Wells P S, Lensing A W, Hirsh J
Hamilton (Ontario) Civic Hospitals Research Centre.
Arch Intern Med. 1994 Jan 10;154(1):67-72.
The effectiveness of graduated compression stockings in prophylaxis of postoperative venous thromboembolism is unclear to many physicians. Surveys show there is considerable variability in their use and their perceived effectiveness. We undertook to establish, by a systematic overview of the literature, the effectiveness of graduated compression stockings in the prophylactic setting of postoperative venous thromboembolism.
Studies published between 1966 and June 1992 were identified through the MEDLINE database, with a search in all languages, through reviews of Current Contents, and including references cited in identified articles. Articles were selected for initial analysis if they assessed the use of graduated compression stockings for the prophylaxis of venous thromboembolism, and if the stocking group was compared with an untreated or unconfounded control group. Criteria were established a priori, to select only studies with sound methods. On the basis of these criteria, 12 studies were identified for the combined analysis. Each eligible study was independently analyzed for the risk of development of deep venous thrombosis in the control and stocking groups, and this was expressed as an odds ratio. Odds ratios were combined across studies by means of the Mantel-Haenszel chi 2 procedure. The data were analyzed separately for orthopedic surgery because of its high risk for venous thromboembolism.
Eleven of the 12 studies were in moderate-risk surgery (abdominal, gynecologic, and neurosurgery); the summary odds ratio was 0.28, which translates into a risk reduction of 68% (95% confidence interval, 53% to 73%), which is statistically significant (P < .0001). In the one study in orthopedic surgery that was eligible for inclusion, the odds ratio was 0.50 (95% confidence interval, 0.19 to 1.29; P = .17).
The use of graduated compression stockings for prophylaxis of venous thromboembolism after moderate-risk surgery results in a significant risk reduction. It is unknown whether the use of graduated compression stockings in combination with other forms of prophylaxis results in further risk reduction. The efficacy of graduated compression stockings in orthopedic surgery has been assessed by only one study that used sound methods, hence no definitive conclusions can be made in these high-risk patients.
许多医生并不清楚分级压力弹力袜在预防术后静脉血栓栓塞方面的有效性。调查显示，其使用情况和人们所认为的有效性存在很大差异。我们试图通过对文献进行系统综述，来确定分级压力弹力袜在预防术后静脉血栓栓塞方面的有效性。
通过MEDLINE数据库检索1966年至1992年6月发表的研究，检索所有语言的文献，并查阅《现刊目次》，同时纳入已识别文章中引用的参考文献。如果文章评估了分级压力弹力袜用于预防静脉血栓栓塞的情况，并且将使用弹力袜的组与未治疗或无混杂因素的对照组进行比较，则选择这些文章进行初步分析。事先制定了标准，只选择方法可靠的研究。根据这些标准，确定了12项研究进行综合分析。对每项符合条件的研究独立分析对照组和使用弹力袜组发生深静脉血栓形成的风险，并将其表示为比值比。通过Mantel-Haenszel卡方检验对各研究的比值比进行合并。由于骨科手术发生静脉血栓栓塞的风险较高，因此对骨科手术的数据进行了单独分析。
12项研究中有11项属于中度风险手术（腹部、妇科和神经外科手术）；汇总比值比为0.28，这意味着风险降低了68%（95%置信区间为53%至73%），具有统计学意义（P <.0001）。在一项符合纳入标准的骨科手术研究中，比值比为0.50（95%置信区间为0.19至1.29；P = 0.17）。
在中度风险手术后使用分级压力弹力袜预防静脉血栓栓塞可显著降低风险。尚不清楚分级压力弹力袜与其他预防形式联合使用是否能进一步降低风险。仅一项方法可靠的研究评估了分级压力弹力袜在骨科手术中的疗效，因此对于这些高风险患者无法得出明确结论。
