间歇性充气加压装置预防静脉血栓栓塞症有效性和安全性评估的系统评价再评价

目的对涉及充气加压装置(PCD)在静脉血栓栓塞症(VTE)预防中的有效性和安全性的系统评价进行再评价。方法计算机检索Cochrane Library、PubMed、Embase、CNKI、中国生物医学文献数据库、万方数据库,检索时间从建库至2019年3月31日,检索PCD与其他物理预防措施、药物预防措施相比较的相关系统评价和Meta分析,由2名研究者独立进行文献筛选、资料提取和质量评价过程,采用AMSTAR工具对纳入的研究进行方法学质量评价,采用GRADE系统对结局指标进行质量评价。结果最终纳入15篇系统评价/Meta分析,包括8篇中文研究、7篇英文研究。其中11篇发表在2012年之后,方法学质量评价显示3篇研究满足AMSTAR的11个评价条目,其他研究均在不同方面存在缺陷。中等质量的证据显示,间歇性充气加压装置(IPC)预防VTE有效,联合药物预防可降低单独使用药物预防引起的出血等不良事件发生率。IPC用于VTE预防时,应按照目前的临床指南使用。目前指导选择特定设备或设备类型的证据基础是有限的。结论IPC在预防VTE过程中是安全有效的,但该结论的论证仍需大样本、高质量的研究进一步证实。

Overview of systematic reviews on effectiveness and safety assessment of intermittent pneumatic compression devices on preventing VTE

Objective To carry out the overview of systematic reviews on effectiveness and safety assessment of pneumatic compression devices(PCD)on preventing venous thromboembolism(VTE).Methods Systematic reviews or Meta-analysis comparing PCD with other physical prophylaxis and drug prophylaxis were retrieved by computer in the Cochrane Library,PubMed,Embase,China National Knowledge Internet(CNKI),China Biological Medicine,WanFang data from building the database to 31st March 2019.Two researchers independently implemented the literature screening,data extraction and quality evaluation.The Assessment of Multiple Systematic Reviews(AMSTAR)tool was used to quality assessment of methodology for included literatures.The Grading of Recommendations Assessment,Development and Evaluation(GRADE)system was used to quality evaluation for outcome indexes.Results Totals of 15 systematic reviews or Metaanalysis were included with 8 in Chinese and 7 in English.There were 11 literatures published after 2012.Quality assessment of methodology showed that 3 literatures met 11 items of AMSTAR,and other researches had the defect existed in different aspects.Evidences with the medium quality displayed the effectiveness of intermittent pneumatic compression devices in VTE prevention which could reduce the incidence of adverse events caused by separate drug prophylaxis,such as bleeding,through combining with drug prophylaxis.Application of intermittent pneumatic compression devices for VTE prevention should be based on clinical guidelines.At present,there was limited evidence guiding selection of specific device and device type.Conclusions Intermittent pneumatic compression devices are safe and effective in VTE prevention which still needs to be demonstrated by researches with the large sample and high of quality.