低分子肝素注射方法安全性的系统评价再评价

Safety of injection methods for low molecular weight heparin:an overview of systematic review

目的对低分子肝素(LMWH)注射方法安全性的系统评价进行再评价。方法计算机检索中国知网、万方数据库、中国生物医学文献服务系统、中国科技期刊数据库、PubMed、Embase、CINAHL、The Cochrane Library、JBI系统评价和证据应用报告数据库和Campbell协作网中有关LMWH注射方法安全性的系统评价,检索时限均为建库至2022年12月31日。使用AMSTAR 2和ROBIS软件进行系统评价的质量评价,使用GRADE系统进行证据分级。文献筛选、资料提取、质量评价和证据分级均由2名经系统循证护理培训的研究者独立进行。结果共纳入10篇系统评价,AMSTAR 2软件评价显示,1篇方法学质量为低级,9篇为极低级;ROBIS软件评价显示,3篇系统评价整体偏倚风险为低级,7篇为高级。使用GRADE系统对10篇系统评价的47条证据进行证据分级显示,中等质量证据4条、低质量证据34条、极低质量证据9条。结论缓慢注射、腹部注射、垂直注射以及注射后局部按压5 min可能对LMWH皮下注射安全性有益,但仍需开展大样本、针对不同亚组人群与不同注射方法的高质量原始研究以支持结论。

Objective To conduct an overview of systematic review of the safety of low molecular weight heparin(LMWH)injection methods.Methods The systematic review of the safety of LMWH injection method was searched through computer on China National Knowledge Infrastructure,WanFang Data,China Biomedical Literature Service System,China Science and Technology Journal Database,PubMed,Embase,CINAHL,The Cochrane Library,Joanna Briggs Institute(JBI)System Review and Evidence Application Report Database,and Campbell Collaborative Collaboration.The search period was from the establishment of the database to December 31,2022.AMSTAR 2 and ROBIS software were used for quality evaluation of system reviews,and the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)system was used for evidence grading.Results A total of 10 systematic reviews were included.AMSTAR 2 software evaluation showed that the methodological quality of 1 article was low and 9 articles were extremely low.The ROBIS software evaluation showed that the overall bias risk of 3 system atic reviews was low,and 7 reviews were high.The GRADE system was used to grade 47 pieces of evidence from 10 systematic reviews,including 4 pieces of medium-quality evidence,34 pieces of low-quality evidence,and 9 pieces of extremely low-quality evidence.Conclusions Slow injection,abdominal injection,vertical injection,and local compression for 5 minutes after injection may be beneficial for the safety of LMWH subcutaneous injection.However,high-quality original studies targeting different subgroups and injection methods still need to be conducted on a large sample to support the conclusions.