Pooled Analysis of Best Evidences of Prevention of Pulmonary Embolism in Patients with Ischemic Stroke

doi:10.3969/j.issn.1673-5765.2021.12.011

Abstract

Abstract: Objective To summarize the best evidences of prevention of pulmonary embolism in patients with ischemic stroke, and provide evidence-based reference for clinical nursing practice. Methods A total of 21 database and guideline websites including BMJ Practice, UpToDate, NICE, PubMed, Cochrane Library, CNKI and so on were retrieved for the papers involving prevention of pulmonary embolism in patients with ischemic stroke, including guidelines, clinical decisions, best practices, evidence reviews, systematic reviews, expert consensus and randomized controlled trials (RCTs). The publication time of the retrieved papers was from January 2010 to July 2021. AGREEⅡ, AMSTAR 2 and JBI evidence-based health care center literature quality evaluation criteria were used to evaluate the literatures, and the evidence grading system of JBI evidencebased health care center was used for the evidence grading and evidence recommendation. Results A total of 28 literatures were pooled, including 17 guidelines, 4 systematic reviews, 4 expert consensus, 2 RCTs, and 1 evidence summary. A total of 28 best evidences were summarized from 6 dimensions of admission assessment, health education, basic prevention, mechanical prevention, drug prevention, and disease monitoring. Conclusions The evidences for prevention of pulmonary embolism in patients with ischemic

stroke covered the whole process from admission evaluation to discharge health education. The

evidence generation process was scientific and highly targeted, which can provide reference for clinical nursing practice.

Key words: Pulmonary embolism; Ischemic stroke; Prevention; Evidence summary; Evidencebased medicine

摘要： 目的总结缺血性卒中患者预防肺栓塞的最新、最佳证据，为临床护理实践提供循证依据。方法计算机检索BMJ最佳实践（BMJ Best Practice）、UpToDate、英国国家卫生与临床优化指南库（National Institute for Health and Care Excellence，NICE）、PubMed、Cochrane Library和中国知网等21个数据库和指南网站关于预防缺血性卒中患者肺栓塞的指南、临床决策、最佳实践、证据总结、系统评价、专家共识和随机对照试验，检索文献的发表时间为2010年1月-2021年7月。采用临床指南研究与评价系统Ⅱ（appraisal of guidelines for research and evaluation Ⅱ，AGREE Ⅱ）、系统评价评估系统（assessment of multiple systematic reviews 2，AMSTAR 2）和澳大利亚Joanna Briggs循证卫生保健中心（Joanna Briggs Institute，JBI）文献质量评价标准对相应文献进行评价，并采用JBI的证据分级系统对纳入证据进行证据分级和证据推荐。结果共纳入28篇文献，其中指南17篇、系统评价4篇、专家共识4篇、随机对照试验2篇、证据总结1 篇。分别从入院评估、健康宣教、基本预防、机械预防、药物预防、病情监测6个维度总结了共计28条最佳证据。结论缺血性卒中患者预防肺栓塞的证据总结涵盖了自入院评估至出院宣教的全过程，证据生成过程科学，针对性强，可为临床护理实践提供一定参考。

关键词: 肺栓塞; 缺血性卒中; 预防; 证据总结; 循证医学

YANG Muwei, LIU Gao, HE Yixian, GUO Qingyuan, CAI Enli. Pooled Analysis of Best Evidences of Prevention of Pulmonary Embolism in Patients with Ischemic Stroke[J]. Chinese Journal of Stroke, 2021, 16(12): 1259-1267.

杨慕维, 刘高, 和意娴, 郭清源, 蔡恩丽. 缺血性卒中患者预防肺栓塞的最佳证据总结[J]. 中国卒中杂志, 2021, 16(12): 1259-1267.

References

[1] 王拥军，李子孝，谷鸿秋，等. 中国卒中报告2019（中
文版）（1）[J]. 中国卒中杂志，2020，15（10）：1037-
1043.
[2] PONGMORAGOT J，RABINSTEIN A A，
NILANONT Y，et al. Pulmonary embolism in
ischemic stroke：clinical presentation，risk factors，
and outcome[J/OL]. J Am Heart Assoc，2013，2
（6）：e000372[2021-08-01]. https：//doi.org/10.1161/
jaha.113.000372.
[3] SØGAARD K K，SCHMIDT M，PEDERSEN L，et
al. 30-year mortality after venous thromboembolism：
a population based cohort study[J]. Circulation，2014，
130（10）：829-836.
[4] AUJESKY D，OBROSKY D S，STONE R A，et al.
Derivation and validation of a prognostic model for
pulmonary embolism[J]. Am J Respir Crit Care Med，
2005，172（8）：1041-1046.
[5] SCHÜNEMANN H J，CUSHMAN M，BURNETT
A E，et al. American Society of Hematology
2018 guidelines for management of venous
thromboembolism：prophylaxis for hospitalized
and nonhospitalized medical patients[J]. Blood Adv，
2018，2（22）：3198-3225.
[6] 中华医学会神经病学分会，中华医学会神经病学分
会神经康复学组，中华医学会神经病学分会脑血管
病学组. 中国脑卒中早期康复治疗指南[J]. 中华神经

科杂志，2017，50（6）：405-412.

