机械装置预防深静脉血栓形成依从性:基于观察性研究的Meta分析

Mechanical device for prevention of deep vein thrombosis on patient compliance: a meta-analysis based on observational studies

背景:机械装置在预防深静脉血栓形成过程中存在装置依从性降低等问题。目的:评价在深静脉血栓形成预防措施应用过程中,住院患者对机械预防措施的依从性,分析导致机械装置依从性降低的原因。方法:计算机检索Cochrane Library,Pub Med,Embase,Medline等英文数据库中关于住院患者对机械装置预防深静脉血栓依从性的相关观察性研究,检索时限为建库至2015年12月。同时采用"滚雪球"法筛检纳入文献后的参考文献。文献进行筛选后,使用纽卡斯尔-渥太华NOS工具和美国卫生保健质量和研究机构AHRQ标准,由2名研究者独立对纳入文献质量进行严格评鉴,对符合质量标准的文献进行数据资料提取,采用Meta-analyst Beta3.13软件分别对提取的资料信息进行异质性分析和发表偏倚检验,根据异质性分析结果和文献类型选取合理的统计分析方法进行资料整理、总结及讨论。结果与结论:最终纳入12篇文献,其中9篇横断面研究,2篇队列研究,病例-对照研究1篇。住院患者对机械装置的合并依从率检测显示:OR=53.2%,95%CI:38.7-67.2,亚组分析显示使用充气加压装置依从率检测显示:OR=54.9%,95%CI:34.9-73.4,使用弹力袜依从率检测显示:OR=47.9%,95%CI:34.3-61.8,手术患者机械装置依从率检测显示:OR=66.8%,95%CI:47.4-81.7。结果证实,临床住院患者使用机械装置预防深静脉血栓措施的依从率有待提高,需要进一步研究分析导致依从率降低原因,提高依从率。

BACKGROUND： Compliance of mechanical device reduced in the prevention of deep venoUs thrombosis. OBJECTIVE： To evaluate the compliance on mechanical prevention measures in the prevention of deep venous thrombosis, and to analyze the reason for compliance reduction. METHODS： We searched Cochrane Library, PubMed, Embase, and Medline for articles on compliance of inpatients on mechanical device for prevention of deep vein thrombosis published from inception to December 2015. At the same time, the ＂snowball＂ method was used to screen the references. After the literatures were screened, using the Newcastle Ottawa Scale tools and Agency for Healthcare Research and Quality standard, two researchers evaluated the quality of the literatures independently and strictly. Data were extracted if meet the discharge standard. The software of Meta-analyst Beta3.13 was used for heterogeneity analysis and publication bias test in the extracted data. According to the heterogeneity analysis results and literature types, a reasonable statistical analysis method was selected to collate, summarize and discuss. RESULTS AND CONCLUSION： Finally, 12 papers were included, 9 of which were cross-sectional studies 2 cohort studies, and 1 case-control study. The odds ratio about compliance rate of inpatients with mechanical devices was 53.2% （95%C/： 38.7-67.2）. Subgroup analysis showed that the odds ratio about compliance rate of pneumatic compression devices was 54.9% （95%C/： 34.9-73.4）. The odds ratio about compliance rate on elastic stockings was 47.9% （95%C/： 34.3-61.8）. The detection of mechanical device of surgical patients showed that odds ratio about compliance rate was 66.8% （95%C/： 47.4-81.7）. Our results confirm that the compliance rate of the use of mechanical devices for the prevention of deep venous thrombosis in clinical inpatients requests to be improved. The reason for reduced compliance rate should be further investigated to improve the compliance rate. Subject headings： Tissue Engineering; Venous Thrombosis; Intermittent Pneumatic Compression Devices; Stockings, Pressure; Meta-Analysis