本文關(guān)鍵詞：間歇充氣加壓泵對(duì)預(yù)防內(nèi)科危重癥患者VTE效果及安全的系統(tǒng)評(píng)價(jià)　出處：《重慶醫(yī)科大學(xué)學(xué)報(bào)》2016年09期 　論文類型：期刊論文

  更多相關(guān)文章： 間歇充氣壓力泵 靜脈血栓栓塞癥 內(nèi)科重癥患者 Meta分析

【摘要】：目的:探索利用間歇充氣壓力泵(intermittent pneumatic compression,IPC)預(yù)防重癥內(nèi)科患者的有效性及安全性,為臨床合理有效利用氣壓泵預(yù)防靜脈血栓栓塞癥(venous thromboembolism,VTE)提供循證依據(jù)。方法:通過(guò)檢索中外文數(shù)據(jù)庫(kù)收集關(guān)于研究IPC預(yù)防重癥內(nèi)科住院患者VTE的隨機(jī)對(duì)照試驗(yàn)的文獻(xiàn),運(yùn)用Rev Man5.3軟件進(jìn)行統(tǒng)計(jì)處理。結(jié)果:納入文獻(xiàn)19篇,Meta分析顯示,與對(duì)照組相比較,IPC組在預(yù)防下肢深靜脈血栓(deep venous thrombosis,DVT)的發(fā)生率明顯降低(RR=0.25,95%CI=0.15~0.41,P=0.000),盡管存在較大的異質(zhì)性(I2=63%,P=0.000),但其亞組分析顯示其發(fā)生率明顯低于對(duì)照組(RR=0.17,95%CI=0.11~0.27,P=0.000)、(RR=0.23,95%CI=0.16~0.33,P=0.006),在肺血栓栓塞的發(fā)生率方面并沒(méi)有明顯降低(RR=0.66,95%CI=0.43~1.02,P=0.060);在與使用對(duì)照組的比較中,IPC組在預(yù)防VTE發(fā)生率也明顯降低(RR=0.37,95%CI=0.17~0.79,P=0.010),但存在較大的異質(zhì)性(I2=73%,P=0.005),按IPC干預(yù)時(shí)間的不同進(jìn)行亞組分析能消除其異質(zhì)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)。與使用抗凝劑比較,IPC組在預(yù)防下肢DVT發(fā)生并無(wú)統(tǒng)計(jì)學(xué)差異(RR=2.47,95%CI=0.79~7.75,P=0.120),但出血的風(fēng)險(xiǎn)明顯降低(RR=0.45,95%CI=0.22~0.92,P=0.030)。結(jié)論:IPC能夠有效地預(yù)防內(nèi)科危重癥患者下肢DVT和總的靜脈血栓事件的發(fā)生;與藥物抗凝相比,IPC除了能有效規(guī)避出血風(fēng)險(xiǎn)以外,還可以有效地預(yù)防下肢DVT的發(fā)生產(chǎn)生與藥物抗凝相當(dāng)?shù)目顾ㄐЧ?br/>[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.

【作者單位】： 重慶醫(yī)科大學(xué)附屬第一醫(yī)院呼吸內(nèi)科;
【分類號(hào)】：R459.7
【正文快照】： 靜脈血栓栓塞癥(venous thromboembolism,VTE)包括肺栓塞(pulmonary embolism,PE)和深靜脈血栓形成(deep venous thrombosis,DVT),作為住院患者一種潛在的嚴(yán)重并發(fā)癥,它的預(yù)防已經(jīng)成為醫(yī)師對(duì)住院患者疾病管理中不容忽視的部分。盡管在外科手術(shù)病人中血栓預(yù)防的重要性早已為醫(yī)

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