药物预防妇科盆腔术后下肢深静脉血栓形成的Meta分析

Meta Analysis of the Prevention of Lower Extremity Deep Venous Thrombosis after Gynecological Pelvic Surgery

目的探讨不同药物预防妇科盆腔术后下肢深静脉血栓形成的效果。方法检索国内外已发表的相关文献,选择比较药物预防妇科盆腔术后下肢深静脉血栓形成的所有随机对照试验,提取资料后对疗效、副反应进行Meta分析,计算不同药物对妇科盆腔术后下肢深静脉血栓形成的的影响。结果从1988年-2014年,组1观察组为单一药物,对照组为不采用预防性用药预防妇科盆腔术后下肢深静脉血栓形成,有5项研究入选,共969例患者,观察组509例,对照组460例,分析结果显示药物可有效预防妇科盆腔术后下肢深静脉血栓形成（OR=0.2,95%CI为0.09-0.44,P〈0.0001）;术后引流物量比较无统计学意义（MD 7.61,95%CI为-11.71-26.93,P=0.44）。组2去纤肽与肝素钙对比研究的3篇,纳入患者313例。预防下肢深静脉血栓形成差异无统计学意义（OR=0.19,95%CI为0.01-4.11,P=0.29）。结论预防性使用低分子肝素、丹参、去纤肽等可降低妇科盆腔手术术后下肢深静脉血栓的形成的风险,未增加术后引流物量及出血。去纤苷与低分子肝素钙效果相当。

Objective To investigate the effect of different drugs on the prevention the lower extremity deep venous thrombosis after gynecological pelvic surgery. Methods Relevant literature published in China and abroad on all randomized controlled drug trials on the prevention the lower extremity deep venous thrombosis after the gynecological pelvic surgery were selected,and meta analysis of the efficacy and side effects were conducted,and the influence of different drugs on the lower extremity deep venous thrombosis after the gynecological pelvic surgery were analyzed. Results From 1988 - 2014,the observation group used the single drug,the control group did not use the preventive medicine in group 1. 5 papers were enrolled including 969 patients. The observation group were 509 cases,the control group were 406 cases. The results showed that the drug can effectively prevent the deep venous thrombosis（ OR = 0. 2,95% CI,0. 44 - 0. 09,P〈 0. 0001）; The comparison of postoperative drainage volume had no statistical difference（ MD 7. 61,95% CI,- 11. 71 - 26. 93,P = 0. 44）. In group 2,there were 3 papers on the comparison study between the defibrillators peptide and the heparin calcium,and 313 cases of the patients were included. There was no significant difference in the prevention the deep venous thrombosis（ OR = 0. 19,95% CI,0. 01 - 4. 11,P = 0. 29）. Conclusion The preventive use of the low molecular weight heparin,salvia,and other peptides can reduce the formation risk,and not increase the amount of drainage and bleeding after surgery. The effect is equivalent between the defibrotide and the low molecular weight heparin calcium.