[7] NYQUIST P，BAUTISTA C，JICHICI D，et al.
Prophylaxis of venous thrombosis in neurocritical
care patients：an evidence-based guideline：a
statement for healthcare professionals from the
Neurocritical Care Society[J]. Neurocrit Care，2016，
24（1）：47-60.
[8] DENNIS M，CASO V，KAPPELLe L J，et al.
European Stroke Organisation（ESO）guidelines
for prophylaxis for venous thromboembolism in
immobile patients with acute ischaemic stroke[J].
Eur Stroke J，2016，1（1）：6-19.
[9] KONSTANTINIDES S V，MEYER G，BECATTINI
C，et al. 2019 ESC guidelines for the diagnosis
and management of acute pulmonary embolism
developed in collaboration with the European
Respiratory Society（ERS）[J]. Eur Heart J，2020，41
（4）：543-603.
[10] 中国健康促进基金会血栓与血管专项基金专家委员
会. 静脉血栓栓塞症机械预防中国专家共识[J]. 中华
医学杂志，2020，100（7）：484-492.
[11] 中国研究型医院学会心肺复苏专业委员会. 《中国心
肺复苏专家共识》之静脉血栓栓塞性CA指南[J]. 中
华危重病急救医学，2018，30（12）：1107-1116.
[12] 中国健康促进基金会血栓与血管专项基金专家委员
会，中华医学会呼吸病学分会肺栓塞与肺血管病学
组，中国医师协会呼吸医师分会肺栓塞与肺血管病
工作委员会. 医院内静脉血栓栓塞症防治与管理建议
[J]. 中华医学杂志，2018，98（18）：1383-1388.
[13] 内科住院患者静脉血栓栓塞症预防中国专家建议写
作组，中华医学会呼吸病学分会，中华医学会老年医
学分会，等. 内科住院患者静脉血栓栓塞症预防中国
专家建议（2015）[J]. 中华结核和呼吸杂志，2015，38
（7）：484-491.
[14] 朱政，胡雁，邢唯杰，等. 不同类型循证问题的构成
[J]. 护士进修杂志，2017，32（21）：1991-1994.
[15] DICENSO A，BAYLEY L，HAYNES R B.
Accessing pre-appraised evidence：fine-tuning the
5S model into a 6S model[J]. Evid Based Nurs，2009，
12（4）：99-101.
[16] BROUWERS M C，KHO M E，BROWMAN G P，et
al. AGREE Ⅱ：advancing guideline development，
reporting and evaluation in health care[J/OL]. CMAJ，
2010，182（18）：e839-e842[2021-08-01]. https：//doi.
org/10.1503/cmaj.090449.
[17] SHEA B J，REEVES B C，WELLS G，et al.
AMSTAR 2：a critical appraisal tool for systematic
reviews that include randomised or non-randomised
studies of healthcare interventions，or both[J/OL].
BMJ，2017，358：j4008[2021-08-01]. https：//doi.
org/10.1136/bmj.j4008.
[18] Joanna Briggs Institute. Joanna Briggs Institute
reviewers' manual：2016 edition[EB/OL]（2016-08-
20）[2021-08-01]. https：//jbi.global/sites/default/
files/2021-10/Checklist_for_Text_and_Opinion.docx.
[19] The Joanna Briggs Institute. Checklist for
randomized controlled trials[EB/OL]2019-06-
27）[2021-08-01]. https：//jbi.global/sites/default/
files/2021-10/Checklist_for_RCTs.docx.
[20] 王春青，胡雁. JBI证据预分级及证据推荐级别系统
（2014版）[J]. 护士进修杂志，2015，30（11）：964-
967.
[21] WEIN T，LINDSAY M P，GLADSTONE D J，et al.
Canadian Stroke Best Practice Recommendations：
acetylsalicylic acid for prevention of vascular
events[J/OL]. CMAJ，2020，192（12）：e302-e311
[2021-08-01]. https：//doi.org/10.1503/cmaj.191599.
[22] POWERS W J，RABINSTEIN A A，ACKERSON
T，et al. Guidelines for the early management of
patients with acute ischemic stroke：2019 update
to the 2018 guidelines for the early management of
acute ischemic stroke：a guideline for healthcare
professionals from the American Heart Association/
American Stroke Association[J/OL]. Stroke，2019，
50（12）：e344-e418[2021-08-01]. https：//doi.
org/10.1161/str.0000000000000211.
[23] National Guideline Centre（UK）. Venous
thromboembolism in over 16s：reducing the risk
of hospital-acquired deep vein thrombosis or
pulmonary embolism[EB/OL]（2018-05-21）[2021-
08-01]. https：//www.nice.org.uk/guidance/ng89.
[24] 《中国血栓性疾病防治指南》专家委员会. 中国血栓
性疾病防治指南[J]. 中华医学杂志，2018，98（36）：
2861-2888.
[25] 中华医学会神经病学分会，中华医学会神经病学分
会脑血管病学组. 中国急性缺血性脑卒中诊治指南
2018[J]. 中华神经科杂志，2018，51（9）：666-682.
[26] 中华医学会呼吸病学分会肺栓塞与肺血管病学组，
中国医师协会呼吸医师分会肺栓塞与肺血管病工作
委员会，全国肺栓塞与肺血管病防治协作组. 肺血栓
栓塞症诊治与预防指南[J]. 中华医学杂志，2018，98
（14）：1060-1087.
[27] LIEW N C，ALEMANY G V，ANGCHAISUKSIRI
P，et al. Asian venous thromboembolism guidelines：
