周期性充气加压预防骨科大手术后深静脉血栓形成的系统评价

Intermittent Pneumatic Compression for Deep Venous Thrombosis Prevention after Major Orthopedic Operation:A Systematic Review

目的系统评价周期性充气加压(intermittent pneumatic compression,IPC)预防骨科大手术后深静脉血栓形成(deep venous thrombosis,DVT)的有效性和安全性。方法计算机检索MEDLINE(1966～2008.1)、Cochrane Librar(y2008年第2期)、中国生物医学文献数据库(CBM,1996～2008.1)、中国期刊全文数据库(CNKI,1998～2008.1)及中文科技期刊数据库(VIP,1998～2008.1),手工检索相关文献资料,按照纳入标准与排除标准搜集有关IPC预防骨科大手术后DVT的随机对照试验和临床对照试验。参照Cochrane系统评价方法评价纳入研究的方法学质量,并采用RevMan4.2软件进行统计学分析。结果共纳入8篇文献(7篇RCT,1篇CCT,共2773例患者),但其方法学质量普通不高。Meta分析结果显示:①IPC组DVT发生率低于空白对照组[OR=0.20,95%CI(0.11,0.35),P<0.00001];②IPC组DVT发生率与低分子肝素组比无明显差异[OR=0.70,95%CI(0.28,1.74),P=0.44];③联合使用IPC与低分子肝素组DVT发生率低于只单独使用低分子肝素组[OR=0.23,95%CI(0.10,0.52),P=0.0004]。此外,联合使用IPC与低分子肝素组DVT发生率低于联合使用逐级加压弹力袜与低分子肝素组(P<0.0001)。目前尚无使用IPC后发生严重不良反应的报道。结论采用IPC能有效预防DVT且安全,但由于纳入研究质量不高,样本含量较少,上述结论尚有待于更多大样本、高质量的研究加以验证。

Objective To evaluate the safety and efficacy of intermittent pneumatic compression in prevention of deep venous thrombosis after major orthopedic operation. Methods We searched MEDLINE （1966 to January 2008）, The Cochrane Library （Issue 2, 2008）, CBM （1996 to January 2008）, CNKI （1998 to January 2008）, VIP （1998 to January 2008）, and retrieved clinical controlled trials （CCTs） or randomized controlled trials （RCTs） in which IPC was used as an intervention to prevent DVT, and all the trials were published in English or Chinese. The methodological quality of the included studies was assessed according to the standard of Cochrane systematic review. RevMan 4.2 software was used for meta-analysis. Results Seven RCTs and 1 CCT were included. Their methodological quality was poor. The results of Meta–analyses showed： （1） The incidence of DVT in the IPC group was lower than that in the control group （RR=0.20, 95%CI 0.11 to 0.35, P〈0.000 01）; （2） There was no difference in the incidence of DVT between the IPC group and the LMWH group （RR=0.70, 95%CI 0.28 to 1.74, P=0.44）; （3） The incidence of DVT in the IPC plus LMWH group was lower than that in the LMWH-alone group （RR=0.23, 95%CI 0.10 to 0.52, P=0.000 4）. Furthermore, the incidence of DVT in the IPC plus LMWH group was lower than that in the GCS plus LMWH group （P〈0.000 1）. No severe adverse reaction of IPC in DVT prevention was reported. Conclusion IPC shows an effective tendency in DVT prevention, but because of the low quality and the small sample of the included studies, this conclusion needs to be verified by protocols of more samples and high quality.