五种常用敷料对供皮区创面愈合作用的网状Meta分析
|
摘要
背景:目前,关于不同敷料用于供皮区创面愈合效果的优劣尚无定论,且很少有研究直接比较不同敷料愈合效果的差异。目的:采用网状Meta分析评价5种不同敷料对供皮区创面愈合效果。方法:应用计算机检索PubMed、EMBASE、Cochrane、中国学术期刊全文数据库、中国生物医学文献光盘数据库、万方数据平台和中文科技期刊数据库中,发表的关于不同敷料治疗供皮区创面的随机对照试验,设定检索时限为建库至2018年5月。由2名研究生独立进行文献筛选、质量评价和资料提取,采用Winbugs1.4.3和Stata13.0软件进行数据分析。结果与结论:共纳入13篇随机对照试验,观察组采用泡沫敷料、水胶体敷料、藻酸盐敷料和含银敷料中的一种,对照组均采用传统敷料凡士林纱布。网状Meta分析结果显示:藻酸盐敷料、银敷料、水胶体敷料和泡沫敷料用于供皮区创面的愈合时间明显短于凡士林纱布(P <0.05),泡沫敷料、水胶体敷料、藻酸盐敷料、银敷料用于供皮区创面的愈合时间比较无差异(P> 0.05);各敷料用于供皮区创面后的愈合效果排序(由好到差):藻酸盐敷料、含银敷料、水胶体敷料、泡沫敷料、凡士林纱布;结果表明,藻酸盐敷料可能是目前缩短供皮区创面愈合时间的最佳敷料,未来需要更多研究来证实。
BACKGROUND: At present, there is no consensus on the effect of different dressings in the healing of donor site, and few studies have directly compared the healing effect of different dressings. OBJECTIVE: To evaluate the healing effect of five different dressings on donor site wounds by network meta-analysis. METHODS: Randomized controlled trials about different dressings in the treatment of donor site wounds were retrieved by computer in PubMed, EMBASE, Cochrane, Chinese Academic Journal Full Text Database, Chinese Biomedical Literature CD-ROM Database, WanFang Data Platform and Chinese Science and Technology Journal Database. The retrieval time limit was from inception until May 2018. Literature screening, quality evaluation and data extraction were conducted independently by two postgraduates. Winbugs 1.4.3 and Stata 13.0 softwares were used for data analysis. RESULTS AND CONCLUSION: A total of 13 randomized controlled trials were included. In the observation group, foam dressing, hydrocolloid dressing, alginate dressing or silver dressing was used. In the control group, vaseline gauze was used. The results of network meta-analysis showed that the healing time of donor sites for alginate dressing, silver dressing, hydrocolloid dressing and foam dressing was significantly shorter than that of vaseline gauze(P < 0.05), but there was no difference in wound healing time between foam dressing, hydrocolloid dressing, alginate dressing and silver dressing at the donor site(P > 0.05). The healing effects of different dressings were ranked as follows(from good to bad): alginate dressing, silver dressing, hydrocolloid dressing, foam dressing and vaseline gauze. Overall findings indicate that alginate dressing may be the best choice to shorten the healing time of donor site, and further investigations are warranted.
BACKGROUND: At present, there is no consensus on the effect of different dressings in the healing of donor site, and few studies have directly compared the healing effect of different dressings. OBJECTIVE: To evaluate the healing effect of five different dressings on donor site wounds by network meta-analysis. METHODS: Randomized controlled trials about different dressings in the treatment of donor site wounds were retrieved by computer in PubMed, EMBASE, Cochrane, Chinese Academic Journal Full Text Database, Chinese Biomedical Literature CD-ROM Database, WanFang Data Platform and Chinese Science and Technology Journal Database. The retrieval time limit was from inception until May 2018. Literature screening, quality evaluation and data extraction were conducted independently by two postgraduates. Winbugs 1.4.3 and Stata 13.0 softwares were used for data analysis. RESULTS AND CONCLUSION: A total of 13 randomized controlled trials were included. In the observation group, foam dressing, hydrocolloid dressing, alginate dressing or silver dressing was used. In the control group, vaseline gauze was used. The results of network meta-analysis showed that the healing time of donor sites for alginate dressing, silver dressing, hydrocolloid dressing and foam dressing was significantly shorter than that of vaseline gauze(P < 0.05), but there was no difference in wound healing time between foam dressing, hydrocolloid dressing, alginate dressing and silver dressing at the donor site(P > 0.05). The healing effects of different dressings were ranked as follows(from good to bad): alginate dressing, silver dressing, hydrocolloid dressing, foam dressing and vaseline gauze. Overall findings indicate that alginate dressing may be the best choice to shorten the healing time of donor site, and further investigations are warranted.
