神经肌肉电刺激预防静脉血栓栓塞症的研究进展

Advances in the use of neuromuscular electrical stimulation in the prevention of venous thromboembolism

目前静脉血栓栓塞症(VTE)最常用的预防措施是药物预防,但高出血风险限制了部分患者药物预防的应用。单独或联合使用机械预防是高出血风险患者预防VTE的重要方式,但现有主流机械预防中的分级加压弹力袜、间歇充气加压泵、足底静脉加压泵均存在一定局限性,如接触面积较大导致患者佩戴产生不适,甚至影响患者的日常活动。神经肌肉电刺激(NMES)是一种新型的穿戴式电子设备,被证实可能通过改善局部血流、减少血液淤滞有效预防VTE。临床研究发现NMES联合药物预防可能较单独药物预防在VTE预防中具有更好的有效性和安全性,且单独使用NMES的预防作用不劣于单独使用其他机械预防措施,同时NMES具有佩戴方便、舒适的优点,但国内尚未将其纳入常规机械预防措施。本文将对其在VTE预防中的原理、临床研究进展及前景进行介绍。

Pharmacologic prophylaxis is the most commonly used prophylaxis for venous thromboembolism(VTE),but the pharmacologic prophylaxis is limited in patients at high risk of bleeding.Mechanical prophylaxis alone or in combination is an important method of VTE prophylaxis in patients at high risk of bleeding,but the current mainstream mechanical prophylaxis,which includes graded compression stockings,intermittent inflatable compression pumps and plantar venous compression pumps,has some limitations,leading to discomfort for patients wearing them due to the large contact area,and even affecting ability to perform daily activities.Many clinical studies have found that NMES combined with pharmacological prophylaxis has better efficacy and safety than pharmacological prophylaxis alone in preventing VTE in medical and surgical patients,and the preventive effect of NMES alone is not inferior to other mechanical prophylaxis.Besides,it also has the advantages of ease of wear and patient compliance.Currently,clinicians have limited experience and knowledge of NMES.We aimed to present the rationale,progress in clinical research and future perspective of NMES in VTE prophylaxis.