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

发布时间：2018-01-03 13:36

本文关键词：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　出处：《重庆医科大学学报》2016年09期 　论文类型：期刊论文

【摘要】：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。
[Abstract]:Objective: To explore the use of intermittent pneumatic pressure pump (intermittent pneumatic, compression, IPC) to prevent the effectiveness and safety of patients with severe medicine, reasonable and effective use of pneumatic pump for clinical prevention of venous thromboembolism (venous thromboembolism VTE) provides evidence-based basis. Methods: by collecting the literatures on IPC prevention of a randomized controlled trial in patients with VTE hospitalized severe medical retrieval database, statistical processing using Rev Man5.3 software. Results: 19 studies, Meta analysis showed that, compared with the control group, IPC group in the prevention of deep vein thrombosis (deep venous, thrombosis, DVT) was significantly decreased (RR=0.25,95%CI=0.15~0.41, P=0.000), although there is heterogeneity the larger (I2=63%, P=0.000), but the subgroup analysis showed that the incidence rate was significantly lower than the control group (RR=0.17,95%CI=0.11~ 0.27, P=0.000 (RR=0.23,95%CI=0.16~0.3). 3, P=0.006), the incidence of pulmonary embolism is not significantly reduced (RR=0.66,95%CI=0.43~1.02, P=0.060); and in the use of a control group comparison, IPC group in the prevention of the incidence of VTE was significantly reduced (RR=0.37,95%CI=0.17~0.79, P=0.010), but there is considerable heterogeneity (I2=73%, P=0.005), according to the intervention time of IPC different subgroup analysis can eliminate the heterogeneity (RR=0.76,95%CI=0.66~0.88, P=0.000), (RR=0.15,95%CI=0.07~0.35, P=0.000). Compared with the use of anticoagulants, IPC group had no significant difference in the prevention of lower extremity DVT (RR=2.47,95%CI=0.79~7.75, P=0.120), but significantly reduced the risk of bleeding (RR=0.45,95%CI=0.22~0.92, P=0.030). Conclusion: IPC can effectively prevent thrombosis critically ill patients with lower extremity venous events DVT and total occurrence; compared with anticoagulant, IPC can effectively avoid the risk of bleeding, but also can effectively pre The antithrombotic effect of the anti DVT of the lower extremities is equivalent to that of the anticoagulant drug.

【作者单位】：重庆医科大学附属第一医院呼吸内科;
【分类号】：R459.7
【正文快照】： 静脉血栓栓塞症(venous thromboembolism,VTE)包括肺栓塞(pulmonary embolism,PE)和深静脉血栓形成(deep venous thrombosis,DVT),作为住院患者一种潜在的严重并发症,它的预防已经成为医师对住院患者疾病管理中不容忽视的部分。尽管在外科手术病人中血栓预防的重要性早已为医

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