引文
[1]尤蓓蓓,袁玲玲.烧伤患者头部供皮区行红光治疗护理的效果观察[J].世界最新医学信息文摘,2017,17(46):249.
[2]孙超锋,李跃军,李望舟,等.中厚皮供区创面愈合临床研究[J].兰州大学学报(医学版),2016,42(4):8-13.
[3]田金徽,陈耀龙,杨克虎,等.SR/MA研究进展与挑战[J].兰州大学学报(医学版),2016,42(1):42-47.
[4]曾宪涛,曹世义,孙凤,等.Meta分析系列之六:间接比较及网状分析[J].中国循证心血管医学杂志,2012,4(5):399-402.
[5]杨云,王继华,朱礼昆,等.藻酸盐敷料在整形外科的应用[J].中外医疗,2010,29(5):108.
[6]田彭,周业平.藻酸盐敷料对瘢痕皮肤供皮区创面愈合的临床效果研究[J].中国全科医学,2014,17(24):2871-2873.
[7]邬天刚,冯登超.藻酸盐敷料和凡士林纱布对瘢痕皮肤供皮区创面愈合及相关分子表达的影响[J].海南医学院学报,2016,22(16):1911-1913.
[8]许腊梅,刘宸.两种敷料用于中厚皮片供皮区创面处理的效果观察[J].现代医学,2015,43(2):207-210.
[9]邱玉友.水胶体敷料治疗头部供皮创面的效果观察[J].中国当代医药,2014,21(12):194-196.
[10]郑捷新,施浩然.多爱肤敷料在中厚皮片供皮区的应用[J].上海第二医科大学学报,1999,19(4):362-363.
[11]Br?lmann FE,Eskes AM,Goslings JC,et al.Randomized clinical trial of donor-site wound dressings after split-skin grafting.Br J Surg.2013;100(5):619-627.
[12]Pak CS,Park DH,Oh TS,et al.Comparison of the efficacy and safety of povidone-iodine foam dressing(Betafoam),hydrocellular foam dressing(Allevyn),and petrolatum gauze for split-thickness skin graft donor site dressing.Int Wound J.2018.doi:10.1111/iwj.13043.[Epub ahead of print].
[13]鲍志渊.软聚硅酮泡沫敷料在白癜风表皮移植术供皮区创面的应用[J].中国卫生工程学,2015,14(3):277-278.
[14]李学川,乔亮,黄晓琴,等.吸水性聚氨酯泡沫敷料促进皮肤移植供皮区愈合的疗效观察[J].上海交通大学学报(医学版),2013,33(5):663-666.
[15]Lohsiriwat V,Chuangsuwanich A.Comparison of the ionic silver-containing hydrofiber and paraffin gauze dressing on split-thickness skin graft donor sites.Ann Plast Surg.2009;62(4):421-422.
[16]牟军.纳米银敷料治疗供皮区创面的疗效分析[J].中国现代医生,2017,55(4):50-53.
[17]冯光,曹卫红.纳米银敷料在中厚皮片供皮区的应用研究[J].感染、炎症、修复,2008,9(1):43-43.
[18]赵玲霞,白倩.烧伤整形植皮患者术后供皮区的护理[J].医学信息,2016,29(5):148-149.
[19]林元邦,鲁淑英,沈伟嵘,等.湿性敷料在腹部手术术后伤口愈合不良中应用效果的观察[J].感染、炎症、修复,2009,10(3):179-180.
[20]王凤岩,许鑫,胡三莲.密闭湿性敷料、凡士林纱布在供皮区应用效果的研究[J].实用临床医药杂志,2017,21(2):105-107.
