传统健身功法联合常规药物治疗稳定期慢性阻塞性肺疾病的Meta分析
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摘要
【目的】系统评价传统健身功法干预慢性阻塞性肺疾病(COPD)稳定期的康复疗效。【方法】计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普(VIP)、万方(Wanfang)、PubMed、Web of Science、Cochrane Library等数据库,收集试验组中含有传统健身功法治疗稳定期COPD的随机对照试验(RCT)。由2位研究者进行独立筛选文献、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析。【结果】共纳入24个研究,涉及2 171例患者。Meta分析结果显示:在常规药物治疗基础上结合传统健身功法(联合疗法),比单纯常规药物治疗更能改善患者第1 s用力呼气容积(FEV1)[MD=0.26,95%CI(0.11,0.41)]、第1 s呼气容积占预计值百分比(FEV1%)[MD=4.08,95%CI(1.94,6.21)]、FEV1与用力肺活量(FVC)的比值(FEV1/FVC)[MD=3.47,95%CI(1.21,5.72)];联合疗法在改善运动耐量指标如6-min步行距离(6MWD)[MD=40.93,95%CI(25.09,56.77)]、呼吸困难评分如慢性阻塞性肺病评估测试(COPD Assessment Test,CAT)评分[MD=-3.21,95%CI(-4.96,-1.45)]、生活质量评分如St George呼吸问卷(St George Respiratory Questionnaire,SGRQ)评分[MD=-8.20,95%CI(-12.30,-4.11)]方面亦均优于单纯常规药物治疗,差异有统计学意义(P <0.05)。与现代康复训练结合常规药物治疗比较,联合疗法在改善患者肺功能(FEV1、FEV1%、 FEV1/FVC)、运动耐量和呼吸困难等方面差异均无统计学意义(P> 0.05)。【结论】当前证据表明,传统健身功法联合常规药物治疗稳定期COPD能明显改善患者肺功能、运动耐量、呼吸困难症状及生活质量,而与现代康复训练结合常规药物治疗比较疗效差异无统计学意义。但由于纳入研究存在一定方法学偏倚,且样本量较小,该结论尚需更多高质量大样本的临床研究予以证实。
Objective To systematically review the effect of traditional health-preservation exercises for the patients with stable chronic obstructive pulmonary disease(COPD). Methods Databases of CNKI, CBM,Wanfang, VIP, PubMed, Web of Science and Cochrane Library were electronically searched to collect randomized controlled trials(RCT)of traditional health-preservation exercises for the treatment of patients with stable COPD. Two reviewers performed the screening of the literature,extraction of the data,and evaluation of the quality of the included studies independently. And then RevMan 5.3 software was adopted for the Meta-analysis.Results A total of 24 RCTs and 2 171 patients were included. The results of Meta-analysis showed that in comparison with the conventional drug therapy alone, traditional health-preservation exercises combined with conventional drug therapy(combined therapy)could significantly improve the forced expiratory volume in the first second(FEV1)[MD = 0.26,95%CI(0.11,0.41)],FEV1 predicted(FEV1%)[MD = 4.08,95%CI(1.94,6.21)],and the ratio of FEV1 to forced vital capacity(FEV1/FVC)[MD = 3.47,95%CI(1.21,5.72)];the combined therapy also had stronger effect than the conventional drug therapy alone on improving exercise tolerance index of the 6-min walking distance(6 MWD)[MD = 40.93,95%CI(25.09,56.77)],dyspnea scores of COPD Assessment Test(CAT)scores [MD =-3.21,95%CI(-4.96,-1.45)] and the scores of quality of life of the patients with St George Respiratory Questionnaire(SGRQ)[MD =-8.20, 95% CI(-12.30,-4.11)], the difference being statistically significant(P < 0.05). Compared to modern rehabilitation training combined with conventional drug therapy,the differences of the combined therapy on improving lung function(FEV1,FEV1%,FEV1/FVC), exercise tolerance and dyspnea of patients were not significant(P > 0.05). Conclusion Current evidence showed that traditional health-preservation exercises combined with conventional drug therapy can be distinctly benefit to lung function,exercise tolerance,dyspnea and the quality of life of the patients with stable COPD,but its effect is not superior to that of the modern rehabilitation training combined with conventional drug therapy. Due to methodogical bias in the included studies and the small sample size,more high-quality studies will be needed to verify the above conclusion.
