目的 系统评价束臂加压锻炼对动静脉内瘘(arteriovenous fistula,AVF)手术后成熟的干预效果。 方法 检索中国知网、万方、PubMed、Cochrane Library等数据库中AVF手术后采用束臂加压锻炼的相关研究。采用RevMan 5.4软件进行Meta分析。 结果 共纳入10项研究，包含1 737例患者。 Meta分析显示，与常规锻炼组相比，束臂加压锻炼对AVF超声成熟率(OR=2.50，95% CI：1.94～3.22，P＜0.001)、临床成熟率(OR=2.85，95% CI:1.73～5.68，P＜0.001)、首次AVF穿刺成功率(OR =3.95，95% CI:1.67～9.36，P=0.002)、AVF并发症的发生率(OR=0.21，95% CI:0.10～0.44，P＜0.001)、AVF内径(MD=2.50，95% CI:1.94～3.22，P＜0.001)、AVF成熟时间(MD=-1.56，95% CI:-1.97～-1.15，P＜0.001)及AVF血流量(MD=84.98，95% CI:60.87～109.09，P＜0.001)，均表现出显著优势，结果有统计学差异。亚组分析显示，手术后3d、1周、2周启动锻炼的组间差异无统计学意义，但手术后3d组在超声成熟率、临床成熟率、首次穿刺成功率及缩短成熟时间方面的效应值最大。 结论 束臂加压锻炼可以有效促进AVF的成熟，降低并发症风险，建议建议将术后3 d作为启动干预的最佳时间窗并纳入常规护理方案。
Objective To systematically evaluate the effect of bundle arm compression exercise on maturation of arteriovenous fistulas (AVF) after surgery. Methods A systematic search in CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases was conducted for randomized controlled trials (RCTs) and quasi-experimental studies to evaluate bundle arm compression exercise on maturation of AVF after surgery. Data were analyzed using RevMan 5.4.1 software. Results A total of 10 studies involving 1,737 patients were included. Meta-analysis results showed that compared with the routine exercise group, bundle arm compression exercise significantly increased ultrasound AVF maturation rate (OR=2.50, 95% CI:1.94～3.22, P＜0.001), clinical AVF maturation rate (OR=2.85, 95% CI:1.73～5.68, P＜0.001) and first successful AVF puncture rate (OR=3.95, 95% CI:1.67～9.36, P=0.002), and decreased AVF-related complication rate (OR=0.21, 95% CI:0.10～0.44, P＜0.001). It also significantly increased AVF diameter (MD=2.50, 95% CI:1.94～3.22, P＜0.001) and AVF blood flow (MD=84.98, 95% CI:(60.87～109.09, P＜0.001), and decreased AVF maturation time (MD=-1.56, 95% CI:-1.97～-1.15, P＜0.001). There were no significant differences between the subgroups based on the time to initiate the exercise (3 days, 1 week, and 2 weeks after surgery), but the effective degree was the biggest in patients to initiate the exercise 3 days after surgery in terms of ultrasound AVF maturation rate, clinical AVF maturation rate, first successful AVF puncture rate and AVF maturation time. Conclusion Bundle arm compression exercise can promote AVF maturation and decrease the risks of AVF complications. We recommend the inclusion of bundle arm compression exercise beginning from 3rd days after AVF surgery in the routine nursing program.
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