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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 severe medical patients and provide an evidence base for clinical rational and effective use of pneumatic pump to prevent venous thromboembolism (VTE). METHODS: The literature about the randomized controlled trials of IPC in prevention of VTE in intensive care unit inpatients was collected by searching Chinese and foreign databases and the data were analyzed by using Rev Man5.3 software. Results: A total of 19 articles were included in the study. Meta-analysis showed that the incidence of deep venous thrombosis (DVT) in the IPC group was significantly lower than that in the control group (RR = 0.25, 95% CI = 0.15-0.41, (P = 0.000). The subgroup analysis showed that the incidence rate was significantly lower than that of the control group (RR = 0.17, 95% CI = 0.11-0.27) despite the large heterogeneity (I2 = 63%, P = , P = 0.000) (RR = 0.23, 95% CI = 0.16-0.33, P = 0.006), and there was no significant decrease in the incidence of pulmonary thromboembolism (RR = 0.66,95% CI = 0.43-1.02, P = 0.060). Compared with the control group, the incidence of VTE in IPC group was significantly lower (RR = 0.37, 95% CI = 0.17-0.79, P = 0.010), but there was a large heterogeneity (RR = 0.76, 95% CI = 0.66-0.88, P = 0.000), (RR = 0.15, 95% CI = 73%, P = 0.005). The differences of IPC intervention time % CI = 0.07 ~ 0.35, P = 0.000). Compared with the use of anticoagulants, IPC group had no significant difference in the prevention of DVT of lower extremities (RR = 2.47, 95% CI = 0.79-7.75, P = 0.120), but the risk of bleeding was significantly lower (RR = 0.45, 95% CI = 0.22-0.92, P = 0.030). Conclusion: IPC can effectively prevent DVT and total venous thrombosis in lower extremities of patients with medical critical illness. Compared with drug anticoagulation, IPC can effectively prevent the occurrence of DVT in lower extremities in addition to the risk of bleeding, Anticoagulation quite antithrombotic effect.