Different inspiratory muscle training methods improve exercise and cardiopulmonary function of patients after cardiac surgery: a network meta-analysis

doi:10.12307/2026.702

Abstract

Abstract: OBJECTIVE: Inspiratory muscle training can increase inspiratory muscle strength and endurance, thereby improving maximum inspiratory negative pressure and cardiopulmonary function, reducing the incidence of complications, and aiding patient recovery. Herein, a systematic review is conducted to evaluate the differences in efficacy between different inspiratory muscle training modalities on functional recovery in cardiac surgery patients.
METHODS: We searched CNKI, VIP, WanFang, CBM, PubMed, Embase and Cochrane Library to collect randomized controlled trials about inspiratory muscle training applied to cardiac surgery from database inception to November 2024. Language was limited to Chinese and English. Subject terms were combined with keywords during the search process. After screening, we performed a meta-analysis using Review Manager 5.4 and Stata 14.2.
RESULTS: (1) Finally, 24 papers were included, including 11 high-quality papers and 13 low-quality papers, totaling 1 907 patients and 4 inspiratory muscle training modes. (2) Direct meta-analysis results indicated that after sensitivity analysis, compared with the control group, inspiratory threshold load training, inspiratory resistance load training, and high carbon dioxide inspiratory training had a significant effect on inspiratory muscle function [mean difference=-15.01, 95% confidence interval (CI) (-18.72, -11.30), P < 0.01], motor function [standardized mean difference=-0.60, 95% CI (-0.82, -0.38), P < 0.01], and cardiorespiratory function score [standardized mean difference=-0.66, 95% CI (-1.26, -0.07), P=0.03]. There were significant differences in the incidence of pneumonia [odds ratio=2.42, 95% CI (1.44, 4.06), P < 0.01] and pulmonary atelectasis [odds ratio=6.18, 95% CI (1.85, 20.64), P < 0.01]. (3) The results of network meta-analysis showed that in terms of improvement in inspiratory muscle function, the therapeutic efficacy was ranked as inspiratory threshold loading training (92.6) > inspiratory resistance loading training (57.4) > conventional inspiratory training (0); and in terms of improvement in motor function, the therapeutic efficacy was ranked as inspiratory threshold loading training (100) > high carbon dioxide inspiratory training (66.4) > inspiratory resistance loading training (33.6) > conventional inspiratory training (0); and in terms of improvement in cardiorespiratory function, the therapeutic efficacy was ranked as inspiratory threshold loading training (94.4) > high carbon dioxide inspiratory training (52.2) > inspiratory resistance loading training (44.8) > conventional inspiratory training (8.2).
CONCLUSION: The available clinical evidence suggests that inspiratory threshold loading training has the best efficacy in improving inspiratory muscle function, motor function, and cardiorespiratory function of patients undergoing cardiac surgery, followed by high carbon dioxide inspiratory training and inspiratory resistance loading training. However, due to the low methodological quality of some of the included studies, there is an urgent need for high-quality studies to validate this finding.

Key words: inspiratory muscle training, cardiac surgery, motor function, cardiorespiratory function, network meta-analysis

CLC Number:

Chen Ping, Du Jinchao, Wang Hongying, Zhang Hui, Wang Haixia. Different inspiratory muscle training methods improve exercise and cardiopulmonary function of patients after cardiac surgery: a network meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(12): 3134-3144.

Figures/Tables 12

2.1 文献检索结果初步检索得到426篇文献，经过阅读筛选后共纳入24篇文献[19-42]。具体筛选流程见图1。 2.2 纳入文献的基本特征与质量评估 2.2.1 纳入文献的基本特征此次研究共纳入24篇随机对照试验，其中15篇为英文文献，9篇为中文文献。另外，此次研究共纳入1 907例研究对象，其中对照组984例，干预组923例。涉及6种吸气肌训练仪器，分别为POWER breathe呼吸训练器，阈值吸气装置，低阻力吸气肌训练，呼吸机内置训练模式，渐减式流阻负荷训练模式，Voldyne5000呼吸训练器。6种呼吸训练仪器按照训练机制共分为4种呼吸训练模式，分别为传统常规吸气肌训练、吸气阈值负荷训练、吸气阻力负荷训练、高CO2吸气训练。详见表1。 2.2.2 纳入文献的方法学质量评价 24篇文献均报道了分组方式，其中13篇文献报道了具体的随机方式[19-20，27，30-32，34-38，40，42]，2篇采用随机抽签法[19，27]，1篇文献以最大吸气压占预计值的百分比数值分组[35]，1篇文献以入院顺序以及最大吸气压占预计值的百分比数值分组[36]。7篇文献报告了盲法的使用情况[20，25-26，30-32，40]，其中4篇实施了双盲[20，30-32]，3篇实施了单盲[25-26，40]，所有随机对照试验均未报道其他偏倚。见图2。根据修订版 Jadad 量表进行质量评价结果，1-3 分为低质量，4-7 分为高质量，结果显示高质量文献11篇[20-21，23，25-26，28，30-32，38，40]，低质量文献13篇[19，22，24，27-28，33-37，39，41-42]，平均3.54分，纳入文献总体质量较高。见表2。 2.3 吸气肌功能改善的Meta分析结果 2.3.1 直接Meta分析及异质性检验共有15篇文献报道了最大吸气压的评分结果[19，21-22，24，26-29，31-34，38-40]，共"

