超早期下床活动对急性下肢深静脉血栓者负性事件和肿胀疼痛影响的系统评价-现代医学

超早期下床活动对急性下肢深静脉血栓者负性事件和肿胀疼痛影响的系统评价

单位：1. 南京医科大学护理学院临床护理学系, 江苏南京 210000;
2. 南京医科大学第一附属医院呼吸与危重症医学科, 江苏南京 210029

分类号：R473.6

出版年·卷·期（页码）：2019·47·第二期（204-209）

摘要：

目的：探讨有效抗凝下超早期下床活动对急性下肢深静脉血栓患者负性事件、患肢肿胀和疼痛的影响。方法：系统检索英文数据库PubMed、Cochrane Library、EMbase以及中文数据库CNKI、Wangfang data、VIP和CBM中关于深静脉血栓患者超早期下床活动的临床对照研究，在文献质量的严格评价和资料提取基础上，对随机对照试验进行Meta分析。结果：纳入7篇研究，其中6篇随机对照试验和1篇前瞻性队列研究。Meta分析结果显示：与卧床休息相比，超早期下床活动在降低患者负性事件发生率（OR=0.63，95% CI：0.44~0.90）、缓解患肢肿胀程度（MD=-1.78，95% CI：-1.97~-1.60）和减轻患者的疼痛方面（MD=-0.97，95% CI：-1.64~-0.31）均有统计学差异。结论：有效抗凝下，超早期下床活动不仅可以降低下肢深静脉血栓患者负性事件的发生风险，还能促进患肢肿胀程度的缓解和疼痛减轻。

Objective:To explore negative events, swelling and pain of very early mobilization in patients with acute deep venous thromboembolism.Methods:Electronic databases including PubMed, Cochrane Library, EMbase, CNKI, Wanfang Data, VIP and CBM were searched for the literatures about very early mobilization of patients with acute deep venous thromboembolism. The quality of the literatures was evaluated.Results:Seven studies were included. Compared with bed rest, very early mobilization decreased the incidence of negative events(OR=0.63, 95% CI:0.44~0.90), degree of swelling and pain(MD=-1.78, 95% CI:-1.97~-1.60; MD=-0.97, 95% CI:-1.64~-0.31).Conclusion:Very early mobilization with standard anticoagulation could decrease the incidence of negative events and relieveswelling and pain.

参考文献：

[1] 中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南(第三版)[J].中华普通外科杂志,2017,32(9):807-812.
[2] 郑月宏.静脉血栓栓塞症抗凝治疗微循环血栓防治专家共识[J].中华老年多器官疾病杂志,2017,16(4):241-244.
[3] KAHN S R.Frequency and determinants of the postthrombotic syndrome after venous thromboembolism.[J].Curr Opin Pulm Med,2006,12(5):299-303.
[4] Partsch H.Ambulation and compression after deep vein thrombosis:dispelling myths[J].Semin Vasc Surg,2005,18(3):148-152.
[5] 孙建华,马玉芬,郭一峰,等.急性深静脉血栓患者早日下床活动可行性与安全性的系统评价[J].中华护理杂志,2017,52(05):581-585.
[6] LIU Z,TAO X,CHEN Y,et al.Bed Rest versus early ambulation with standard anticoagulation in the management of deep vein thrombosis:A meta-analysis[J].PloS One,2015,10(4):e0121388.
[7] KEARON C,AKL E A,ORNELAS J,et al.Antithrombotic therapy for VTE disease:Chest guideline and expert panel report[J].Chest,2016,149(2):315-352.
[8] 胡玉丽,温晓红,徐菊玲,等.快速康复外科理念在髋部骨折术后早期活动中的应用进展[J].护士进修杂志,2017,32(22):2041-2043.
[9] 向娜,马玉芬,李杨.快速康复外科理念下全膝关节置换患者术后早期下床活动的研究进展[J].中国护理管理,2017,17(9):1268-1273.
[10] BERNHARDT J,DEWEY H,COLLIER J,et al.A Very early rehabilitation trial(AVERT)[J].Int J Stroke.2006,1(3):169-171.
[11] MAZZOLAI L,ABOYANS V,AGENO W,et al.Diagnosis and management of acute deep vein thrombosis:A joint consensus document from the European society of cardiology working groups of aorta and peripheral circulation and pulmonary circulation and right ventricular function[J].Eur Heart J,2018,39(47):4208-4218.
[12] The Joanna Briggs Institute.Joanna Briggs Institute Reviewers' manual[M].Australia:The Joanna Briggs Institute,2016.
[13] HIGGINS J P T,GREEN S.Cochrane handbook for systematic reviews of interventions version 5.1.0[updated March 2011] [DB/OL].http://www.cochrane-handbook.org.
[14] WELLS G A,SHEA B,O'CONELL D,et al.The Newcastle-Ottawa scale for assessing the quality of nonrandomized studies in meta-analyses 2014[DB/OL].http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
[15] PARTSCH H,BLATTLER W.Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin[J].J Vasc Surg,2000,32(5):861-869.
[16] PARTSCH H,KAULICH M,MAYER W.Immediate mobilisation in acute vein thrombosis reduces post-thrombotic syndrome[J].Int Angiol,2004,23(3):206-212.
[17] TRUJILLO-SANTOS J,PEREA-MILLA E,JIMENEZ-PUENTE A,et al.Bed rest or ambulation in the initial treatment of patients with acute deep vein thrombosis or pulmonary embolism:findings from the RIETE registry[J].Chest,2005,127(5):1631-1636.
[18] JUNGER M,DIEHM C,STORIKO H,et al.Mobilization versus immobilization in the treatment of acute proximal deep venous thrombosis:a prospective,randomized,open,multicentre trial[J].Curr Med Res Opin,2006,22(3):593-602.
[19] ISMA N,JOHANSSSON E,BJORK A,et al.Does supervised exercise after deep venous thrombosis improve recanalization of occluded vein segments? A randomized study[J].J Thromb Thrombolysis,2007,23(1):25-30.
[20] ROMERAVILLEGAS A,CAIROLSCASTELLOTE M A,Vilacoll R,et al.Early mobilisation in patients with acute deep vein thrombosis does not increase the risk of a symptomatic pulmonary embolism[J].Int Angiol,2008,27(6):494-499.
[21] RAHMAN A,COLAK M C,USTUNEL L,et al.A comparison of different treatment managements in patients with acute deep vein thrombosis by the effects on enhancing venous outflow in the lower limb[J].Med Sci Monit,2009,15(11):CR588-593.
[22] 翁艳秋,刘莹,刘颖,等.急性深静脉血栓患者早期下床活动与卧床休息的系统评价[J].护士进修杂志,2015,30(11):999-1003.
[23] KILLEWICH L A,MACKO R F,COX K,et al.Regression of proximal deep venous thrombosis is associated with fibrinolytic enhancement[J].J Vasc Surg,1997,26:861-868.
[24] KILLEWICH L A,MACKO R F,MONTGOMERY P S,et al.Exercise training enhances endogenous fibrinolysis in peripheral arterial disease[J].J Vasc Surg,2004,40(4):741.
[25] MANGANARO A,BUDA D,ANDO G,et al.Compression therapy in deep venous thrombosis[J].Minerva Cardioangiol,2000,48(1):57-60.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录