updated recommendations for the prevention of
venous thromboembolism[J]. Int Angiol，2017，36
（1）：1-20.
[28] Scottish Intercollegiate Guidelines Network.
Prevention and management of venous
thromboembolism[FB/OL]（2010-11）[2021-08-01].
https：//www.sign.ac.uk/our-guidelines/preventionand-
management-of-venous-thromboembolism/.
[29] NICOLAIDES A N，FAREED J，KAKKAR
A K，et al. Prevention and treatment of venous
thromboembolism-international consensus
statement[J]. Int Angiol，2013，32（2）：111-260.
[30] KAHN S R，LIM W，DUNN A S，et al. Prevention
of VTE in nonsurgical patients：antithrombotic
therapy and prevention of thrombosis，9th ed：
American College of Chest physicians evidencebased
clinical practice guidelines[J/OL]. Chest，2012，
141（2）：e195S-e226S. https：//doi.org/10.1378/
chest.11-2296.
[31] LANSBERG M G，O'DONNELL M J，KHATRI
P，et al. Antithrombotic and thrombolytic therapy
for ischemic stroke：antithrombotic therapy and
prevention of thrombosis，9th ed：American
College of Chest physicians evidence-based clinical
practice guidelines[J/OL]. Chest，2012，141（2）：
e601S-e636S[2021-08-01]. https：//doi.org/10.1378/
chest.11-2302.
[32] QASEEM A，CHOU R，HUMPHREY L L，et
al. Venous thromboembolism prophylaxis in
hospitalized patients：a clinical practice guideline
from the American College of Physicians[J]. Ann
Intern，2011，155（9）：625-632.
[33] KAKKOS S K，CAPRINI J A，GEROULAKOS
G，et al. Combined intermittent pneumatic leg
compression and pharmacological prophylaxis
for prevention of venous thromboembolism[J/
OL]. Cochrane Database Syst Rev，2016，9
（9）：CD005258[2021-08-01]. https：//doi.
org/10.1002/14651858.cd005258.pub3.
[34] SANDERCOCK P A，COUNSELL C，KANE
E J. Anticoagulants for acute ischaemic
stroke[J/OL]. Cochrane Database Syst Rev，
2015，（3）：CD000024[2021-08-01]. https：//doi.
org/10.1002/14651858.cd000024.pub4.
[35] LEDERLE F A，ZYLLA D，MACDONALD R，
et al. Venous thromboembolism prophylaxis in
hospitalized medical patients and those with stroke：
a background review for an American College of
Physicians clinical practice guideline[J]. Ann Intern
Med，2011，155（9）：602-615.
[36] NACCARATO M，GRANDI F C，DENNIS M，
et al. Physical methods for preventing deep vein
thrombosis in stroke[J]. Cochrane Database Syst Rev，
2010，（8）：CD001922[2021-08-01]. https：//doi.
org/10.1002/14651858.cd001922.pub3.
[37] DENNIS M，SANDERCOCK P，GRAHAM C，et
al. The clots in legs or stockings after stroke（CLOTS）
3 trial：a randomised controlled trial to determine
whether or not intermittent pneumatic compression
reduces the risk of post-stroke deep vein thrombosis
and to estimate its cost-effectiveness[J]. Health
Technol Assess，2015，19（76）：1-90.
[38] DENNIS M，SANDERCOCK P，REID J，et al.
Effectiveness of intermittent pneumatic compression
in reduction of risk of deep vein thrombosis in
patients who have had a stroke（CLOTS 3）：a
multicentre randomised controlled trial[J]. The
Lancet，2013，382（9891）：516-524.
[39] MOOLA S. Venous thromboembolism：prevention in
patients post-stroke[EB/OL]（2021-03-25）[2021-08-
01]. https：//jbi.global/jbi-search?q=JBI-ES-1030-1.
[40] AVERT Trial Collaboration group. Efficacy and
safety of very early mobilisation within 24 h of
stroke onset（AVERT）：a randomised controlled
trial[J]. Lancet，2015，386（9988）：46-55.
[41] LIU Z L，TAO X X，CHEN Y X，et al. Bed
rest versus early ambulation with standard
anticoagulation in the management of deep vein
thrombosis：a meta-analysis[J/OL]. PLoS ONE，
2015，10（4）：e0121388[2021-08-01]. https：//doi.
org/10.1371/journal.pone.0121388.