| 刘文俊,胡海燕,刘亚孔,刘 扬,杨 简.脊柱手术后静脉血栓发生率的Meta分析[J].中国脊柱脊髓杂志,2017,(10):913-923. |
| 脊柱手术后静脉血栓发生率的Meta分析 |
| 中文关键词: 脊柱手术 静脉血栓 Meta分析 |
| 中文摘要: |
| 【摘要】 目的：利用Meta分析的方法评价脊柱手术后发生静脉血栓的相关影响因素。方法：计算机检索2017年7月31日以前PubMed、Web of Science、EMBASE、the Cochrane Library等英文数据库和万方、知网、维普等中文数据库中关于脊柱手术后静脉血栓自然发生率的相关研究，采用NOS量表对纳入的研究进行质量评价，提取年龄、性别、体重指数（BMI）、手术方式与部位、手术时间、出血量、高血压、糖尿病、心脏病、D-二聚体水平、术前行走障碍等病史信息，将这些信息通过Review Manager 5.3软件进行Meta分析。结果：共纳入22篇文献，包含2841542例脊柱术后患者，其中发生静脉血栓者7557例，纳入文献的NOS评分在5~8分。Meta分析结果示，脊柱手术后静脉血栓发生者年龄[WMD=6.05，95%CI（3.62，8.48），P＜0.0001]、失血量[SMD=2.22，95%CI（1.03，3.41），P=0.0003]、手术时间[WMD=59.60，95%CI（10.27，108.93），P=0.02]均高于非静脉血栓者；男性患者术后静脉血栓发生率低于女性患者[OR=0.59，95%CI（0.38，0.94），P=0.03]；手术方式中脊柱融合术患者术后静脉血栓发生率高于非融合术患者[OR=1.67，95%CI（1.40，1.99），P＜0.00001]；术前有高血压[OR=1.78，95%CI（1.51，2.10），P＜0.00001]、糖尿病[OR=1.48，95%CI（1.40，1.57），P＜0.00001]、行走障碍史者[OR=4.47，95%CI（4.47，10.98），P=0.001]均增加了术后静脉血栓发生率；而BMI、手术入路、手术部位、心脏病史和D-二聚体水平对脊柱手术后静脉血栓发生率影响差异无统计学意义（P＞0.05）。结论：年龄偏高、女性、行脊柱融合术、失血量大、手术时间长者及伴有高血压、糖尿病、行走障碍史者术后易发生静脉血栓，临床应加以防范。 |
A Meta-analysis of the spontaneous incidence of venous thromboembolism after spine surgery |
| 英文关键词:Spinal surgery Venous thromboembolism Meta-analysis |
| 英文摘要: |
| 【Abstract】 Objectives: To evaluate the related factors affecting the spontaneous incidence of venous thromboembolism after spinal surgery by Meta-analysis. Methods: A computer-based online search was conducted on the topic of the spontaneous incidence of venous thromboembolism after spinal surgery up to July 31, 2017 in PubMed, Web of Science, EMBASE, the Cochrane Library, Wanfang Database, CNKI and VIP databases and spinal surgery, thromboembolism as key words. The NOS scale was used to evaluate the included research. The following variables were extracted: age, sex, body mass index, surgical procedure, approach and site, duration of surgery, blood loss, hypertension, diabetes, heart disease, D-dimer level and preoperative walking disability. Data analysis was conducted via RevMan 5.3. Results: A total of 22 studies which were scaled from 5 to 8 points by NOS were identified, including 2841542 patients undergoing a spinal surgery and 7557 patients who had venous thromboembolism after spinal surgery. The Meta-analysis showed that compared with the non-VTE patients after spine surgery, there were significantly higher age[WMD=6.05, 95%CI(3.62, 8.48), P＜0.0001], more blood loss[SMD=2.22, 95%CI(1.03, 3.41), P=0.0003] and longer duration of surgery[WMD=59.60, 95%CI(10.27, 108.93), P=0.02] among the VTE patients. Male had a significantly lower incidence of VTE after spine surgery[OR=0.59, 95%CI(0.38, 0.94), P=0.03]. Patients undergoing fusion surgery[OR=1.67, 95%CI(1.40, 1.99), P＜0.00001], patients with a history of hypertension[OR=1.78, 95%CI(1.51, 2.10), P＜0.00001], diabetes[OR=1.48, 95%CI(1.40, 1.57), P＜0.00001] and preoperative walking disability[OR=4.47, 95%CI(4.47, 10.98), P=0.001] had a significantly higher incidence of VTE after spine surgery. However, there were no significant differences in BMI, surgical approach and site, history of heart disease and level of d-dimer(P＞0.05). Conclusions: Higher incidence of postoperative venous thromboembolism is closely related with elder, female, fusion surgery, long duration of surgery, more blood loss and patients with hypertension, diabetes or preoperative walking disability, these should be guard against. |
| 投稿时间：2017-08-14 修订日期：2017-09-14 |
| DOI： |
| 基金项目:国家自然科学基金（编号：81470387） |
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