间歇充气加压泵对预防内科危重症患者VTE效果及安全的系统评价

Efficacy and safety of intermittent pneumatic compression on prevention of venous thromboembolism in critical ill patients:a systematic review

目的:探索利用间歇充气压力泵(intermittent pneumatic compression,IPC)预防重症内科患者的有效性及安全性,为临床合理有效利用气压泵预防静脉血栓栓塞症(venous thromboembolism,VTE)提供循证依据。方法:通过检索中外文数据库收集关于研究IPC预防重症内科住院患者VTE的随机对照试验的文献,运用Rev Man5.3软件进行统计处理。结果:纳入文献19篇,Meta分析显示,与对照组相比较,IPC组在预防下肢深静脉血栓(deep venous thrombosis,DVT)的发生率明显降低(RR=0.25,95%CI=0.15~0.41,P=0.000),尽管存在较大的异质性(I2=63%,P=0.000),但其亚组分析显示其发生率明显低于对照组(RR=0.17,95%CI=0.11~0.27,P=0.000)、(RR=0.23,95%CI=0.16~0.33,P=0.006),在肺血栓栓塞的发生率方面并没有明显降低(RR=0.66,95%CI=0.43~1.02,P=0.060);在与使用对照组的比较中,IPC组在预防VTE发生率也明显降低(RR=0.37,95%CI=0.17~0.79,P=0.010),但存在较大的异质性(I2=73%,P=0.005),按IPC干预时间的不同进行亚组分析能消除其异质性(RR=0.76,95%CI=0.66~0.88,P=0.000),(RR=0.15,95%CI=0.07~0.35,P=0.000)。与使用抗凝剂比较,IPC组在预防下肢DVT发生并无统计学差异(RR=2.47,95%CI=0.79~7.75,P=0.120),但出血的风险明显降低(RR=0.45,95%CI=0.22~0.92,P=0.030)。结论:IPC能够有效地预防内科危重症患者下肢DVT和总的静脉血栓事件的发生;与药物抗凝相比,IPC除了能有效规避出血风险以外,还可以有效地预防下肢DVT的发生产生与药物抗凝相当的抗栓效果。

Objective:To explore the effectiveness and safety of intermittent pneumatic compression(IPC)in the prevention of venous thromboembolism(VTE)for critical ill patients and to provide reasonable and effective evidences for use of IPC. Methods:Databases were retried to collect randomized controlled trial on prevention of IPC in patients with VTE hospitalized in intense care unit. Data were statistically processed using Rev Man5.3 software. Results:A total of 19 articles were included. The incidence of lower extremity deep vein thrombosis was significantly lower in IPC group than in control group(RR=0.25,95%CI=0.15 to 0.41,P=0.000),despite of the extensive heterogeneity(I2=63%,P=0.000);its subgroup analysis showed that the incidence was significantly lower in IPC group than in control group(RR=0.17,95%CI=0.11 to 0.27,P=0.000),(RR=0.23,95%CI=0.16 to 0.33,P=0.006);in terms of the incidence of pulmonary thromboembolism,there was no significant decrease(RR=0.66,95%CI=0.43 to 1.02,P=0.060). VTE incidence was also significantly reduced in IPC group than in control group(RR=0.37,95%CI=0.17 to 0.79,P=0.010),despite of extensive heterogeneity(I2=73%,P=0.005). Sub-grouping according to different time points of IPC intervention can eliminate the heterogeneity(RR=0.76,95%CI=0.66 to 0.88,P=0.000),(RR=0.15,95%CI=0.07 to 0.35,P=0.000). There was no difference in VTE incidence between ICP group and those using anticoagulants(RR=2.47,95%CI=0.79 to 7.75,P=0.120),but the risk of bleeding can be significantly lowered by using anticoagulants(RR=0.45,95%CI=0.22 to 0.92,P=0.030). Conclusion:IPC can effectively prevent total incidence of VTE and incidence of lower extremity deep venous thrombosis(DVT)among critically ill patients. Compared with anti-coagulant drugs,IPC can effectively circumvent the risk of bleeding as well as prevent the lower extremity DVT,with the same anti-coagulating effect.