桃红四物汤预防全髋关节置换术后深静脉血栓的临床疗效Meta分析
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摘要
目的:系统评价桃红四物汤预防全髋关节置换术后深静脉血栓形成的临床疗效。方法:检索中国生物医学文献、中国知网、万方、维普、Pubmed、Embase、Cochrane Library等数据库,纳入桃红四物汤预防全髋关节置换术后DVT的随机对照试验,纳入研究质量评估采用Cochrane风险偏移评估工具,并使用Revman5.3软件对DVT发生率、伤口引流量和D-二聚体进行Meta分析。结果:共纳入6项研究,包括412例患者。Meta分析发现:在预防THR术后DVT发生率方面,桃红四物汤组与低分子肝素[RR=0.91,95%CI(0.41,1.99),P=0.81]或者利伐沙班组[RR=0.84,95%CI(0.20,3.55),P=0.81]的效应比较,差异均无统计学意义;桃红四物汤联合利伐沙班可明显降低DVT的发生率[RR=0.15,95%CI(0.04,0.55),P=0.004]。结论:桃红四物汤预防THR术后DVT发生的疗效与常规抗凝药物相近,而联合常规抗凝药物应用可以增加疗效。
Objective: To systematically evaluate the effectiveness of Taohong Siwu decoction(桃红四物汤,THSWD) for the prevention of DVT after total hip replacement(THR). Methods: We retrieved Pub Med, EMBASE, Cochrane Library, CNKI, VIP, Wanfang and Chinese Biomedical Literature Database. Randomized clinical trials about the prevention of DVT caused by THR for which THSWD was used either as a monotherapy or in combination with conventional therapy compared to conventional therapy, were included. The risk of bias was evaluated using the Cochrane Collaboration tool. Rev Man 5.3 software was used to statistically analyze the data included the incidence rates of DVT, the amount of drainage and D-Dimer. Results: Six studies with 412 participants were identified. Meta-analysis results displayed that the relative risk in the incidence rates of DVT did not significantly differ between THSWD group and low molecular heparin [RR=0.91, 95%CI(0.41-1.99), P=0.81]or rivaroxaban [RR=0.84, 95% CI(0.20-3.55), P=0.81]. However, THSWD combined with rivaroxaban had a more significant effect in reducing the incidence rates of DVT [RR=0.15, 95% CI(0.04-0.55), P=0.004]. Conclusion:The effect of THSWD on preventing the occurrence of DVT after THR is similar to that of conventional anticoagulant drugs, while the combination of conventional anticoagulant drugs can increase the effect.
Objective: To systematically evaluate the effectiveness of Taohong Siwu decoction(桃红四物汤,THSWD) for the prevention of DVT after total hip replacement(THR). Methods: We retrieved Pub Med, EMBASE, Cochrane Library, CNKI, VIP, Wanfang and Chinese Biomedical Literature Database. Randomized clinical trials about the prevention of DVT caused by THR for which THSWD was used either as a monotherapy or in combination with conventional therapy compared to conventional therapy, were included. The risk of bias was evaluated using the Cochrane Collaboration tool. Rev Man 5.3 software was used to statistically analyze the data included the incidence rates of DVT, the amount of drainage and D-Dimer. Results: Six studies with 412 participants were identified. Meta-analysis results displayed that the relative risk in the incidence rates of DVT did not significantly differ between THSWD group and low molecular heparin [RR=0.91, 95%CI(0.41-1.99), P=0.81]or rivaroxaban [RR=0.84, 95% CI(0.20-3.55), P=0.81]. However, THSWD combined with rivaroxaban had a more significant effect in reducing the incidence rates of DVT [RR=0.15, 95% CI(0.04-0.55), P=0.004]. Conclusion:The effect of THSWD on preventing the occurrence of DVT after THR is similar to that of conventional anticoagulant drugs, while the combination of conventional anticoagulant drugs can increase the effect.
引文
[1]中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南[J].中华骨科杂志,2016,36(2):65-71.
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[7]冯仁优,罗洪波,刘智明.桃红四物汤预防全髋关节置换术后深静脉血栓形成26例临床观察[J].云南中医中药杂志,2011,32(7):50.
[8]叶家炼,吴淼金,吕杏伟.桃红四物汤预防全髋关节置换术后并发下肢深静脉血栓形成的有效性及安全性[J].中国中医药现代远程教育,2016,14(8):92-93.
[9]印丽莉,刘志军,丁青.加味桃红四物汤预防股骨颈骨折全髋关节置换术后深静脉血栓形成的临床研究[J].中医正骨,2011,23(11):24-25,28.
[10]展宝明,陈达,张庆文.桃红四物汤预防全髋关节置换术后下肢深静脉血栓形成的临床研究[J].中医正骨,2014,26(9):25-28.
[11]史晓利.下肢深静脉血栓形成并发肺栓塞相关危险因素分析[J].河南医学研究,2014,23(7):85-86.
[12]吴芸,陈志鹏,蔡宝昌.桃红四物汤化学成分及药理作用的研究进展[J].中成药,2011,33(11):1965-1968.
[13]张海龙,黄素萍,王绍辉,等.加味桃红四物汤口服减少全髋关节置换术后低分子肝素钙用量临床分析[J].亚太传统医药,2017,13(1):146-148.
[2]刘攀,卢冰,王跃,等.骨创伤后深静脉血栓形成的相关危险因素分析[J].现代生物医学进展,2014,14(32):6332-6335.
[3]Liberati A,Altman D G,Tetzlaff J,et al.The PRISMA statement for reporting systematic reviews and metaanalyses of studies that evaluate health care interventions:explanation and elaboration[J].Ann Intern Med,2009,151(4):W65-W94.
[4]Higgins,Green.Cochrane Handbook for Systematic Reviews of Interventions Version 5.3[Z].The Cochrane Collaboration,2011.
[5]牟行健.桃红四物汤合利伐沙班预防髋关节置换术后下肢DVT的临床研究[D].沈阳:辽宁中医药大学,2014.
[6]阎亮.桃红四物汤对THR术后血液高凝状态的影响及DVT预防的实验和临床研究[D].广州:广州中医药大学,2011.
[7]冯仁优,罗洪波,刘智明.桃红四物汤预防全髋关节置换术后深静脉血栓形成26例临床观察[J].云南中医中药杂志,2011,32(7):50.
[8]叶家炼,吴淼金,吕杏伟.桃红四物汤预防全髋关节置换术后并发下肢深静脉血栓形成的有效性及安全性[J].中国中医药现代远程教育,2016,14(8):92-93.
[9]印丽莉,刘志军,丁青.加味桃红四物汤预防股骨颈骨折全髋关节置换术后深静脉血栓形成的临床研究[J].中医正骨,2011,23(11):24-25,28.
[10]展宝明,陈达,张庆文.桃红四物汤预防全髋关节置换术后下肢深静脉血栓形成的临床研究[J].中医正骨,2014,26(9):25-28.
[11]史晓利.下肢深静脉血栓形成并发肺栓塞相关危险因素分析[J].河南医学研究,2014,23(7):85-86.
[12]吴芸,陈志鹏,蔡宝昌.桃红四物汤化学成分及药理作用的研究进展[J].中成药,2011,33(11):1965-1968.
[13]张海龙,黄素萍,王绍辉,等.加味桃红四物汤口服减少全髋关节置换术后低分子肝素钙用量临床分析[J].亚太传统医药,2017,13(1):146-148.