呼吸训练对脑卒中患者肺功能、呼吸肌力量及ADL的Meta分析

Meta-Analysis of Respiratory Training on Respiratory Function, Respiratory Muscle Strength and ADL in Stroke Patients

摘要: 目的：评价呼吸训练对脑卒中患者肺功能、呼吸肌力量及日常生活活动能力(ADL)的影响。方法：计算机系统检索PubMed、Embase、Cochrane Library、Web of Science、CBM、中国知网、万方、维普数据库，搜集关于呼吸训练改善脑卒中患者呼吸功能和ADL的随机对照试验(RCT)，检索时限为建库至2026年5月11日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险(采用PEDro量表和Cochrane偏倚风险评估工具)。采用Revman 5.4软件进行Meta分析，Stata 18.0软件判断发表偏倚。结果：共纳入13篇文献，包括875例脑卒中患者。Meta分析结果显示：呼吸训练可显著提高脑卒中患者第一秒用力呼气量(FEV1)、用力肺活量(FVC)、呼气峰流速(PEF)、最大吸气压(MIP)和Barthel指数BI (P < 0.05)。然而，对最大呼气压(MEP)的改善作用不显著。结论：现有证据提示呼吸训练可能改善脑卒中偏瘫患者的肺功能(FEV1、FVC、PEF)、吸气肌力量(MIP)及ADL (BI)。但受纳入研究方法学质量偏低(分配隐藏和盲法缺失)影响，阳性结果应谨慎解读。MEP的改善尚不明确(仅2项研究，属探索性发现)。亚组分析未证实不同疗程间效果存在统计学差异。

Abstract: Objective: To evaluate the effects of respiratory training on pulmonary function, respiratory muscle strength, and activities of daily living (ADL) in stroke patients with hemiplegia. Methods: Randomized controlled trials (RCTs) on the effects of respiratory training on respiratory function and ADL in stroke patients were retrieved from PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, WanFang, and VIP databases from inception to May 11, 2026. Two researchers independently screened the literature, extracted data, and assessed the risk of bias using the PEDro scale and the Cochrane risk-of-bias tool. Meta-analysis was performed using RevMan 5.4 software, and publication bias was evaluated using Stata 18.0 software. Results: A total of 13 studies involving 875 stroke patients were included. Meta-analysis results showed that respiratory training significantly improved forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), and Barthel Index (BI) in stroke patients (P < 0.05). However, its effect on maximal expiratory pressure (MEP) was not significant. Conclusions: Current evidence suggests that respiratory training may improve pulmonary function (FEV1, FVC, PEF), inspiratory muscle strength (MIP), and activities of daily living (BI) in stroke patients with hemiplegia. However, due to the generally low methodological quality of the included studies (lack of allocation concealment and blinding), the positive findings should be interpreted with caution. The improvement in MEP remains unclear (based on only 2 studies, which is an exploratory finding). Subgroup analysis did not confirm a statistically significant difference in effects between different intervention durations.