住院患者下床活动预防静脉血栓栓塞的有效性：一项系统评价
Effectiveness of ambulation to prevent venous thromboembolism in patients admitted to hospital: a systematic review.
作者信息
Lau Brandyn D, Murphy Patrick, Nastasi Anthony J, Seal Stella, Kraus Peggy S, Hobson Deborah B, Shaffer Dauryne L, Holzmueller Christine G, Aboagye Jonathan K, Streiff Michael B, Haut Elliott R
机构信息
Russell H. Morgan Department of Radiology and Radiological Science (Lau), Johns Hopkins University School of Medicine; Armstrong Institute for Patient Safety and Quality (Lau, Holzmueller, Streiff), Johns Hopkins Medicine, Baltimore, Md.; Department of Surgery (Murphy), Indiana University, Indianapolis, Ind.; Division of Acute Care Surgery, Medical College of Wisconsin, Wauwatosa, Wis.; London Health Sciences Centre, London, Ont. and Department of Surgery, Indiana University, (Murphy; during the conduct of the study); School of Medicine (Nastasi), Stanford University, Li Ka Shing Building, Stanford, Calif.; Welch Medical Library (Seal), Johns Hopkins University School of Medicine; Department of Pharmacy (Kraus), Johns Hopkins Hospital; Division of Acute Care Surgery (Hobson, Aboagye, Haut), Department of Surgery, School of Medicine, Johns Hopkins University; Department of Nursing (Hobson), Johns Hopkins Hospital; Department of Nursing (Shaffer), Johns Hopkins Hospital; Division of Hematology (Streiff), Department of Medicine, Johns Hopkins University School of Medicine; Department of Health Policy and Management (Haut), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
出版信息
CMAJ Open. 2020 Dec 8;8(4):E832-E843. doi: 10.9778/cmajo.20200003. Print 2020 Oct-Dec.
BACKGROUND
Patient ambulation is frequently recommended to help prevent venous thromboembolism during hospital admission. Our objective was to synthesize the evidence for ambulation as a prophylaxis for venous thromboembolism in hospital.
METHODS
We conducted a systematic review. We searched MEDLINE, Embase, Scopus, Web of Science and Cochrane Central Register of Controlled Trials indexed from their inception through April 2020 for studies of adult patients admitted to hospital, in which ambulation or mobilization alone or concomitant with prophylaxis was indicated for prevention of venous thromboembolism. We searched ClinicalTrials.gov for unpublished trials. We included randomized controlled trials (RCTs) and observational studies. Two reviewers independently screened articles and assessed risk of bias using 2 validated tools. We scored studies on quality of reporting, internal and external validity and study power; combined scores determined the overall quality.
RESULTS
Eighteen articles met the inclusion criteria: 8 retrospective and 2 prospective cohorts, 7 RCTs and 1 secondary analysis of an RCT. The intervention (ambulation or mobilized) groups varied across studies. Five studies examined exercise as a therapeutic prophylaxis for thrombosis and 9 described an ambulation protocol. Five studies attempted to quantify amount and duration of patient ambulation and 3 reported ambulation distance. In the 5 studies rated as good or excellent statistical quality, findings were mixed. Incidence of venous thromboembolism was lowest when pharmacologic anticoagulants were added as part of the prescribed prophylaxis regimen.
INTERPRETATION
We did not find high-quality evidence supporting ambulation alone as an effective prophylaxis for venous thromboembolism. Ambulation should not be considered an adequate prophylaxis for venous thromboembolism, nor as an adequate reason to discontinue pharmacologic prophylaxis for venous thromboembolism during a patient's hospital admission.
背景
经常建议患者进行活动，以帮助预防住院期间的静脉血栓栓塞。我们的目的是综合有关活动作为住院患者静脉血栓栓塞预防措施的证据。
方法
我们进行了一项系统评价。我们检索了MEDLINE、Embase、Scopus、Web of Science和Cochrane对照试验中央注册库，检索时间从各数据库创建至2020年4月，以查找有关成年住院患者的研究，这些研究表明单独进行活动或动员或与预防措施同时进行可预防静脉血栓栓塞。我们在ClinicalTrials.gov上搜索未发表的试验。我们纳入了随机对照试验（RCT）和观察性研究。两名评审员独立筛选文章，并使用2种经过验证的工具评估偏倚风险。我们对研究的报告质量、内部和外部效度以及研究效能进行评分；综合评分决定总体质量。
结果
18篇文章符合纳入标准：8篇回顾性队列研究、2篇前瞻性队列研究、7篇RCT和1篇RCT的二次分析。各研究中的干预（活动或动员）组各不相同。5项研究将运动作为血栓形成的治疗性预防措施进行了研究，9项研究描述了活动方案。5项研究试图量化患者活动的量和持续时间，3项研究报告了活动距离。在5项统计质量评为良好或优秀的研究中，结果不一。当将药物抗凝剂作为规定预防方案的一部分添加时，静脉血栓栓塞的发生率最低。
解读
我们未找到高质量证据支持单独进行活动可有效预防静脉血栓栓塞。活动不应被视为预防静脉血栓栓塞的充分措施，也不应被视为在患者住院期间停止静脉血栓栓塞药物预防的充分理由。
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