早期目标导向活动对ICU获得性衰弱的影响：一项荟萃分析。
完整摘要 · 中文译文
背景：重症监护病房获得性衰弱（ICU-AW）显著损害危重症患者的肌力和身体功能。早期活动干预已越来越多地被采用，但结构化早期目标导向动员（EGDM）方案对ICU-AW及功能结局的具体效果尚未被系统量化。本荟萃分析旨在评估EGDM对ICU-AW、肌力和功能结局的影响。 方法：检索PubMed、Web of Science、Embase、Cochrane Library、中国知网（CNKI）、万方数据（Wanfang Data）和维普资讯（VIP）数据库中截至2025年11月30日的随机对照试验（RCT）。两名评价者独立筛选研究、提取数据，并使用RoB 2.0评估偏倚风险。使用RevMan 5.4进行荟萃分析。预先设定按分配隐藏进行亚组分析。 结果：共纳入9项随机对照试验（907例患者）。EGDM降低了ICU-AW [总效应RR = 0.57，95%CI（0.33~0.97），p = 0.04；异质性I2 = 77%，p = 0.002]，但高质量试验的敏感性分析显示无显著效果 [总效应RR = 0.84，95%CI（0.48~1.46），p = 0.54]。EGDM改善了肌力 [MD = 4.94，95%CI（3.39~6.50），异质性I2 = 59%，p = 0.02]，缩短了机械通气时间 [总效应MD = -81.95小时，95%CI（-115.45~-48.46），p < 0.00001；异质性I2 = 85%，p < 0.00001]，并缩短了ICU住院时间 [总效应MD = -4.55天，95%CI（-6.22~-2.89），p < 0.00001；异质性I2 = 74%，p = 0.0004]。 异质性]，两者均具有显著的异质性。尽管主要巴氏指数分析结果无统计学意义，但敏感性分析提示，在基线功能中等的患者中有所改善[MD = 8.27，95%CI（5.66～10.87），总体效应p < 0.00001]。 结论：早期目标导向活动可能改善ICU患者的肌力和身体功能。现有证据未能证实其可减少ICU获得性衰弱。对通气时长和ICU住院时间的影响在各研究中差异较大，可能受镇静方案、脱机实践及其他情境特定因素影响。需要进一步开展报告干预措施及情境因素的严格试验，以指导精准的临床实施。 系统评价注册：https://www.crd.york.ac.uk/PROSPERO/view/CRD420261280603, CRD420261280603。
完整摘要 · 英文原文
BACKGROUND: ICU-acquired weakness (ICU-AW) significantly impairs muscle strength and physical function in critically ill patients. Early mobilization interventions have been increasingly adopted, yet the specific effects of a structured EGDM program on ICU-AW and functional outcomes have not been systematically quantified. This meta-analysis aimed to evaluate the effects of EGDM on ICU-AW, muscle strength, and functional outcomes. METHODS: PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Viper Information Products (VIP) databases were searched for randomized controlled trials (RCTs) up to November 30, 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0. RevMan 5.4 was used for meta-analysis. Subgroup analysis was prespecified by allocation concealment. RESULTS: Nine RCTs (907 patients) were included. EGDM reduced ICU-AW [RR = 0.57, 95%CI (0.33 ~ 0.97), p = 0.04 for the overall effect; I2 = 77%, p = 0.002 for heterogeneity], but sensitivity analysis of high-quality trials showed no significant effect [RR = 0.84, 95%CI (0.48 ~ 1.46), p = 0.54 for the overall effect]. EGDM improved muscle strength [MD = 4.94, 95%CI (3.39 ~ 6.50), I2 = 59%, p = 0.02 for heterogeneity], shortened the duration of mechanical ventilation [MD = -81.95 h, 95%CI (-115.45 ~ -48.46), p < 0.00001 for the overall effect; I2 = 85%, p < 0.00001 for heterogeneity], and reduced ICU stay[MD = -4.55 days, 95%CI (-6.22 ~ -2.89), p < 0.00001 for the overall effect; I2 = 74%, p = 0.0004 for heterogeneity], both with substantial heterogeneity. Although the primary Barthel Index analysis was not statistically significant, sensitivity analysis suggested improvement in patients with moderate baseline function [MD = 8.27, 95%CI (5.66 ~ 10.87), p < 0.00001 for the overall effect]. CONCLUSION: EGDM may improve muscle strength and physical function in ICU patients. The available evidence does not confirm a reduction in ICU-AW. The effects on ventilation duration and ICU stay varied substantially across studies, likely influenced by sedation protocols, weaning practices, and other context-specific factors. Further rigorous trials with detailed reporting of interventions and contextual factors are needed to guide precise clinical implementation. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261280603, CRD420261280603.