腰椎融合术后静脉血栓栓塞症的危险因素Meta分析

Meta-analysis of risk factors for venous thromboembolism after lumbar fusion

目的总结腰椎融合术后静脉血栓栓塞症的危险因素,为临床识别和预防提供循证医学证据。方法检索PubMed、Embase、Cochrane Library、Web of Science、CNKI、WanFang Data、VIP和CBM数据库,搜集建库至2021年5月3日关于腰椎融合术后静脉血栓栓塞症的危险因素的研究。由2位研究者独立进行文献筛选、资料提取和质量评估,采用RevMan 5.4软件进行数据分析。结果共纳入22篇文献,累计3259845例,其中21320例患者发生静脉血栓栓塞症。Meta分析结果显示,腰椎融合术后VTE的危险因素为:高龄[OR=8.91,95%CI(7.65~10.18)],吸烟[OR=1.72,95%CI(1.03~2.88)],高血压[OR=2.07,95%CI(1.64~2.60)],糖尿病[OR=1.30,95%CI(1.24~1.35)],抗凝药的使用[OR=1.64,95%CI(1.01~2.65)],多节段融合[OR=3.07,95%CI(1.53~6.18)],前路腰椎融合术[OR=1.49,95%CI(1.34~1.66)],手术时间≥3 h[OR=1.60,95%CI(1.13~2.27)],输血[OR=3.98,95%CI(2.34~6.77)],D-二聚体≥500 ug/L[OR=2.33,95%CI(1.53~3.54)]。运动锻炼[OR=0.43,95%CI(0.30~0.60)]是腰椎融合术后静脉血栓栓塞症的保护因素。结论通过Meta分析发现,高龄、吸烟、高血压史、抗凝药的使用、多节段融合、前路手术、手术时间≥3 h、输血、D-二聚体是腰椎融合术后静脉血栓栓塞症的危险因素,而运动锻炼是其保护因素。

Objective To summarize the risk factors for venous thromboembolism after lumbar fusion,and provide evidence-based medical evidence for clinical identification and prevention of venous thromboembolism after lumbar fusion.Methods PubMed,Embase,Cochrane Library,Web of Science,CNKI,WanFang Data,VIP,and CBM databases were searched,and studies were collected until May 3,2021 on the risk factors of venous thromboembolism after lumbar fusion.Two researchers independently carried out literature screening,data extraction and quality assessment,and RevMan5.4 software was used for data analysis.Results A total of 22 articles were included,and the cumulative number of patients was 3,259,845,of which 21,320 patients developed venous thromboembolism.Meta-analysis results showed that the risk factors for VTE after lumbar fusion were:advanced age[OR=8.91,95%CI(7.65~10.18)],smoking[OR=1.72,95%CI(1.03~2.88)],hypertension[OR=2.07,95%CI(1.64~2.60)],diabetes[OR=1.30,95%CI(1.24~1.35)],use of anticoagulants[OR=1.64,95%CI(1.01~2.65)],multi-segment fusion[OR=3.07,95%CI(1.53~6.18)],anterior lumbar fusion[OR=1.49,95%CI(1.34~1.66)],operation time≥3 h[OR=1.60,95%CI(1.13~2.27)],blood transfusion[OR=3.98,95%CI(2.34~6.77)],D-dimer≥500 ug/L[OR=2.33,95%CI(1.53~3.54)].Exercise[OR=0.43,95%CI(0.30~0.60)]was a protective factor for venous thromboembolism after lumbar fusion.Conclusion Meta-analysis finds that old age,smoking,history of hypertension,use of anticoagulants,multi-segment fusion,anterior surgery,operation time≥3 h,blood transfusion,D-dimer≥500 ug/L are the risk factors of venous thromboembolism after lumbar fusion.The protective factor of venous thromboembolism after lumbar fusion is exercise.