预警预防医院获得性静脉血栓栓塞症有效性和安全性的Meta分析

目的系统评价预警预防医院获得性静脉血栓栓塞症(HAT)的有效性和安全性。方法计算机检索PubMed、Embase、Web of Science、CINAHL、Cochrane Central Register of Controlled Trials、中国生物医学文献数据库、CNKI、万方数据库,系统检索国内外关于预警预防HAT的RCT,检索时限为建库至2020年6月1日。2名研究者按文献纳入和排除标准独立筛选文献、提取数据并评价研究的偏倚风险;采用RevMan 5.3软件对HAT发生率、肺血栓栓塞(PTE)发生率、DVT发生率、出血发生率及HAT预防率进行Meta分析。结果最终纳入8篇文献。Meta分析结果显示,预警组PTE发生率(RR=0.69,95%CI 0.53~0.91,P=0.009)和HAT预防率(RR=1.45,95%CI 1.14~1.84,P<0.001)与非预警组比较,差异均有统计学意义;但两组在HAT发生率(RR=0.89,95%CI 0.68~1.16,P=0.380)、DVT发生率(RR=0.99,95%CI 0.76~1.29,P=0.970)和出血发生率(RR=0.95,95%CI 0.81~1.11,P=0.500)方面比较,差异均无统计学意义。HAT预防界定为恰当预防的亚组,两组患者的HAT预防率比较差异无统计学意义(RR=1.01,95%CI 0.95~1.07,P=0.810);而未详细描述预防是否恰当的亚组,预警组患者的HAT预防率高于非预警组,差异有统计学意义(RR=2.28,95%CI 2.09~2.49,P<0.001)。结论预警可以通过提高HAT预防率降低PTE发生率,且不增加出血发生率,但对HAT和DVT的发生率无明显影响。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Meta-analysis of effectiveness and safety of early warning and prevention of hospital-acquired venous thromboembolism

Objectives To systematically evaluate effectiveness and safety of early warning and prevention of hospital-acquired venous thromboembolism(HAT).Methods Computers were used to search PubMed,Embase,Web of Science,CINAHL,Cochrane Central Register of Controlled Trials,China Biology Medicine disc,CNKI and Wanfang Database.RCTs of early warning and prevention HAT at home and abroad was searched systematically and the retrieval time was from the establishment of databases to June 1,2020.Two researchers independently screened the literature according to the literature inclusion and exclusion criteria,extracted data and evaluated the risk of bias in the study.RevMan 5.3 software was used to conduct Metaanalysis of the incidences of HAT,pulmonary thromboembolism(PTE),deep vein thrombosis(DVT),bleeding and prevention rate of HAT.Results A total of 8 articles were included.Results of Meta-analysis showed that the incidence of PTE in the early-warning group(RR=0.69,95%CI 0.53-0.91,P=0.009)and the prevention rate of HAT(RR=1.45,95%CI 1.14-1.84,P<0.001)were statistically significantly different from those in the non-warning group.However,the incidences of HAT(RR=0.89,95%CI 0.68-1.16,P=0.380),DVT(RR=0.99,95%CI 0.76-1.29,P=0.970)and bleeding(RR=0.95,95%CI 0.81-1.11,P=0.500)had no statistically significant difference between the two groups.HAT prevention was defined as a subgroup of appropriate prevention.There was no statistically significant difference in the HAT prevention rate of patients between the two groups(RR=1.01,95%CI 0.95-1.07,P=0.810).In the subgroup that did not describe in detail whether prevention was appropriate,the HAT prevention rate in the early-warning group was higher than that in the non-early warning group,and the difference was statistically significant(RR=2.28,95%CI 2.09-2.49,P<0.001).Conclusions Early warning can reduce the incidence of PTE by increasing the prevention rate of HAT without increasing the incidence of bleeding,but it has no significant effect on the incidences of HAT and DVT.Limited by the quantity and quality of the included studies,the above conclusions need to be verified by more high-quality studies.