血管闭合装置与人工压迫止血在经皮血管腔内治疗外周动脉疾病的Meta分析

Meta-analysis of vascular closure device versus manual compression hemostasis in percutaneous intervention of peripheral arterial disease

目的比较血管闭合装置(vascular closure device,VCD)与人工压迫(manual compression,MC)止血方法在外周动脉疾病(peripheral arterial disease,PAD)患者行经皮血管腔内治疗的疗效和安全性。方法系统性检索PubMed、Embase、Cochrane Library、Web of Science、万方数据、中国知网、维普和中国生物医学文献数据库从建库至2021年5月发表的比较VCD和MC止血在经皮血管腔内治疗PAD应用的中英文RCT文献,对结局事件包括止血时间、并发症等进行Meta分析。结果共纳入文献10篇,共1271例患者,其中MC组587例,VCD组684例。Meta分析结果显示,VCD的止血时间比与MC明显缩短(均数差-10.80,95%CI=-14.03~-7.56,P<0.001),且有更低的严重并发症(相对危险度0.57,95%CI=0.32~0.99,P=0.049)和轻微并发症(相对危险度0.36,95%CI=0.26~0.50,P<0.001)发生率。结论PAD患者行经皮血管腔内治疗使用VCD止血与MC相比,可缩短止血时间,减少并发症的发生率。

Objective To compare the effectiveness and safety of vascular closure device(VCD)and manual compression(MC)hemostasis in percutaneous intervention for patients with peripheral arterial disease(PAD).Methods We systematically searched for Chinese and English RCT literatures in compare VCD and MC hemostasis in percutaneous intervention for PAD patients from the establishment of the database to May 2021 in PubMed,Embase,Cochrane Library,Web of Science,Wanfang,CNKI,VIP and China Biomedical Literature Database.We performed a meta-analysis to evaluate the outcome events,including hemostasis time and complications.Results A total of 10 literatures involving 1271 patients were included,with 587 cases in the MC group and 684 cases in the VCD group.Meta-analysis showed that the hemostasis time of VCD group was significantly shorter than that of MC group(mean difference:-10.80,95%CI=-14.03--7.56,P<0.001).VCD group had lower incidence of serious complications(relative risk:0.57,95%CI=0.32-0.99,P=0.049)and minor complications(relative risk:0.36,95%CI=0.26-0.50,P<0.001)than that of MC group.Conclusion Compared with MC hemostasis,VCD in the percutaneous endovascular treatment of PAD patients can shorten the hemostasis time and reduce the incidence of complications.