辅助间歇气动加压预防静脉血栓形成
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Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis
背景与目的
在接受药物性血栓预防治疗的危重患者中，与单独使用药物预防治疗相比，辅助间歇气动加压是否可降低深静脉血栓形成的发生率尚未确定。
方 法
在患者入住重症监护室（ICU）后48h内，我们根据当地标准将那些被视为成年人的患者（年龄≥14岁、16岁或18岁）随机分为2组：气动加压组：除了用普通肝素或低分子肝素等药物预防血栓形成外，每天接受至少18h的间歇气动加压治疗；对照组：单用药物预防血栓形成。主要结局是发生（即新发的）下肢近端深静脉血栓形成，随机分组后第三个工作日开始每周进行两次下肢超声检查，直至ICU出院、死亡、可完全活动或试验第28天，以先发生者为准。
结 果
共有2003例患者进行了随机分组，其中气动加压组为991例，对照组为1012例。间歇气动加压平均每天22h（IQR：21~23），平均7天（IQR：4~13）。气动加压组的957例患者中37例（3.9%）出现主要结局，对照组的985例患者中41例（4.2%）出现主要结局（RR：0.93；95%CI：0.60-1.44；P=0.74）。气动加压组的991例患者中103例（10.4%）发生静脉血栓栓塞（肺栓塞或任何下肢深静脉血栓形成），对照组的1012例患者中95例（9.4%）发生静脉血栓栓塞（RR：1.11；95%CI：0.85-1.44）。气动加压组的990例患者中258例在90天内因任何原因死亡（26.1%），对照组的1011例患者中270例在90天内因任何原因死亡（26.7%）（RR：0.98；95%CI：0.84-1.13）。
结 论
在接受药物性血栓预防治疗的危重患者中，辅助性间歇性气动加压与单独药物性血栓预防治疗相比，并没有显著降低下肢近端深静脉血栓形成的发生率。
原始文献摘要
Arabi YM, Al-Hameed F, Burns KEA, et al.Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis[J].N Engl J Med. 2019 Apr 4;380(14):1305-1315. doi: 10.1056/NEJMoa1816150. Epub 2019 Feb 18.
BACKGROUND：
Whether adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis would result in a lower incidence of deep-vein thrombosis than pharmacologic thromboprophylaxis alone is uncertain.
METHODS：
We randomly assigned patients who were considered adults according to the local standards at the participating sites (≥14, ≥16, or ≥18 years of age) within 48 hours after admission to an intensive care unit (ICU) to receive either intermittent pneumatic compression for at least 18 hours each day in addition to
pharmacologic thromboprophylaxis with unfractionated or low-molecular-weight heparin (pneumatic compression group) or pharmacologic thromboprophylaxis alone (control group). The primary outcome was incident (i.e., new) proximal lower-limb deep-vein thrombosis, as detected on twice-weekly lower-limb ultrasonography after the third calendar day since randomization until ICU discharge, death, attainment of full mobility, or trial day 28, whichever occurred first.
RESULTS：
A total of 2003 patients underwent randomization — 991 were assigned to the pneumatic compression group and 1012 to the control group. Intermittent pneumatic compression was applied for a median of 22 hours (interquartile range, 21 to 23) daily for a median of 7 days (interquartile range, 4 to 13). The primary outcome occurred in 37 of 957 patients (3.9%) in the pneumatic compression group and in 41 of 985 patients (4.2%) in the control group (relative risk, 0.93; 95% confidence interval [CI], 0.60 to 1.44; P=0.74). Venous thromboembolism (pulmonary embolism or any lower-limb deep-vein thrombosis) occurred in 103 of 991 patients (10.4%) in the pneumatic compression group and in 95 of 1012 patients (9.4%) in the control group (relative risk, 1.11; 95% CI, 0.85 to 1.44), and death from any cause at 90 days occurred in 258 of 990 patients (26.1%) and 270 of 1011 patients (26.7%), respectively (relative risk, 0.98; 95% CI, 0.84 to 1.13).
CONCLUSIONS：
Among critically ill patients who were receiving pharmacologic thromboprophylaxis, adjunctive intermittent pneumatic compression did not result in a significantly lower incidence of proximal lower-limb deep-vein thrombosis than pharmacologic thromboprophylaxis alone.
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贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：何幼芹 审校：王贵龙