[21]陈红涛,董彩梅,吕冬,等.藻酸盐敷料在伤口创面护理中的应用进展[J].护理研究,2015,29(3):257-259.
[22]顾其胜,王帅帅,王庆生,等.海藻酸盐敷料应用现状与研究进展[J].中国修复重建外科杂志,2014,28(2):255-258.
[23]苏怡芳,马俊,章左艳,等.银离子藻酸盐敷料在糖尿病合并压疮患者中的应用效果[J].解放军护理杂志,2016,33(4):61-63.
[24]温珊珊.藻酸盐敷料治疗糖尿病足溃疡临床观察和护理[J].海峡药学,2017,29(6):191-192.
[25]周艳红,郝彤,李俊杰,等.新型纳米银基抗感染敷料的研制及生物学效应评价[J].军事医学,2016,40(6):497-501.
[26]Esteban-Tejeda L,Malpartida F,Esteban-Cubillo A,et al.The antibacterial and antifungal activity of a soda-lime glass containing silver nanoparticles.Nanotechnology.2009;20(8):085103.
[27]刘俊玲,陈彤,刘建云,等.纳米银敷料、银离子敷料、磺胺嘧啶银治疗Ⅱ度烧伤的网状Meta分析[J].国外医学医学地理杂志,2016,37(3):258-262.
[28]程祥,赵玉云,邵安良,等.含银敷料的表征和银的体外释放实验方法研究及其应用[J].药物分析杂志,2015,25(3):491-499.
[29]Doggen K,Van Acker K,Beele H,et al.Implementation of a quality improvement initiative in Belgian diabetic foot clinics:feasibility and initial results.Diabetes Metab Res Rev.2014;30(5):435-443.
[30]吴文婷,王艳君,赵文杰,等.防污载银复合材料的研究进展[J].表面技术,2017,46(11):128-137.
[31]陈学情,蒋家璇,任志鸿,等.纳米银的抗菌特性及对多重耐药菌株的抗菌作用[J].微生物学报,2017,57(4):85-95.
[32]刘鑫,任艳,周子军,等.纳米银抗菌机理及应用研究进展[J].安徽农业大学学报,2017,44(4):702-708.
[33]陈炯,韩春茂,张力成,等.纳米银用于Ⅱ度烧伤创面的疗效及安全性评价[J].中华创伤杂志,2009,25(5):451-455.
[34]郑辉烈,俞慧强,刘勇,等.Meta分析发表偏倚的联合诊断研究[J].现代预防医学,2016,43(7):1153-1155,1161.
[2]孙超锋,李跃军,李望舟,等.中厚皮供区创面愈合临床研究[J].兰州大学学报(医学版),2016,42(4):8-13.
[3]田金徽,陈耀龙,杨克虎,等.SR/MA研究进展与挑战[J].兰州大学学报(医学版),2016,42(1):42-47.
[4]曾宪涛,曹世义,孙凤,等.Meta分析系列之六:间接比较及网状分析[J].中国循证心血管医学杂志,2012,4(5):399-402.
[5]杨云,王继华,朱礼昆,等.藻酸盐敷料在整形外科的应用[J].中外医疗,2010,29(5):108.
[6]田彭,周业平.藻酸盐敷料对瘢痕皮肤供皮区创面愈合的临床效果研究[J].中国全科医学,2014,17(24):2871-2873.
[7]邬天刚,冯登超.藻酸盐敷料和凡士林纱布对瘢痕皮肤供皮区创面愈合及相关分子表达的影响[J].海南医学院学报,2016,22(16):1911-1913.
[8]许腊梅,刘宸.两种敷料用于中厚皮片供皮区创面处理的效果观察[J].现代医学,2015,43(2):207-210.
[9]邱玉友.水胶体敷料治疗头部供皮创面的效果观察[J].中国当代医药,2014,21(12):194-196.
[10]郑捷新,施浩然.多爱肤敷料在中厚皮片供皮区的应用[J].上海第二医科大学学报,1999,19(4):362-363.
[11]Br?lmann FE,Eskes AM,Goslings JC,et al.Randomized clinical trial of donor-site wound dressings after split-skin grafting.Br J Surg.2013;100(5):619-627.
