电子警报系统预防静脉血栓栓塞症的系统评价

Systematic review of electronic alert system for prevention of venous thromboembolism

[目的]系统评价电子警报系统对静脉血栓栓塞症(venousthromboembolism,VTE)的预防效果。[方法]计算机检索PubMed、EMbase、theCochraneLibrary、中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(VIP)、万方(WangFangData)和中国知网(CNKI)中关于电子警报系统预防VTE的随机对照试验(randomizedcontrolledtrial,RCT)、半随机对照试验、临床对照试验以及观察性研究。由2位研究者根据纳入和排除标准筛选文献,并进行资料提取和质量评价,使用RevMan5.3软件进行Meta分析。[结果]共纳入11项研究(6项RCT、5项队列研究),39741例病人。Meta分析的结果表明:与常规护理相比,电子警报系统的应用提高了VTE预防率[OR=2.03,95%CI(1.60,2.59),P<0.00001],但对VTE发生率[OR=0.98,95%CI(0.79,1.20),P=0.82]、死亡率[OR=0.99,95%CI(0.88,1.11),P=0.84]和出血发生率[OR=0.86,95%CI(0.71,1.03),P=0.11]无显著影响。[结论]电子警报系统可以提高VTE护理措施实施的依从性,提高VTE预防率,但是对降低VTE发生率、死亡率和出血发生率无显著影响,本研究结果尚需更严谨的临床试验进一步验证。

Objective: To systematically evaluate the preventive effect of electronic alert system on venous thromboembolism. Methods: The randomized controlled trials(RCTs) and observational studies for electronic alert systems to prevent venous thromboembolism were searched by computer in PubMed,EMbase,the Cochrane Library,CBM,VIP,WangFang Data,and CNKI.Two researchers screened the literature based on inclusion and exclusion criteria, and performed data extraction and quality evaluation. RevMan 5.3 software was used for Meta analysis. Results: A total of 11 studies(6 RCTs,5 cohort studies) and 39 741 patients were included. The results of the Meta-analysis showed that compared with the conventional care group, the electronic alarm system group increased the VTE prevention rate[OR=2.03,95% CI (1.60,2.59), P <0.000 01], and had no effect on the incidence of VTE[OR= 0.98,95% CI (0.79,1.20), P =0.82], mortality[OR=0.99,95% CI (0.88,1.11), P =0.84], and bleeding rate[OR=0.86,95% CI (0.71,1.03), P =0.11]. Conclusions: The electronic alert system can improve the implementation of VTE care measures and increase the VTE prevention rate,but has no effect on reducing the incidence of VTE,mortality and bleeding,and further verification is needed in more rigorous clinical trials.