Objective To systematically review the effect of traditional health-preservation exercises for the patients with stable chronic obstructive pulmonary disease(COPD). Methods Databases of CNKI, CBM,Wanfang, VIP, PubMed, Web of Science and Cochrane Library were electronically searched to collect randomized controlled trials(RCT)of traditional health-preservation exercises for the treatment of patients with stable COPD. Two reviewers performed the screening of the literature,extraction of the data,and evaluation of the quality of the included studies independently. And then RevMan 5.3 software was adopted for the Meta-analysis.Results A total of 24 RCTs and 2 171 patients were included. The results of Meta-analysis showed that in comparison with the conventional drug therapy alone, traditional health-preservation exercises combined with conventional drug therapy(combined therapy)could significantly improve the forced expiratory volume in the first second(FEV1)[MD = 0.26,95%CI(0.11,0.41)],FEV1 predicted(FEV1%)[MD = 4.08,95%CI(1.94,6.21)],and the ratio of FEV1 to forced vital capacity(FEV1/FVC)[MD = 3.47,95%CI(1.21,5.72)];the combined therapy also had stronger effect than the conventional drug therapy alone on improving exercise tolerance index of the 6-min walking distance(6 MWD)[MD = 40.93,95%CI(25.09,56.77)],dyspnea scores of COPD Assessment Test(CAT)scores [MD =-3.21,95%CI(-4.96,-1.45)] and the scores of quality of life of the patients with St George Respiratory Questionnaire(SGRQ)[MD =-8.20, 95% CI(-12.30,-4.11)], the difference being statistically significant(P < 0.05). Compared to modern rehabilitation training combined with conventional drug therapy,the differences of the combined therapy on improving lung function(FEV1,FEV1%,FEV1/FVC), exercise tolerance and dyspnea of patients were not significant(P > 0.05). Conclusion Current evidence showed that traditional health-preservation exercises combined with conventional drug therapy can be distinctly benefit to lung function,exercise tolerance,dyspnea and the quality of life of the patients with stable COPD,but its effect is not superior to that of the modern rehabilitation training combined with conventional drug therapy. Due to methodogical bias in the included studies and the small sample size,more high-quality studies will be needed to verify the above conclusion.
引文
[1]Global Initiative for Chronic Obstructive Lung Disease(GOLD):global strategy for the diagnosis,management and prevention of chronic obstructive pulmonary disease(2017 REPORT)[EB/OL].http://www.goldcopd.org.
[2]王志英,金路.周仲瑛教授治疗慢性阻塞性肺病的经验[J].南京中医药大学学报,2013,29(6):585.
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[4]Ng B H,Tsang H W,Jones A Y,et al.Functional and psychosocial effects of health qigong in patients with COPD:a randomized controlled trial[J].J Altern Complement Med,2011,17(3):243.
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[8]冯毅翀,潘华山,汶希,等.八段锦运动对慢性阻塞性肺病稳定期老年患者的疗效观察[J].新中医,2009,41(8):36.
[9]郭继彩.传统健身功法八段锦促进COPD稳定期患者肺康复的疗效分析[J].山东医学高等专科学校学报,2016,38(3):171.
[10]潘梅英,罗健华,杨三春.站势八段锦康复锻炼对慢性阻塞性肺疾病稳定期患者疗效的观察[J].成都中医药大学学报,2016,39(3):49.
[11]孙一平.健身气功“八段锦”对Ⅱ级慢性阻塞性肺疾病稳定期患者治疗的疗效观察[D].长春:长春中医药大学,2014.
[12]徐远红,邓玉平,何小珍.气功结合呼吸康复训练对慢性阻塞性肺疾病患者肺功能及运动耐力的影响[J].实用医学杂志,2010,26(12):2139.
[13]杨碧英.八段锦调补肺脾肾法在COPD患者辅助治疗中的应用[J].国际护理杂志,2016,35(17):2357.
[14]杨冬玲,武俊红,韩志娟.健身气功八段锦在慢性阻塞性肺疾病稳定期肺康复中的疗效评价[J].中国全科医学,2017,20(S3):356.
[15]朱正刚,陈燕.坐式八段锦锻炼对COPD患者肺功能的影响[J].世界中西医结合杂志,2014,9(8):846.
[16]王龙兵.六字诀联合抗阻训练对稳定期慢性阻塞性肺疾病患者BODE指数和生活质量的影响[D].上海:上海体育学院,2015.
[17]翟宗岗.中西医结合呼吸康复训练改善慢阻肺患者运动能力的效果评价[J].中国卫生产业,2016,13(2):75.
[18]Chan A W,Lee A,Lee D T,et al.The sustaining effects of Tai chi Qigong on physiological health for COPD patients:a randomized controlled trial[J].Complement Ther Med,2013,21(6):585.