1 157例患者，各研究间异质性较高(I2=71%，P < 0.01)，通过逐篇剔除文献的方法进行敏感性分析，异质性未发生明显改变，显示结果较为稳定，故对结果进行描述性分析，吸气肌功能训练能显著提高患者的吸气肌功能[MD=-15.01，95%CI(-18.72，-11.30)，P < 0.01]。根据不同吸气肌训练模式进行亚组分析，与传统常规吸气肌训练相比，吸气阈值负荷训练[MD=-17.38，95%CI(-22.86，-11.91)]、吸气阻力负荷训练[MD=-13.00，95%CI(-18.65，-7.43)]均能够显著改善患者的吸气肌功能，且吸气阈值负荷训练的效应量优于吸气阻力负荷训练。见图3。 2.3.2 网状关系图网状关系图包含3种吸气肌训练模式，分别为传统常规吸气肌训练方式、吸气阈值负荷训练方式7篇、吸气阻力负荷训练方式8篇，未形成闭环，见图4A。 2.3.3 网状Meta分析结果在吸气肌功能改善方面，直接比较与间接比较共有3种结果，其中吸气阈值负荷训练、吸气阻力负荷训练与传统常规吸气训练疗效相比差异有显著性意义(P < 0.05)；吸气阈值负荷训练与吸气阻力负荷训练疗效相比差异无显著性意义(P > 0.05)。见表3。 2.3.4 累积概率排序在吸气肌功能改善方面，SUCRA值排序依次为吸气阈值负荷训练(92.6) > 吸气阻力负荷训练(57.4) > 传统常规吸气训练(0)；概率高低依次为吸气阈值负荷训练、吸气阻力负荷训练、传统常规吸气训练。排序概率图显示吸气阈值负荷训练排序最高的概率最大，吸气阻力负荷训练次之，传统常规吸气训练再次之。见图5。 2.3.5 风险偏倚图漏斗图显示，15篇文献分布呈非对称，3篇文献落于95%CI外。同时，Egger回归检验(P=0.16)，提示纳入文章未存在明显的发表偏倚，见图6a。 2.4 运动功能改善的Meta分析结果 2.4.1 直接Meta分析及异质性检验共有13篇文献报道了患者的运动能力[19-20，23，27，30-32，34-35，37-40]，包含848例患者，各研究间异质性较高(I2=93%，"

统常规吸气训练(0)；概率高低依次为吸气阈值负荷训练、高CO2吸气训练、吸气阻力负荷训练、传统常规吸气训练。排序概率图显示吸气阈值负荷训练排序最高的概率最大，高CO2吸气训练、吸气阻力负荷训练、传统常规吸气训练次之。见图8。 2.4.5 风险偏倚图漏斗图显示，13篇文献均位于漏斗内、呈非对称性。同时，Egger回归检验(P=0.04)，提示纳入文章可能存在发表偏倚。见图6b。 2.5 心肺功能改善的Meta分析结果 2.5.1 直接Meta分析及异质性检验共有13篇文献报道了患者的心肺功能情况[21，26，29，31-35，37-40，42]，由于机械通气时间与其他3种数据的评分方向相反，故将机械通气时间的结果赋予“-”来表示。13篇文献包含942例患者，研究间异质性较高(I2=94%，P < 0.05)，故选用随机效应模型合并分析，结果发现研究间的数据差异无显著性意义。通过逐篇剔除文献的方法进行敏感性分析，发现剔除SAVCI等[21]的文献后，对照组与干预组间差异有显著性意义[SMD=-0.66，95%CI(-1.26，-0.07)，P=0.03]，但是异质性仍较高(I2=94%，P < 0.05)，因此根据吸气肌训练模式进行亚组分析，与传统常规吸气肌训练相比，吸气阻力负荷训练[SMD=-0.46，95%CI (-0.70，-0.22)]、高CO2吸气训练[SMD=-0.64，95%CI(-0.99，-0.28)]能够显著提高患者的心肺功能，而吸气阈值负荷训练的疗效改善无统计学意义。见图9。 2.5.2 网状关系图剔除1篇文献后，网状Meta分析共纳入12篇文献，包含4种吸气肌训练方式，分别为传统常规吸气肌训练方式、吸气阈值负荷训练方式3篇、吸气阻力负荷训练方式7篇、高CO2吸气训练2篇，未形成闭环，见图4C。 2.5.3 网状Meta分析结果在心肺功能改善方面，直接比较与间接比较共有6种结果，除吸气阈值负荷训练与传统常规吸气训练相比疗效差异有显著性意义外(P < 0.05)，其余5种比较结"

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