间歇充气加压对肿瘤患者静脉血栓栓塞和血流影响的Meta分析

Effect of intermittent pneumatic compression on venous thromboprophylaxis and blood flow in tumor patients:a Meta-analysis

目的通过Meta分析评价间歇充气加压对肿瘤患者静脉血栓栓塞(VTE)和股静脉血流速度的影响。方法检索PubMed、Embase、Web of Science、The Cochrane Library、中国知网、万方、维普、中国生物医学文献数据库共8个数据库,获取以间歇充气加压措施干预肿瘤患者的随机对照试验相关文献,检索时限为建库至2022年9月。2名研究人员独立提取数据,采用RevMan5.4软件和Stata15.1软件进行Meta分析,应用Egger′s检验分析发表偏倚。结果本研究最终纳入20篇文献进行分析。Meta分析结果显示,间歇充气加压组(RR=0.35,95%CI:0.23~0.53,P<0.01)、间歇充气加压联合梯度压力弹力袜组(RR=0.42,95%CI:0.31~0.57,P<0.01)、间歇充气加压联合抗凝药物组(RR=0.38,95%CI:0.20~0.72,P<0.01)的VTE发生率分别低于常规组(或梯度压力弹力袜组)、常规组(或梯度压力弹力袜组)、抗凝药物组;间歇充气加压组预防VTE的效果差于抗凝药物组(RR=3.48,95%CI:1.66~7.28,P<0.01);间歇充气加压组的下肢股静脉血流速度快于对照组,差异有统计学意义(MD=0.35,95%CI:0.11~0.60,P<0.01)。结论间歇性充气加压装置可以加快肿瘤患者的股静脉血流速度,预防VTE发生,但单独应用并不能取代抗凝治疗,建议联用其他干预措施以降低VTE发生率。

Objective To evaluate the effect of intermittent inflatable compression on venous thrombosis(VTE)and femoral vein blood flow velocity in tumor patients by Meta-analysis.Methods PubMed,Embase,Web of Science,The Cochrane Library,Chinese National Knowledge Infrastructure(CNKI),Wanfang,VIP database and Chinese Biomedical literature were searched to obtain randomized controlled trials of intermittent inflatable compression as an intervention for tumor patients.The retrieval period was from database construction to September 2022.Data were extracted independently by two researchers,and Meta-analysis was performed by RevMan5.4 software and Stata15.1 software,and Egger′s was applied to test publication bias.Results A total of 20 articles were included.Meta-analysis showed that the incidence of VTE in intermittent inflatable compression group(RR=0.35;95%CI,0.23 to 0.53;P<0.01),intermittent inflatable compression combined with gradient pressure tension socks group(RR=0.42;95%CI,0.31 to 0.57;P<0.01),intermittent inflatingpressure combined with anticoagulant drugs group(RR=0.38;95%CI,0.20 to 0.72;P<0.01)was lower than the conventional group(or gradient pressure tension socks group),conventional group(or gradient pressure tension socks group)and anticoagulant drug group,respectively.The preventive effect of the intermittent inflatable compression group was worse than that of anticoagulant group(RR=3.48;95%CI,1.66 to 7.28;P<0.01).The blood flow velocity of lower limb femoral vein in the intermittent inflatable compression group was faster than that in the control group(MD=0.35;95%CI,0.11 to 0.60;P<0.01).Conclusion Intermittent pneumatic compression devices can increase the blood flow velocity of the femoral veins in tumor patients and prevent venous thrombosis.However,anticoagulation alone is not a substitute for anticoagulation,and it is recommended that it should be clinically combined with other interventions to reduce the incidence of venous thrombosis.