不同间歇充气加压治疗方案对骨科大手术病人深静脉血栓预防效果的系统评价

Meta-analysis of preventive effect of different intermittent pneumatic compression therapies on deep venous thrombosis in major orthopaedic surgery patients

[目的]系统评价不同间歇充气加压(IPC)治疗方案对骨科大手术病人深静脉血栓(DVT)的预防效果。[方法]检索Cochrane Library、AMED、EMBASE、CINHAL、PubMed、Ovid MEDLINE In-Process、Web of Science、Springer、中国生物医学数据库、中国知网、万方数据库、维普数据库中关于骨科大手术病人使用IPC预防DVT发生的随机对照试验和半随机对照试验。检索时限均自建库至2018年2月。由2名研究者独立进行文献筛选、资料提取与质量评价后,录入RevMan 5.3行Meta分析。[结果]共纳入10项研究。Meta分析结果显示:IPC治疗时间为每日80min～360min的骨科大手术病人DVT发生率低于治疗时间每日≤60min的病人[OR=3.21,95%CI(1.26,8.14),P=0.01],IPC治疗频次为每日2次或3次的骨科大手术病人DVT发生率低于治疗频次为每日1次的病人[OR=2.20,95%CI(1.03,4.69),P=0.04],术前开始IPC治疗的骨科大手术病人DVT发生率低于术后开始治疗病人[OR=0.29,95%CI(0.11,0.77),P=0.01],"每日2次,每次40min"或"每日3次,每次2h"IPC治疗策略的骨科大手术病人纤维蛋白原水平低于"每日1次,每次1h"治疗策略病人[每日2次,每次40min:SMD=1.22,95%CI(0.85,1.58),P<0.000 01;每日3次,每次2h:SMD=1.35,95%CI(0.98,1.71),P<0.000 01]。描述性分析显示:术前开始IPC治疗的骨科大手术病人D-二聚体水平低于术后开始IPC治疗的病人,两组比较差异有统计学意义(P=0.046)。[结论]现有证据表明:术前即开始进行IPC治疗,并将治疗时间设定在为每日80min～360min,治疗频次设定为每日2次或3次,有利于降低病人DVT发生率;"每日2次,每次40min"或"每日3次,每次2h"可降低骨科大手术病人纤维蛋白原水平;术前即开始使用IPC方法可降低病人D-二聚体水平。由于原始文献数量和质量限制,确切结果有待未来大样本、高质量随机对照试验予以验证。

Objective: To systematically evaluate the preventive effect of different intermittent pneumatic compression(IPC) therapies on deep venous thrombosis in major orthopaedic surgery patients. Methods: Databases including Cochrane Library,AMED,EMBASE,CINHAL,PubMed,Ovid MEDLINE In-Process,Web of Science,Springer,CBM,CNKI,Wanfang Data,VIP were searched electronically from inception to February 2018 to collect the randomized controlled trial and semi-randomized controlled trial on prevention of DVT by IPC in patients undergoing major orthopaedic surgery.Documents screening,data extraction and quality assessment of methodology were conducted by two researchers separately.Meta analysis was performed using RevMan 5.3 software. Results: 10 RCTs were included.Meta analysis showed that incidence of DVT in major orthopaedic surgery patients with IPC treatment time of 80 to 360 mins a day was lower than that in patients with IPC treatment time of less than 60 mins a day[OR=3.21,95% CI (1.26,8.14),P=0.01].The incidence of DVT in major orthopaedic surgery patients with IPC treatment frequency of twice a day or three times a day was lower than that in patients with IPC treatment frequency of one time a day[OR=2.20,95% CI(1.03,4.69),P=0.04].The incidence of DVT in major orthopaedic surgery patients who started IPC treatment before surgery was lower than that in patients who started treatment after surgery[OR=0.29,95% CI(0.11,0.77),P=0.01].The fibrinogen levels in major orthopaedic surgery patients with "twice a day,40 mins at a time" or "three times a day,two hours at a time" IPC treatment strategy were lower than that in patients with "one time a day,one hour at a time" IPC treatment strategy[twice a day,40 mins at a time:SMD=1.22,95% CI(0.85,1.58),P<0.00001;three times a day,two hours at a time:SMD=1.35,95% CI(0.98,1.71),P<0.00001].Descriptive analysis showed that the D-dimer level in major orthopaedic surgery patients who started IPC treatment before surgery was lower than that in patients who started IPC treatment after surgery. There was a significant difference between the two groups(P=0.046). Conclusion: Present evidences showed that it is helpful to reduce the incidence of DVT in major orthopaedic surgery patients who started IPC treatment before surgery,the duration of treatment was set at 80 to 360 mins and the frequency of treatment was set at twice a day or three times a day.It is helpful to reduce the fibrinogen levels in major orthopaedic surgery patients with "twice a day,40 mins at a time" or "three times a day,two hours at a time" IPC treatment strategy.It is helpful to reduce the D-dimer level in major orthopaedic surgery patients who started IPC treatment before surgery.But it is limited by the quantity and quality of included researches so it needs to be verified by future large-sample,high-quality randomized controlled trials.