踝关节运动预防骨科术后深静脉血栓形成的meta分析

Ankle joint exercise for prevention of deep vein thrombosis after orthopedic surgery:a meta-analysis

目的对踝关节运动在防治深静脉血栓(DVT)中的作用进行系统性评估,为临床实践提供参考依据。方法通过计算机搜索Cochrane Library、Web of Science、PubMed、CINAHL、Embase、中国知网、万方医学网、维普资讯中文期刊服务平台、中国生物医学文献服务系统等数据库中关于踝关节运动预防下肢DVT的原始文献,检索时限为建库至2023年7月。由2名研究人员根据纳入/排除标准独立对文献进行筛选,提取相关数据,并对文献质量进行评价,使用Stata16软件进行meta分析。结果共纳入文献14篇,包括1572名患者。踝关节运动能降低骨科患者术后DVT发生率、增加最大静脉容量及最大静脉流出量、减小大腿周径,差异均有统计学意义(风险比/均数差0.26、1.14、0.94、-2.18,95%可信区间0.16~0.42、0.60~1.67、0.43~1.44、-3.31~-1.05,P<0.001);减小小腿周径、降低术后不良事件发生率比较,差异均无统计学意义(均数差/风险比-2.27、0.76,95%可信区间-5.12~0.57、0.31~1.85,P=0.117、0.543)。结论踝关节运动可有效降低骨科患者术后DVT发生率,同时可改善患者血流动力学状况和减小大腿周径,但对减小小腿周径、降低不良反应的效果不明显。

Objective To systematically evaluate the role of ankle joint movement in the prevention and treatment of deep vein thrombosis(DVT),and to provide reference for clinical practice.Methods We searched the Cochrane Library,Web of Science,PubMed,CINAHL,Embase,China Knowledge Network,Wanfang Medical Network,Weipu Information Chinese Journal Service Platform,China Biomedical Literature Service System and other databases for ankle exercise to prevent lower extremity DVT.The original literature,the search time limit is from the establishment of the database to July 2023.Two researchers independently screened the literature according to the inclusion/exclusion criteria,extracted relevant data,and evaluated the quality of the literature.Meta-analysis was performed using Stata16 software.Results A total of 14 articles were included,including 1572 patients.Ankle joint exercise can reduce the incidence of DVT after orthopedic surgery,increase the maximum venous volume and maximum venous outflow,and reduce the circumference of the thigh.The differences were statistically significant(RR/MD=0.26,1.14,0.94,-2.18,95%CI 0.16-0.42,0.60-1.67,0.43-1.44,-3.31-1.05,P<0.001).There was no significant difference in reducing the circumference of the calf and reducing the incidence of postoperative adverse events(MD/RR=-2.27,0.76,95%CI-5.12-0.57,0.31-1.85,P=0.117,0.543).Conclusion Ankle joint exercise can effectively reduce the incidence of DVT in orthopedic patients after operation,improve the hemodynamic status of patients and reduce the circumference of thigh,but it has no obvious effect on reducing the circumference of calf and reducing adverse reactions.