[19]Yeh G Y,Roberts D H,Wayne P M,et al.Tai chi exercise for patients with chronic obstructive pulmonary disease:a pilot study[J].Respir Care,2010,55(11):1475.
[20]邓正旭,陈红,徐治波,等.太极拳在稳定期慢性阻塞性肺疾病肺康复中的作用[J].安徽卫生职业技术学院学报,2016,15(2):18.
[21]张兴彩,蔡余力,张伟,等.二十四式太极拳及呼吸功能训练辅助西药对慢性阻塞性肺疾病稳定期患者的影响[J].中医杂志,2014,55(22):1937.
[22]程玉峰,魏姗姗,何蕊.传统华佗五禽戏对慢性阻塞性肺疾病稳定期患者临床疗效观察[J].中医药临床杂志,2015,27(5):683.
[23]魏姗姗,程玉峰,何蕊.传统华佗五禽戏对慢性阻塞性肺疾病稳定期患者肺功能的影响[J].中医药临床杂志,2015,27(6):793.
[24]赵桥梁.五禽戏防治社区稳定期慢性阻塞性肺疾病临床研究[J].中医学报,2015,30(6):801.
[25]张敏,徐桂华,李峰,等.健身气功易筋经促进慢性阻塞性肺疾病稳定期患者康复[J].中国运动医学杂志,2016,35(4):339.
[26]杜舒婷,丁连明,王春霞,等.太极拳运动对慢性阻塞性肺疾病患者运动耐力及肺功能的影响[J].中国康复医学杂志,2013,28(4):374.
[27]邓丽金.“六字诀”呼吸操改善COPD稳定期患者预后的干预研究[D].福州:福建中医学院,2009.
[28]李冬秀.从呼吸力学角度探讨“六字诀”对慢性阻塞性肺疾病作用的研究[D].福州:福建中医药大学,2011.
[29]王振伟,杨佩兰,汤杰,等.“六字诀”对慢性阻塞性肺疾病患者生活质量及中医证候的影响[J].上海中医药杂志,2010,44(5):54.
[30]王振伟,杨佩兰,汤杰.中医肺康复操对COPD患者肺功能及急性发作的随机对照研究[J].中国中医急症,2013,22(1):23.
[31]潘怡,毛兵.中医肺康复技术的应用现状与展望[J].河北中医,2016,38(11):1733.
[32]韩燕,王清馨,罗丹,等.八段锦对稳定期慢性阻塞性肺疾病患者肺康复影响Meta分析[J].护理学报,2017,24(9):15.
[33]陈燕华,肖璐,赵容,等.八段锦对稳定期慢性阻塞性肺疾病患者康复效果影响的meta分析[J].中国康复医学杂志,2018,33(4):451.
[34]王龙兵,吴卫兵,刘晓丹,等.传统健身功法对稳定期慢性阻塞性肺疾病患者康复疗效的meta分析[J].中国康复医学杂志,2014,29(10):957.
[2]王志英,金路.周仲瑛教授治疗慢性阻塞性肺病的经验[J].南京中医药大学学报,2013,29(6):585.
[3]Leung R W,Alison J A,McKeough Z J,et al.A study design to investigate the effect of short-form Sun-style Tai Chi in improving functional exercise capacity,physical performance,balance and health related quality of life in people with chronic obstructive pulmonary disease(COPD)[J].Contemp Clin Trials,2011,32(2):267.
[4]Ng B H,Tsang H W,Jones A Y,et al.Functional and psychosocial effects of health qigong in patients with COPD:a randomized controlled trial[J].J Altern Complement Med,2011,17(3):243.
[5]Spruit M A,Polkey M I.Tai chi for individuals with COPD:an ancient wisdom for a 21st century disease[J].Eur Respir J,2013,41(5):1005.
[6]Higgins J P T,Green S.Cochrane Collaboration:Cochrane handbook for systematic reviews of interventions[EB/OL].http://www.cochranehandbook.org.
[7]邓艳芳.八段锦之单举式对肺脾气虚证慢性阻塞性肺疾病患者肺康复效果的影响[D].福州:福建中医药大学,2014.
[8]冯毅翀,潘华山,汶希,等.八段锦运动对慢性阻塞性肺病稳定期老年患者的疗效观察[J].新中医,2009,41(8):36.
[9]郭继彩.传统健身功法八段锦促进COPD稳定期患者肺康复的疗效分析[J].山东医学高等专科学校学报,2016,38(3):171.
