[摘要] 目的 系统评价早期康复活动对机械通气患者膈肌功能的影响。方法 检索PubMed、Embase、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网、万方数据知识服务平台及维普网有关早期康复活动对机械通气患者膈肌功能影响的研究。检索时间为建库至2025年3月。由两名研究人员根据纳排标准独立进行文献筛选、质量评价和数据提取。结果 最终纳入9篇文献，包括902例患者。Meta分析结果显示早期康复活动可改善吸气末膈肌厚度[标准化均数差（standard mean difference，SMD）=0.67，95%CI：0.39～0.95，Plt;0.000 01]、呼气末膈肌厚度（SMD=0.39，95%CI：0.16～0.63，P=0.0001）、膈肌增厚分数（SMD=0.76，95%CI：0.58～0.94，Plt;0.000 01）和膈肌移动度（SMD=0.49，95%CI：0.27～0.72，Plt;0.000 01），降低患者撤机失败发生率（相对危险度=0.45，95%CI：0.31～0.65，Plt;0.0001）。结论 早期康复活动可改善机械通气患者的膈肌功能，具有较好的临床价值，值得在重症监护病房中规范推广与应用。未来应进一步细化干预策略，完善膈肌功能障碍的防治策略。

[关键词] 早期康复活动；机械通气；膈肌；Meta分析

[中图分类号] R493；R459.7" """"[文献标识码] A """""[DOI] 10.3969/j.issn.1673-9701.2025.18.006

Meta-analysis of the effect of early rehabilitation activities on diaphragm function in patients with mechanical ventilation

HU Feifei¹， WANG Fang²， WANG Zhi¹， MING Yao¹

1.School of Nursing， Chengdu University of Traditional Chinese Medicine， Chengdu 610075， Sichuan， China; 2.Party Committee Office， Guang’an Hospital of Traditional Chinese Medicine， Guang’an 638001， Sichuan， China

[Abstract] Objective To systematically evaluate the effect of early rehabilitation activities on diaphragm function in patients with mechanical ventilation. Methods Computerized system search databases included PubMed， Embase， Web of Science， Cochrane Library， China Biology Medicine disc， China National Knowledge Infrastructure， Wanfang Data Knowledge Service Platform， and VIP on the effects of early rehabilitation activities on diaphragm function in patients with mechanical ventilation. The search period was from the creation of the database to March 2025. Two researchers independently performed literature screening， literature quality evaluation， and data extraction. Results 9 papers， including 902 patients， were finally included. Meta-analysis showed that early rehabilitation activities improved diaphragm inspiratory thickness [standard mean difference （SMD）=0.67， 95%CI： 0.39-0.95， Plt;0.000 01]， diaphragm"expiratory thickness （SMD=0.39， 95%CI： 0.16-0.63， P=0.0001）， diaphragm thickness fraction （SMD=0.76， 95%CI： 0.58-0.94， Plt;0.000 01） and diaphragm excursion （SMD=0.49， 95%CI： 0.27-0.72， Plt;0.000 01）， and reduced the incidence of patient failure to withdraw from the machine （relative risk=0.45， 95%CI： 0.31-0.65， Plt;0.0001）. Conclusion Early rehabilitation activities can improve diaphragm function in patients with mechanical ventilation， which has good clinical value and is worth standardized promotion and application in intensive care unit; The intervention strategy should be further refined in the future to improve the prevention and treatment strategy of diaphragm dysfunction.

[Key words] Early rehabilitation activities; Mechanical ventilation; Diaphragm; Meta-analysis

机械通气（mechanical ventilation，MV）作为一种呼吸支持技术，是重症监护病房（intensive care unit，ICU）救治呼吸衰竭患者的核心支持技术之一^[1-2]。但长时间MV可导致膈肌丧失主动运动，进而引起膈肌肌纤维萎缩和收缩能力下降，称为呼吸机相关膈肌功能障碍（ventilator-induced diaphragmatic dysfunction，VIDD）^[3]。MV超过24h后膈肌功能障碍的发生率为64%，而对拔管失败高危（65岁以上或患有潜在慢性心脏或呼吸系统疾病）患者膈肌功能障碍的发生率高达80%^[4-5]。膈肌功能障碍可导致MV和ICU入住时间延长，拔管后再插管率增加等^[6]。早期康复活动作为一种多模态干预策略，通过被动/主动肢体运动、呼吸肌训练等方式可减少MV患者相关并发症的发生率、缩短MV和ICU住院时间、降低ICU获得性衰弱的发生^[7-8]。……