目的 系统评价多种运动方式对改善血液透析（hemodialysis，HD）患者心肺耐力的效果，为临床运动方案的构建提供理论依据。 方法 计算机检索PubMed、Embase、The Cochran Library、中国知网、万方等8个数据库中关于改善HD患者心肺耐力的相关文献。检索时间自建库至2022年6月30日。经过文献筛查和资料提取，采用Cochran偏倚评估2.0版进行文献质量评价，采用Revman 5.3和STATA 16.0统计软件进行分析。 结果 最终纳入18项研究，共818例，涉及5种运动方式。透析中有氧运动、透析中有氧联合抗阻运动、非透析中有氧运动、非透析中有氧联合抗阻运动与常规护理相比，均可以提高HD患者峰值摄氧量（均P＜0.05）。网状Meta分析显示，非透析中有氧联合抗阻运动和非透析中有氧运动对HD患者心肺耐力的改善效果在5种运动方式中居于前2位。 结论 多种运动方式可以提高HD患者的心肺耐力，其中以非透析中有氧联合抗阻运动效果最为明显。

Objective To systematically evaluate the effect of 5 types of exercises on the cardiorespiratory endurance of hemodialysis(HD) patients,and to provide a theoretical basis for the construction of clinical exercise programs. Methods The relevant literature on improving cardiopulmonary endurance of HD patients were searched by computer from 8 databases including PubMed,Embase,The Cochran Library,CNKI,Wanfang,etc.The retrieval time was from the inceptions to June 2022.After literature screening and data extraction,Cochran bias Assessment 2.0 was used for literature quality evaluation,and Revman 5.3 and STATA16.0 statistical software were used for analysis. Results Eighteen studies with a total of 818 patients involving 5 types of exercises were included.Compared with conventional nursing care,aerobic exercise on dialysis,aerobic exercise on dialysis combined with resistance exercise,aerobic exercise on non-dialysis and aerobic combined with resistance exercise on non-dialysis could increase the peak oxygen uptake in HD patients(all P＜0.05).Network Meta-analysis showed that aerobic combined resistance exercise in non-dialysis and aerobic exercise in non-dialysis ranked the top 2 improvement effects on cardiopulmonary endurance of HD patients among the 5 types of exercises. Conclusions Various types of exercises can improve the cardiopulmonary endurance of HD patients,among which the effect of aerobic combined resistance exercise in non-dialysis is the best.

R473.55;R47-05

陕西省自然科学基础研究计划（2021JM-498）；苏州市护理学会科研项目（SZHL-B-202204）