[10]潘梅英,罗健华,杨三春.站势八段锦康复锻炼对慢性阻塞性肺疾病稳定期患者疗效的观察[J].成都中医药大学学报,2016,39(3):49.
[11]孙一平.健身气功“八段锦”对Ⅱ级慢性阻塞性肺疾病稳定期患者治疗的疗效观察[D].长春:长春中医药大学,2014.
[12]徐远红,邓玉平,何小珍.气功结合呼吸康复训练对慢性阻塞性肺疾病患者肺功能及运动耐力的影响[J].实用医学杂志,2010,26(12):2139.
[13]杨碧英.八段锦调补肺脾肾法在COPD患者辅助治疗中的应用[J].国际护理杂志,2016,35(17):2357.
[14]杨冬玲,武俊红,韩志娟.健身气功八段锦在慢性阻塞性肺疾病稳定期肺康复中的疗效评价[J].中国全科医学,2017,20(S3):356.
[15]朱正刚,陈燕.坐式八段锦锻炼对COPD患者肺功能的影响[J].世界中西医结合杂志,2014,9(8):846.
[16]王龙兵.六字诀联合抗阻训练对稳定期慢性阻塞性肺疾病患者BODE指数和生活质量的影响[D].上海:上海体育学院,2015.
[17]翟宗岗.中西医结合呼吸康复训练改善慢阻肺患者运动能力的效果评价[J].中国卫生产业,2016,13(2):75.
[18]Chan A W,Lee A,Lee D T,et al.The sustaining effects of Tai chi Qigong on physiological health for COPD patients:a randomized controlled trial[J].Complement Ther Med,2013,21(6):585.
[19]Yeh G Y,Roberts D H,Wayne P M,et al.Tai chi exercise for patients with chronic obstructive pulmonary disease:a pilot study[J].Respir Care,2010,55(11):1475.
[20]邓正旭,陈红,徐治波,等.太极拳在稳定期慢性阻塞性肺疾病肺康复中的作用[J].安徽卫生职业技术学院学报,2016,15(2):18.
[21]张兴彩,蔡余力,张伟,等.二十四式太极拳及呼吸功能训练辅助西药对慢性阻塞性肺疾病稳定期患者的影响[J].中医杂志,2014,55(22):1937.
[22]程玉峰,魏姗姗,何蕊.传统华佗五禽戏对慢性阻塞性肺疾病稳定期患者临床疗效观察[J].中医药临床杂志,2015,27(5):683.
[23]魏姗姗,程玉峰,何蕊.传统华佗五禽戏对慢性阻塞性肺疾病稳定期患者肺功能的影响[J].中医药临床杂志,2015,27(6):793.
[24]赵桥梁.五禽戏防治社区稳定期慢性阻塞性肺疾病临床研究[J].中医学报,2015,30(6):801.
[25]张敏,徐桂华,李峰,等.健身气功易筋经促进慢性阻塞性肺疾病稳定期患者康复[J].中国运动医学杂志,2016,35(4):339.
[26]杜舒婷,丁连明,王春霞,等.太极拳运动对慢性阻塞性肺疾病患者运动耐力及肺功能的影响[J].中国康复医学杂志,2013,28(4):374.
[27]邓丽金.“六字诀”呼吸操改善COPD稳定期患者预后的干预研究[D].福州:福建中医学院,2009.
[28]李冬秀.从呼吸力学角度探讨“六字诀”对慢性阻塞性肺疾病作用的研究[D].福州:福建中医药大学,2011.
[29]王振伟,杨佩兰,汤杰,等.“六字诀”对慢性阻塞性肺疾病患者生活质量及中医证候的影响[J].上海中医药杂志,2010,44(5):54.
[30]王振伟,杨佩兰,汤杰.中医肺康复操对COPD患者肺功能及急性发作的随机对照研究[J].中国中医急症,2013,22(1):23.
[31]潘怡,毛兵.中医肺康复技术的应用现状与展望[J].河北中医,2016,38(11):1733.
[32]韩燕,王清馨,罗丹,等.八段锦对稳定期慢性阻塞性肺疾病患者肺康复影响Meta分析[J].护理学报,2017,24(9):15.
[33]陈燕华,肖璐,赵容,等.八段锦对稳定期慢性阻塞性肺疾病患者康复效果影响的meta分析[J].中国康复医学杂志,2018,33(4):451.
[34]王龙兵,吴卫兵,刘晓丹,等.传统健身功法对稳定期慢性阻塞性肺疾病患者康复疗效的meta分析[J].中国康复医学杂志,2014,29(10):957.