传统监测与自我监测用于机械瓣膜置换术后口服抗凝患者效果的Meta分析

The application effect of traditional monitoring and self-monitoring methods in oral anticoagulant patients with mechanical valve replacement patients： a meta-analysis

目的 评价传统监测与自我监测在机械瓣膜置换术后口服抗凝患者的应用效果.方法 检索Cochrane图书馆的临床对照试验中心注册库、EMBase、MEDLINE、Web of Knowledge、中国知网、中国生物文献数据库、维普中文科技期刊数据库、万方数据知识服务平台,纳入2015年10月前有关传统监测与自我监测在机械瓣膜置换术后口服抗凝患者应用效果的随机对照研究中英文文献进行分析.由2位研究人员各自独立地对人选研究的有关试验设计、研究对象特征和研究结果等内容进行筛选和记录.采用RevMan 5.3统计学软件对数据进行分析.结果 共纳入8篇随机对照研究,其中,自我监测组l 262例,传统监测组1 198例.Meta分析结果显示,自我监测较传统监测血栓栓塞发生率低（Z=3.50,P=0.000）、病死率低（Z =4.64,P=0.000）,出血差异无统计学意义（Z =0.07,P =0.940）.自我监测较传统监测国际标准化比值（INR）控制在治疗范围内的患者比例增加6％～20.9％,INR总测试数增加2.1～4.98倍.结论 自我监测能降低机械瓣膜置换术后患者口服抗凝的血栓栓塞发生率和病死率,能有效地控制INR在治疗范围内,INR的总测试数增加,有临床实用价值.

Objective To evaluate the effects of traditional monitoring and self-monitoring in patients who take the oral anticoagulation medicine after mechanical valve replacement surgical operations.Methods A great number of Chinese and English literatures about this subject were investigated in detail,and these literatures were selected from the Cochrane Central Register of Controlled Trials,EMBase,MEDLINE,Web of Knowledge,CNKI,CNKI,VIP,and WanFang Data.It should be noted that all of the literatures were published before October,2015.Based on the results of the literature investigation,several studies were selected as the candidates.Moreover,many aspects about these candidates such as the experimental designs,characteristics of the objects of the studies and the results of the studies were filtered and recorded by two researchers independently.Furthermore,RevMan 5.3 were employed to analyze the data of the candidates.Results Eight randomized controlled trials were studied,which included 1 262 cases in self-monitoring group and 1 198 cases in traditional monitoring group.The results of metaanalysis indicated that compared with the traditional monitoring group,lower incidence of thromboembolism （Z =3.50,P =0.000） and lower mortality （Z =4.64,P =0.000） were observed,and the bleeding difference （Z =0.07,P =0.940） had no significant statistical meaning.Moreover,compared with the traditional monitoring,the international normalized ratio （INR） of the patients who were controlled in the range of treatment of the self-monitoring increased from 6％ to 20.9％,and the total number of the INR tests was increased by 2.1 to 4.98 times.Conclusions Self-monitoring could obviously reduce the possibilities of the thromboembolism and death of the patients who took the oral anticoagulation medicine after mechanical valve replacement surgical operations.Furthermore,self-monitoring could not only control the INR in the range of treatment but also increase the total number of the INR tests.In short,self-monitoring has practical value of clinical application.