目的 探究结构化锻炼对自体动静脉内瘘(arteriovenous fistula，AVF)血流量、静脉内径、静脉前臂距皮深度、超声成熟率及临床成熟率的影响。 方法 系统检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、Embase、Medline、Web of Science、Cochrane Library中建库至2024年8月的相关文献，对符合标准的文献进行数据提取及Meta分析。 结果 共检索文献10 736篇，最终纳入11篇，941例研究对象。Meta合并结果显示AVF手术后结构化锻炼患者比常规护理/锻炼患者内瘘血流量更大(SMD=1.39，95% CI：0.74～2.03,P＜0.01)、内瘘静脉内径更大(SMD=0.95，95% CI：0.35～1.51,P＜0.01)、内瘘静脉前臂距皮深度更小(SMD=-1.49，95% CI：-2.57～0.40,P＜0.01)。结构化锻炼患者的超声成熟率是常规护理/锻炼患者的1.43倍(95% CI：1.28～1.59,P＜0.01)，临床成熟率是常规护理/锻炼患者的1.58倍(95% CI：1.23～2.43,P＜0.01)。亚组分析：手术1周后开始锻炼(SMD=2.44，95% CI：1.16～3.72,P＜0.01)与手术后1周内开始锻炼(SMD=0.62，95% CI：0.30～0.95,P＜0.01)相比，内瘘血流量差异更大；AVF手术1周后开始锻炼亚组中，结构化锻炼患者比常规护理/锻炼患者内瘘静脉前臂距皮深度更小(SMD=-2.38，95% CI：-3.89～-0.86,P＜0.01)。 结论 手术后结构化锻炼对于AVF成熟具有促进作用，可增加内瘘血流量、内瘘静脉内径，减小内瘘静脉前臂距皮深度，提高AVF超声成熟率和临床成熟率，建议医务人员为AVF手术后患者制定个体化的结构化锻炼方案。
Objective To explore the effects of structured exercise on blood flow in arteriovenous fistula (AVF), internal diameter of AVF vein, forearm depth of AVF vein, ultrasonic maturity rate and clinical maturity rate in patients with chronic kidney disease. Methods Relevant literatures from CNKI, Wanfang Database, VIP database, Chinese Biomedical Literature database, Embase, Medline, Web of Science and Cochrane Library were systematically searched until August 2024. Two researchers conducted data extraction and meta-analysis of the included references. Results A total of 10,736 literatures were retrieved, and 11 literatures with a total of 941 subjects were extracted. The meta-combined results showed that in patients after AVF surgery treated with structured exercise compared those treated with routine nursing/exercise, the blood flow in AVF was greater (SMD=1.39, 95% CI: 0.74～2.03, P＜0.01), the internal diameter of AVF vein was larger (SMD=0.95, 95% CI: 0.35～1.51, P＜0.01), the forearm depth of AVF vein was smaller (SMD=-1.49, 95% CI: -2.57～0.40, P＜0.01), the ultrasonic maturity rate was 1.43 times higher (95% CI: 1.28~1.59, P＜0.01), and the clinical maturity rate was 1.58 times higher (95% CI: 1.23～2.43, P＜0.01). Subgroup analysis showed that in patients beginning structured exercise after surgery for one week compared those beginning structured exercise after surgery within a week, the changes of blood flow in AVF was greater (structured exercise after surgery for one week: SMD=2.44, 95% CI: 1.16～3.72, P＜0.01; structured exercise after surgery within a week: SMD=0.62, 95% CI: 0.30～0.95, P＜0.01); in patients with structured exercise after surgery for one week compared those with conventional nursing exercise after surgery for one week, the forearm depth of AVF vein was smaller (SMD=-2.38, 95% CI: -3.89～-0.86, P＜0.01). Conclusion Structured exercise after AVF surgery can promote AVF maturation, increase blood flow in AVF and AVF vein diameter, reduce forearm depth of AVF vein, and improve ultrasonic maturity rate and clinical maturity rate of AVF. We recommend that medical staff should develop individualized and structured exercise program for patients after AVF surgery.
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