目的:基于随机对照试验(RCTs),确定吸气肌训练(IMT)在食管癌患者食管癌切除术中的临床效果。
方法:截至2023年8月23日,在几个数据库中搜索相关的RCT。主要结果是呼吸肌功能,包括最大吸气压力(MIP)和最大呼气压力(MEP),和肺功能,包括一秒内的用力呼气量%(FEV1%),强制肺活量%(FVC%),最大呼吸机容量(MVV),FEV1/FVC%和FVC。次要结果是运动表现,包括六分钟步行距离测试(6MWT)和博格指数;心理功能和生活质量,通过医院焦虑抑郁量表(HADS)和诺丁汉健康档案(NHP)评分进行评估;以及术后并发症。所有统计分析均使用REVMAN5.3软件进行。
结果:本荟萃分析包括8项RCT,368名接受IMT的患者和371名对照受试者。合并结果表明,IMT可以显着增强呼吸肌功能(MIP:MD=7.14cmH2O,P=0.006;MEP:MD=8.15cmH2O,P<0.001)和肺功能(FEV1%:MD=6.15%,P<0.001;FVC%:MD=4.65%,P<0.001;MVV:MD=8.66L,P<0.001;FEV1/FVC%:MD=5.27%,P=0.03;FVC:MD=0.50L,P<0.001)。此外,IMT改善了运动表现(6MWT:MD=66.99m,P=0.02;博格指数:MD=-1.09,P<0.001),精神功能和生活质量(HADS焦虑评分:MD=-2.26,P<0.001;HADS抑郁评分:MD=-1.34,P<0.001;NHP总分:MD=-48.76,P<0.001)。然而,IMT并未显着降低术后并发症的发生率。
结论:IMT可改善临床结局,如呼吸肌功能和肺功能,在食管癌患者中接受食管切除术,并在临床上具有广泛的应用潜力。
OBJECTIVE: To identify the clinical effect of inspiratory muscle training (IMT) among esophageal cancer patients undergoing esophagectomy based on randomized controlled trials (RCTs).
METHODS: Several databases were searched for relevant RCTs up to August 23, 2023. Primary outcomes were respiratory muscle function, including the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), and pulmonary function, including the forced expiratory volume in one second % (FEV1%), forced vital capacity% (FVC%), maximal ventilator volume (MVV), FEV1/FVC% and FVC. The secondary outcomes were exercise performance, including the six-minute walk distance test (6MWT) and Borg index; mental function and quality of life, as evaluated by the Hospital Anxiety Depression Scale (HADS) and Nottingham Health Profile (NHP) score; and postoperative complications. All the statistical analyses were performed with REVMAN 5.3 software.
RESULTS: Eight RCTs were included in this meta-analysis, with 368 patients receiving IMT and 371 control subjects. The pooled results demonstrated that IMT could significantly enhance respiratory muscle function (MIP: MD = 7.14 cmH2O, P = 0.006; MEP: MD = 8.15 cmH2O, P<0.001) and pulmonary function (FEV1%: MD = 6.15%, P<0.001; FVC%: MD = 4.65%, P<0.001; MVV: MD = 8.66 L, P<0.001; FEV1/FVC%: MD = 5.27%, P = 0.03; FVC: MD = 0.50 L, P<0.001). Furthermore, IMT improved exercise performance (6MWT: MD = 66.99 m, P = 0.02; Borg index: MD = -1.09, P<0.001), mental function and quality of life (HADS anxiety score: MD = -2.26, P<0.001; HADS depression score: MD = -1.34, P<0.001; NHP total score: MD = -48.76, P<0.001). However, IMT did not significantly decrease the incidence of postoperative complications.
CONCLUSIONS: IMT improves clinical outcomes, such as respiratory muscle function and pulmonary function, in esophageal cancer patients receiving esophagectomy and has potential for broad applications in the clinic.