[12]Pak CS,Park DH,Oh TS,et al.Comparison of the efficacy and safety of povidone-iodine foam dressing(Betafoam),hydrocellular foam dressing(Allevyn),and petrolatum gauze for split-thickness skin graft donor site dressing.Int Wound J.2018.doi:10.1111/iwj.13043.[Epub ahead of print].
[13]鲍志渊.软聚硅酮泡沫敷料在白癜风表皮移植术供皮区创面的应用[J].中国卫生工程学,2015,14(3):277-278.
[14]李学川,乔亮,黄晓琴,等.吸水性聚氨酯泡沫敷料促进皮肤移植供皮区愈合的疗效观察[J].上海交通大学学报(医学版),2013,33(5):663-666.
[15]Lohsiriwat V,Chuangsuwanich A.Comparison of the ionic silver-containing hydrofiber and paraffin gauze dressing on split-thickness skin graft donor sites.Ann Plast Surg.2009;62(4):421-422.
[16]牟军.纳米银敷料治疗供皮区创面的疗效分析[J].中国现代医生,2017,55(4):50-53.
[17]冯光,曹卫红.纳米银敷料在中厚皮片供皮区的应用研究[J].感染、炎症、修复,2008,9(1):43-43.
[18]赵玲霞,白倩.烧伤整形植皮患者术后供皮区的护理[J].医学信息,2016,29(5):148-149.
[19]林元邦,鲁淑英,沈伟嵘,等.湿性敷料在腹部手术术后伤口愈合不良中应用效果的观察[J].感染、炎症、修复,2009,10(3):179-180.
[20]王凤岩,许鑫,胡三莲.密闭湿性敷料、凡士林纱布在供皮区应用效果的研究[J].实用临床医药杂志,2017,21(2):105-107.
[21]陈红涛,董彩梅,吕冬,等.藻酸盐敷料在伤口创面护理中的应用进展[J].护理研究,2015,29(3):257-259.
[22]顾其胜,王帅帅,王庆生,等.海藻酸盐敷料应用现状与研究进展[J].中国修复重建外科杂志,2014,28(2):255-258.
[23]苏怡芳,马俊,章左艳,等.银离子藻酸盐敷料在糖尿病合并压疮患者中的应用效果[J].解放军护理杂志,2016,33(4):61-63.
[24]温珊珊.藻酸盐敷料治疗糖尿病足溃疡临床观察和护理[J].海峡药学,2017,29(6):191-192.
[25]周艳红,郝彤,李俊杰,等.新型纳米银基抗感染敷料的研制及生物学效应评价[J].军事医学,2016,40(6):497-501.
[26]Esteban-Tejeda L,Malpartida F,Esteban-Cubillo A,et al.The antibacterial and antifungal activity of a soda-lime glass containing silver nanoparticles.Nanotechnology.2009;20(8):085103.
[27]刘俊玲,陈彤,刘建云,等.纳米银敷料、银离子敷料、磺胺嘧啶银治疗Ⅱ度烧伤的网状Meta分析[J].国外医学医学地理杂志,2016,37(3):258-262.
[28]程祥,赵玉云,邵安良,等.含银敷料的表征和银的体外释放实验方法研究及其应用[J].药物分析杂志,2015,25(3):491-499.
[29]Doggen K,Van Acker K,Beele H,et al.Implementation of a quality improvement initiative in Belgian diabetic foot clinics:feasibility and initial results.Diabetes Metab Res Rev.2014;30(5):435-443.
[30]吴文婷,王艳君,赵文杰,等.防污载银复合材料的研究进展[J].表面技术,2017,46(11):128-137.
[31]陈学情,蒋家璇,任志鸿,等.纳米银的抗菌特性及对多重耐药菌株的抗菌作用[J].微生物学报,2017,57(4):85-95.
[32]刘鑫,任艳,周子军,等.纳米银抗菌机理及应用研究进展[J].安徽农业大学学报,2017,44(4):702-708.
[33]陈炯,韩春茂,张力成,等.纳米银用于Ⅱ度烧伤创面的疗效及安全性评价[J].中华创伤杂志,2009,25(5):451-455.
[34]郑辉烈,俞慧强,刘勇,等.Meta分析发表偏倚的联合诊断研究[J].现代预防医学,2016,43(7):1153-1155,1161.