,18(1):28.
[36] MANDIC S,BODY D,BARCLAL L,et al.Community-based cardiac rehabilitation maintenance programs:use and effects[J].Heart Lung Circ,2015,24(7):710-718.
[37] 邓维,孙兴国,郭志勇,等.心肺运动试验定量评估PCI前后心肺功能的临床研究[J].重庆医科大学学报,2019,44(5):668-673.
[38] POPOVIC D,KUMAR N,CHAUDHRY S,et al.Improvements in key cardiopulmonary exercise testing variables following cardiac rehabilitation in patients with coronary artery disease[J].J Cardiopulm Rehabil Prev,2018,38(5):E5-E8.
[39] JELINEK H F,HUANG Z Q,KHANDOKER A H,et al.Cardiac rehabilitation outcomes following a 6-week program of PCI and CABG Patients[J].Front Physiol,2013,4:302.
[40] 李颖,陈铎.心肺运动测试指导心脏康复对慢性心力衰竭患者心肺功能、生命质量的影响观察[J].贵州医药,2021,45(1):56-57.
[41] YEH G Y,WANG C,WAYNE P M,et al.Tai chi exercise for patients with cardiovascular conditions and risk factors:a systematic review[J].J Cardiopulm Rehabil Prev,2009,29(3):152-160.
[42] INGLE K K,BLUMENTHAL J A.Should stress managementbe incorporated into cardiac rehabilitation?[J].Expert Rev Cardiovasc Ther,2012,10(2):135-137.
[43] 史利锋,林平,陈巍,等.经皮冠状动脉介入治疗术后心脏不良事件与冠心病危险因素关系的研究进展[J].解放军护理杂志,2015,32(7):27-29,62.
[44] DENDALE P,HANSEN D,BERGER J,et al.Long-term cost-benefit ratio of cardiac rehabilitation after percutaneous coronary intervention[J].Acta Cardiol,2008,63(4):451-456.
[45] SHUICHI T,SATORU S,TAKESHI B,et al.Predictors of left ventricular remodeling in patients with acute myocardial infarction participating in cardiac rehabilitation[J].Circ J,2004,68(3):214-219.
[46] MOHOLDT T,AAMOT I L,GRANOIEN I,et al.Aerobic interval training increases peak oxygen uptake more than usual care exercise training in myocardial infarction patients:a randomized controlled study[J].Clin Rehabil,2012,26(1):33-44.
[47] 倪晓苏,徐红,芮小文,等.八段锦联合社区延续护理在经皮冠状动脉介入治疗术后患者中的应用[J].齐鲁护理杂志,2021,27(19):45-47.
[48] MARZIEH S,SAMANEH M,HOSEIN H,et al.Effects of a comprehensive cardiac rehabilitation program on quality of life in patients with coronary artery disease[J].ARYA Atheroscler,2013,9(3):179-185.