目的 不同的体位对血流动力学和呼吸均有正向和负向的生理作用。本研究旨在进行文献综述并探讨不同体位的血流动力学和呼吸变化。方法研究方案在国际前瞻性系统评价登记处注册(注册号:CRD42021291464)。两名独立研究人员使用Down and Black检查表评估了所有纳入研究的方法学质量，而证据质量的评估则基于"推荐意见分级的评估、制定及评价"(Grading of Recommendations，Assessment，Development，and Evaluations，GRADE)。通过随机效应荟萃分析报告了不同体位的总体效果。结果3项低偏倚风险研究和10项高偏倚风险研究符合纳入标准。与70度直立倾斜位、坐位和站姿相比，仰卧位的心输出量最高(极低至中等质量的证据);与70度直立倾斜位和站姿相比，仰卧位的全身血管阻力最低(中等质量证据)。此外，与70度直立倾斜位、左侧和站姿相比，仰卧位的总呼吸阻力最高(极低至中等质量的证据)，而其肺泡通气量则高于俯卧位(低质量证据)。结论仰卧位与血流动力学变量的正相关性最高，相对应的心输出量最高、全身血管阻力最低。直立体位(70度直立倾斜位和站姿)与呼吸变量的正相关性最高，相对应地总呼吸阻力最低。
Body Positions Alter Hemodynamics and Respiration in Healthy Adults:A Systematic Review and Meta-Analysis
Objective Different body positions can exert both positive and negative physiological effects on hemodynamics and respiration.This study aims to conduct a literature review and examine hemodynamic and respiratory alterations to different body positions.Methods The study protocol was registered with the International Prospective Registry of Systematic Reviews(register no.CRD42021291464).Two independent reviewers evaluated the methodological quality of all included studies using the Down and Black checklist,while the quality of evidence was evaluated using the Grading of Recommendations,Assessment,Development,and Evaluations approach.The overall effects of different body positions were reported from random effects meta-analysis.Results Three studies with low risk of bias and ten with high risk of bias met the eligibility criteria.The supine resulted in the highest cardiac output compared to the 70 deg head-up tilt,sitting,and standing positions(very low-to moderate-quality evidences)and the lowest systemic vascular resistance compared to the 70 deg head-up tilt and standing positions(moderate-quality evidence).Additionally,the supine was associated with the highest total respiratory resistance compared to the 70 deg head-up tilt,left lateral,and standing positions(very low-to moderate-quality evidence)and higher alveolar ventilation than the prone(low-quality evidence).Conclusions The supine position has the most positive association with hemodynamic variables,resulting in the highest cardiac output and the lowest systemic vascular resistance.The upright positions(70 deg head-up tilt and standing positions)has the most positive association with the respiratory variables,resulting in the lowest total respiratory resistance.
body positioncardiac outputsystemic vascular resistancealveolar ventilationtotal respiratory resistance
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