机械预防对卒中患者静脉血栓栓塞预防效果的meta分析

doi:10.3969/j.issn.1673-5765.2021.11.006

摘要/Abstract

摘要： 目的评价机械预防对卒中患者静脉血栓栓塞（venous thromboembolism，VTE）的预防效果。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、CINAHL、中国知网、万方数据知识服务平台、中国生物医学文献数据库有关机械预防（间歇充气加压泵、弹力袜）联合常规预防对卒中患者VTE预防的随机对照研究，检索时间为各数据库建库至2021年2月。根据Cochrane风险偏倚评估工具对纳入文献进行质量评价。使用RevMan 5.3进行meta分析，并采用推荐、评估、发展和评价等级（grades of recommendation，assessment，development，and evaluation，GRADE）系统对VTE、深静脉血栓（deep venous thrombosis，DVT）、肺栓塞（pulmonary embolism，PE）的发生率和入组30 d死亡率的meta分析结果进行证据分级。结果共纳入8篇随机对照研究，5999例患者。meta分析结果显示，机械预防联合常规预防可降低卒中患者VTE的发生率（RR 0.73，95%CI 0.55～0.98，P =0.03）；间歇充气加压泵联合常规预防在DVT 的发生率上预防效果优于单纯常规预防（RR 0.53，95%CI 0.31～0.93，P =0.03），弹力袜对DVT的预防效果不明显；机械预防联合常规预防对卒中患者入组30 d死亡率和PE的发生率改善不明显。GRADE 评分显示，机械预防对VTE和间歇充气加压泵对DVT发生率的证据级别为低级，机械预防对PE发生率、机械预防对入组30 d死亡率、弹力袜对DVT的证据级别为中等。结论机械预防联合常规预防能降低卒中患者VTE发生率，但不能降低患者的PE发生率和入组 30 d死亡率。

文章导读： 本研究通过meta发现对于卒中患者，机械预防联合常规预防可更有效地预防VTE，但GRADE评价本研究结果的证据级别仅为低等和中等。

关键词: 静脉血栓栓塞; 卒中; 机械预防; 间歇充气加压泵; 弹力袜; 证据分级; 系统评价

Abstract: Objective To evaluate the effectiveness of mechanical prophylaxis for venous thromboembolism (VTE) in stroke patients. Methods The database including PubMed, Embase, the Cochrane Library, Web of Science, CINAHL, CNKI, Wanfang Data, CBM from inception to February 2021 were retrieved to search for the randomized controlled trials (RCTs) on mechanical prophylaxis for VTE such as intermittent pneumatic compression (IPC) and compression stocking in stroke patients. The quality of the literatures was evaluated using Cochrane Collaboration's tool for assessing the risk of bias. Metaanalysis was performed using RevMan 5.3. Finally, the GRADE system was used to grade the evidence quality of results of incidence of VTE, deep venous thromboembolism (DVT) and pulmonary embolism (PE) and 30-day mortality. Results A total of 8 RCTs involving 5999 patients were included. The meta-analysis results showed that mechanical prophylaxis combined with conventional prevention could effectively reduce the incidence of VTE in stroke patients (RR 0.73, 95%CI 0.55-0.98, P =0.03). The combination of IPC pump and conventional prevention was better than conventional prevention alone in reducing the incidence of DVT (RR 0.53, 95%CI 0.31-0.93, P =0.03), while the effect of compression stocking

for preventing DVT was not obvious. The mechanical prophylaxis did not significantly reduce the

incidence of 30-day mortality or PE in stroke patients. The GRADE system evaluation showed that the evidence level of mechanical prophylaxis for VTE and IPC for DVT were low, and the level of mechanical prophylaxis for PE and 30-day mortality and compression stocking for DVT were moderate. Conclusions Mechanical prophylaxis can reduce the incidence of VTE in stroke patients, while not reduce the incidence of PE and 30-day mortality.

Key words: Venous thromboembolism; Stroke; Mechanical prophylaxis; Intermittent pneumatic compression; Compression stocking; Classification of evidence; Systematic review

杨慕维, 刘高, 和意娴, 郭清源, 蔡恩丽. 机械预防对卒中患者静脉血栓栓塞预防效果的meta分析[J]. 中国卒中杂志, 2021, 16(11): 1115-1122.

YANG Mu-Wei, LIU Gao, HE Yi-Xian, GUO Qing-Yuan, CAI En-Li. Mechanical Prophylaxis for Venous Thromboembolism in Stroke Patients: A Meta-analysis[J]. Chinese Journal of Stroke, 2021, 16(11): 1115-1122.

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