足底静脉泵预防髋膝关节置换术后深静脉血栓形成有效性的meta分析

Meta analysis on effectiveness of venous foot pump in preventing deep vein thrombosis after hip and knee arthroplasty

目的评价足底静脉泵(VFP)预防髋膝关节置换术后深静脉血栓形成(DVT)的有效性。方法计算机检索Pubmed、EMbase、Cochrane、CBM、CNKI、VIP、WanFang数据库建库至2020年7月,筛选VFP预防髋膝关节置换术后DVT的随机对照试验。由2名研究人员对文献质量进行严格评价,按纳入与排除标准独立筛选和提取文献,采用RevMan 5.3软件对数据进行meta分析。结果纳入16项随机对照试验。VFP组患者DVT发生率与空白对照组比较,差异有统计学意义[相对危险度(RR)=0.23,95%可信区间(95%CI):0.12~0.42,P<0.05];VFP组患者DVT发生率与低分子肝素组比较,差异无统计学意义(RR=0.94,95%CI:0.54~1.65,P=0.83);VFP联合抗凝药物组患者DVT发生率与单独使用抗凝药物组比较,差异有统计学意义(RR=0.36,95%CI:0.24~0.54,P<0.05);VFP组患者肺栓塞发生率与低分子肝素组比较,差异无统计学意义(RR=1.35,95%CI:0.27~6.83,P=0.71)。结论VFP能有效降低髋膝关节置换术后DVT发生率,VFP联合药物预防DVT的效果比单独使用药物预防DVT效果更佳。但仍需进行多中心、大样本、高质量的研究加以验证。对行髋膝关节置换术的患者建议给予VFP联合药物预防以达到最佳效果。

Objective To evaluate the effectiveness of venous foot pump(VFP)in the prevention of deep vein thrombosis(DVT)after hip and knee replacement.Methods The computer was used to retrieve the Pubmed,EMbase,Cochrane,CBM,CNKI,VIP and WanFang databases from their establishment to July 2020.The randomized controlled trials(RCTs)of VEP in the prevention of DVT after hip and knee replacement were screened.Two researchers strictly evaluated the quality of the literature.independently screened and extracted the literature according to the inclusion and exclusion criteria.The RevMan 5.3 software was used to perform the meta analysis on the data.Results Sixteen RCTs were included.The incidence rate of DVT had no statistically significant difference between the VFP group and blank control group[relative risk(RR)=0.23,95%CI(0.12-0.42),P<0.05];the difference in the incidence rate of DVT between the VFP group and the low-molecular-weight heparin group was not statistically significant[RR=0.94,95%CI(0.54 to 1.65),P=0.83];the difference in the incidence rate of DVT between the VFP combined with anticoagulant drug group and the anticoagulant exclusive use group was statistically significant[RR=0.36,95%CI(0.24 to 0.54),P<0.05];the difference in the incidence rate of pulmonary embolism(PE)between the VFP group and the low-molecular-weight heparin group was not statistically significant[RR=1.35,95%CI(0.27 to 6.83),P=0.71].Conclusion VFP can effectively reduce the incidence rate of DVT after hip and knee replacement.The effect of VFP combined with drug for preventing DVT is better than that of the drugs use alone.However,there still needs the multi-center,large sample and high-quality researches to verify.For the patients undergoing hip and knee replacement,it is recommended to give VFP combined with drug prevention to achieve the best results.