全膝关节置换术后静脉血栓栓塞症危险因素的Meta分析

目的通过Meta分析总结全膝关节置换术后静脉血栓栓塞症的危险因素，为临床识别和预防全膝关节置换术后静脉血栓栓塞症提供循证医学的根据。 方法检索PUBMED、EMBASE、Cochrane library、中国知网(CKNI)等数据库建库至2018年6月关于全膝关节置换术后发生静脉血栓栓塞症的临床研究。排除研究对象为非成人的文献及结局指标与静脉血栓不相关的文献。由2位研究者独立进行资料提取和质量评估，采用RevMan 5.3软件进行Meta分析。 结果最终共纳入23篇文献，累计病例775 294例，其中10 325例静脉血栓，平均发生率(18.29±0.23)%。Meta分析结果显示，年龄≥ 70岁OR ＝0.92，95%CI(0.87，0.97)，I² ＝33%，P ＝0.0030]、年龄≥ 80岁OR ＝0.85，95%CI(0.76，0.96)，I² ＝68%，P ＝0.0090]、术中止血带的使用OR＝2.14，95%CI(1.36，3.38)，I² ＝0%，P ＝0.0010]是全膝关节置换术后发生静脉血栓栓塞症的危险因素，差异有统计学意义(P < 0.05)。女性OR ＝0.95，95%CI(0.85，1.05)，I² ＝59%，P ＝0.32]、尼格罗人种OR＝0.40, 95%CI(0.11，1.48)，I²＝99%, P＝0.1700]、高血压OR＝1.46，95%CI(0.87，2.45)，I² ＝91%，P ＝0.1500]、糖尿病OR ＝1.11，95%CI(0.90，1.37)，I² ＝68%，P ＝0.3300]、类风湿性关节炎OR ＝0.78，95%CI(0.38，1.56)，I² ＝89%，P ＝0.4800]、翻修OR ＝1.14，95%CI(0.18，7.25)，I² ＝88%，P ＝0.8900]、下肢静脉曲张OR ＝1.30，95%CI(0.83，2.04)，I² ＝29%，P ＝0.2500]、肿瘤OR ＝1.11，95%CI(0.32，3.92)，I² ＝91%，P ＝0.8700]、心脏疾病OR ＝1.19，95%CI(0.37，2.89)，I² ＝98%，P ＝0.9600]、肝肾疾病OR ＝1.19，95%CI(0.84，1.67)，I² ＝0%，P ＝0.3200]不是全膝关节置换术后发生静脉血栓栓塞症的危险因素，差异无统计学意义(P > 0.05)。 结论年龄≥ 70岁、年龄≥ 80岁、术中止血带的使用是全膝关节置换术后发生静脉血栓栓塞症的高危险因素，临床医护人员应更加关注以上相关危险因素，以预防全膝关节置换术后静脉血栓栓塞症的发生。

Meta-analysis on risk factors for venous thromboembolism after total knee arthroplasty

ObjectiveTo systematically analyze the risk factors associated with venous thromboembolism(VTE) after total knee arthroplasty(TKA) and to provide evidence for prevention of VTE after TKA through meta-analysis. MethodsPotential clinical studies were identified by searching PUBMED, EMBASE, Cochrane library, China National Knowledge Infrastructure (CNKI) and other databases from the start time of the data bases to June 2018. The literatures which were irrelevant to adult, and the literatures in those without general population of VTE and non-VTE groups, were all excluded. Two authors independently extracted data and assessed the methodological quality. RevMan analyses(RevMan 5.3.5)were used to analyze the data. ResultsTwenty-three studies were finally selected. The total number of patients included in this review were 775 294, whereas 10 325 patients developed VTE after TKA. The averaged VTE rate was (18.29±0.23)%. Factors found to be associated with VTE after TKA included age≥70OR=0.92, 95%CI(0.87, 0.97), I²=33%, P<0.05], age≥80OR=0.85, 95%CI(0.76, 0.96), I²=68%, P<0.05], and the use of tourniquet during the surgeryOR=2.14, 95%CI(1.36, 3.38), I²=0%, P<0.05]. No significant association was found in femaleOR=0.95, 95%CI(0.85, 1.05), I²=59%, P>0.05], NegroidsOR=0.40, 95%CI(0.11, 1.48), I²=99%, P>0.05], hypertensionOR=1.46, 95%CI(0.87, 2.45), I²=91%, P>0.05], diabetesOR=1.11, 95%CI(0.90, 1.37), I²=68%, P>0.05], rheumatoid arthritisOR=0.78, 95%CI(0.38, 1.56), I²=89%, P>0.05], revision TKAOR=1.14, 95%CI(0.18, 7.25), I²=88%, P>0.05], varicose veins in lower extremitiesOR=1.30, 95%CI(0.83, 2.04), I²=29%, P>0.05], tumorsOR=1.11, 95%CI(0.32, 3.92), I²=91%, P>0.05], heart diseaseOR=1.19, 95%CI(0.37, 2.89), I²=98%, P>0.05], and liver and kidney diseaseOR=1.19, 95%CI(0.84, 1.67), I²=0%, P>0.05]. ConclusionIn this review, risk factors associated with VTE after TKA include age≥70 and 80 years, the use of tourniquet during the surgery; surgeons should be pay close attention to the patients involved with the these factors to prevent VTE after TKA.