远程心脏康复对慢性心力衰竭患者影响的Meta分析-现代医学

远程心脏康复对慢性心力衰竭患者影响的Meta分析

单位：1. 南京中医药大学护理学院, 江苏南京 210023;
2. 南京中医药大学附属南京医院/南京市第二医院心血管内科, 江苏南京 210003

分类号：R473.5

出版年·卷·期（页码）：2024·52·第三期（397-407）

摘要：

目的：系统评价远程心脏康复(CR)对慢性心力衰竭(CHF)患者的影响。方法：计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网(CNKI)、中国生物医学文献数据库、万方数据知识服务平台、维普中文科技期刊数据库(VIP)，收集远程CR应用于CHF患者的随机对照试验相关文献，检索时限为建库至2022年4月。对符合纳入、排除标准的文献进行质量评价，使用RevMan 5.3软件对提取数据进行Meta分析。结果：最终纳入20篇文献，共2 670例患者。Meta分析结果显示，与传统康复护理相比，远程CR能有效地提高CHF患者心肺功能(MD=31.58, 95%CI:10.5~52.67, P=0.003)、运动功能(MD=38.59, 95%CI:22.73~54.46, P＜0.05)、VO₂峰值(MD=2.72, 95%CI:0.62~4.82, P=0.01)、生活质量(MD=-10.24, 95%CI:-13.51~-6.97, P＜0.000 1)、CR依从性(RR=2.51, 95%CI:1.58~3.99, P＜0.000 1)；在缓解焦虑(MD=-0.30, 95%CI:-0.61~0.02, P＞0.05)和抑郁方面(MD=-0.19, 95%CI:-0.52~0.15, P＞0.05)两者差异无统计学意义。结论：远程CR与传统康复护理相比，能有效地改善CHF患者的心肺功能和运动能力，提升其生活质量和CR依从性，但在改善心理健康方面缺乏证据支持。需要进一步的研究验证远程CR对CHF患者的有效性、安全性和成本效益。

Objective: To systematically evaluate the effect of remote cardiac rehabilitation(CR) on patients with chronic heart failure(CHF).Methods: Computerized search of PubMed, Web of Science, Cochrane Library, Embase, CNKI, China biomedical literature database, Wanfang and VIP were performed to collect randomized controlled trials of remote CR applied to CHF patients,with a search timeframe of the period from inception to April 2022.Literatures that met the inclusion and exclusion criteria were evaluated for quality, and Meta-analysis of the extracted data were performed using RevMan 5.3 software. Results: A total of 20 studies with 2 670 patients were included. The results of the Meta-analysis showed that compared with traditional rehabilitation care, remote CR can effectively improve the cardiopulmonary function(MD=31.58, 95%CI:10.5-52.67, P=0.003), motor function(MD=38.59, 95%CI:22.73-54.46, P＜0.05), peak VO₂(MD=2.72, 95%CI:0.62-4.82, P=0.01), quality of life(MD=-10.24, 95%CI:-13.51--6.97, P＜0.000 1), and adherence CR compliance(RR=2.51, 95%CI:1.58-3.99, P＜0.000 1)of CHF patients. There was no statistically significant difference in relieving anxiety(MD=-0.30, 95%CI:-0.61-0.02, P＞0.05) and depression(MD=-0.19, 95%CI:-0.52-0.15, P＞0.05).Conclusion: Remote CR is effective in improvingcardiopulmonary function and motor function, quality of life and CR compliance in patients with CHF compared with traditional rehabilitation care, but there is a lack of evidence to support the improvement in mental health. Further studies are needed to validate the effectiveness, safety, and cost-effectiveness of remote CR for CHF patients.

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