导管接触性溶栓治疗下肢深静脉血栓安全性和有效性的系统评价再评价

Safety and efficacy of catheter directed thrombolytic therapy for lower extremity deep venous thrombosis:an umbrella review

目的对下肢深静脉血栓形成患者实施导管接触性溶栓治疗的安全性和有效性进行系统评价再评价。方法搜索时间为建库至2021年9月。计算机检索中国知网、万方医学平台、web of science、EBSCO、Cochrane Library、PubMed、Databases@OVID平台等数据库的系统评价/Meta分析。搜索方法为中文/英文自由词和主题词的组合。使用Zotero文献管理器对检索到的文献进行去重和整理,由2名研究人员分别使用AMSTAR2和GRADE进行文献及结局指标质量评价。结果共纳入8篇研究类型为RCT/NRSI的系统评价,AMSTAR2评价结果显示1篇为高级质量、1篇为中级质量、3篇低级质量、3篇极低级质量。GRADE评价结果显示高级证据0条(0.00%);中级证据7条(23.33%),低级证据16条(53.33%),极低级证据7条(23.33%)。结论导管接触性溶栓治疗安全性相关证据涉及导管溶栓治疗灌注方式、溶栓药物使用时间和剂量。有效性指标主要为静脉通畅率和血栓后综合征发生率,但相关证据局限,文献质量不高,仍需进一步研究。

Objective To evaluate the systematic evaluation of the safety and efficacy of catheter directed thrombolysis in patients with lower extremity deep venous thrombosis.Methods In September 2021,systematic reviews/meta-analyses were retrieved from CNKI,WanFang Medical Platform,Web of Science,EBSCO,Cochrane Library,PubMed,Databases@OVID and other databases.The search strategy is a combination of Chinese/English free words and subject words and the Zotero software was used to manage references.Two researchers used AMSTAR2 and GRADE respectively to evaluate the quality of literature and outcome indicators.Results A total of 8 RCT/NRSI systematic evaluations were included.The evaluation results of AMSTAR2 showed that 1 article was of high quality,1 article was of intermediate quality,3 articles were of low quality and 3 articles were of extremely low quality.GRADE evaluation results showed 0 advanced evidences,accounting for 0%;7 pieces of intermediate evidence,accounting for 23.33%,16 pieces of low-level evidence,accounting for 53.33%,and 7 pieces of extremely low-level evidence,accounting for 23.33%.Conclusion The infusion method,time and dose of thrombolytic drugs are the influencing factors of bleeding related safety.The main evidence of effectiveness was the rate of venous patency and the incidence of post-thrombotic syndrome.However,the relevant evidence is limited,which still needs further study.