银离子敷料治疗糖尿病足溃疡疗效的Meta分析
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摘要
背景:国内外治疗糖尿病足使用的敷料种类有很多种,其中银离子敷料应用广泛,但尚未形成定论。目的:应用Meta分析法评价银离子敷料治疗糖尿病足溃疡的疗效。方法:应用计算机检索PubMed、Embase、Elsevier、中国知网(CNKI)、中国生物医学文献数据库、维普数据库、万方数据库中有关银离子敷料治疗糖尿病足溃疡的随机对照试验,文献发表时间设定为建库至2018年3月,文献质量的评价和资料提取由2名研究员进行,对符合质量标准的研究进行Meta分析。结果与结论:(1)共纳入7篇文献,共642例患者;(2)Meta分析结果显示,银离子敷料组伤口痊愈率明显高于其他敷料组[OR=2.34,95%CI(1.57,3.48),P <0.000 1],上皮形成时间明显早于其他敷料组[MD=-2.22,95%CI(-2.77,-1.66),P <0.000 01],肉芽组织出现时间明显早于其他敷料组[MD=-2.84,95%CI(-3.26,-2.41),P <0.000 01],创面基本愈合时间明显早于其他敷料组[MD=-11.13,95%CI(-19.87,-2.39),P=0.01];(3)结果表明,银离子敷料能够促进糖尿病足溃疡愈合。
BACKGROUND: Various kinds of dressings for diabetic foot have been developed, among which, silver dressing has been widely used, but no conclusion has been reached yet.OBJECTIVE: To evaluate the effects of silver dressing in the treatment of diabetic foot ulcers by a Meta-analysis. METHODS: A systematic search of literatures in PubMed, Embase, Elsevier, CNKI, CBM, VIP and WanFang from inception to March 2018 was conducted. The quality of the literatures was appraised and data were extracted by two researchers independently. Meta-analysis was then conducted for the included literatures. RESULTS AND CONCLUSION: A total of 7 randomized controlled trials involving 642 patients were included. The meta-analysis results showed that the wound healing rate of silver dressing group was significantly higher than that of the other dressing groups [odds ratio(OR)=2.34, 95% confidence interval(CI)(1.57, 3.48), P < 0.000 1], epithelial formation time was significantly shorter than that of other dressing groups [mean difference(MD)=-2.22, 95% CI(-2.77,-1.66), P < 0.000 01], occurrence time of granulation tissue was significantly shorter than that of the other dressing groups[MD=-2.84, 95% CI(-3.26,-2.41), P < 0.000 01], wound healing time was significantly shorter than that of the other dressing groups [MD=-11.13, 95% CI(-19.87,-2.39), P=0.01]. Overall, silver dressing can promote the healing of diabetic foot ulcers.
BACKGROUND: Various kinds of dressings for diabetic foot have been developed, among which, silver dressing has been widely used, but no conclusion has been reached yet.OBJECTIVE: To evaluate the effects of silver dressing in the treatment of diabetic foot ulcers by a Meta-analysis. METHODS: A systematic search of literatures in PubMed, Embase, Elsevier, CNKI, CBM, VIP and WanFang from inception to March 2018 was conducted. The quality of the literatures was appraised and data were extracted by two researchers independently. Meta-analysis was then conducted for the included literatures. RESULTS AND CONCLUSION: A total of 7 randomized controlled trials involving 642 patients were included. The meta-analysis results showed that the wound healing rate of silver dressing group was significantly higher than that of the other dressing groups [odds ratio(OR)=2.34, 95% confidence interval(CI)(1.57, 3.48), P < 0.000 1], epithelial formation time was significantly shorter than that of other dressing groups [mean difference(MD)=-2.22, 95% CI(-2.77,-1.66), P < 0.000 01], occurrence time of granulation tissue was significantly shorter than that of the other dressing groups[MD=-2.84, 95% CI(-3.26,-2.41), P < 0.000 01], wound healing time was significantly shorter than that of the other dressing groups [MD=-11.13, 95% CI(-19.87,-2.39), P=0.01]. Overall, silver dressing can promote the healing of diabetic foot ulcers.
引文
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[2]Woo KY,Botros M,Kuhnke J,etal.Best practices for the management of foot ulcers in people with diabetes.Adv Skin Wound Care.2013;26(11):512-524;quiz 225-6.
[3]International diabetes federation.IDF Diabetes Atlas-7th Edition.[RB/OL].http://www.idd.org,2015-11-30.
[4]光明日报.《中国居民营养与慢性病状况报告(2015)》发布[J].食品科技,2015,11(7):13-14.
[5]Wanger Jr WJ.The diabetic food.Orthopedics.1987;10(1):163-172.
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[9]张俐,马建新,张会峰.银离子敷料联合水凝胶与湿疗伤口敷料治疗糖尿病足感染疗效比较[J].中华医院感染学杂志,2012,22(18):4002-4003.
[10]陈志雄.银离子敷料联合水凝胶治疗糖尿病足的效果观察[J].现代医院,2015,15(3):82-83.
[11]李帅.银离子敷料联合水凝胶治疗糖尿病足的疗效分析[J].中国现代药物应用,2016,10(19):222-223.
[12]贺万强,罗伟华,李磊,等.银离子敷料治疗糖尿病足溃疡的疗效观察[J].中国循证医学杂志,2016,16(5):510-512.
[13]吴文娜,陈庚,方亿琼.探究银离子抗菌敷料在糖尿病足溃疡创面护理中的应用疗效[J].中国卫生标准管理,2017,8(24):191-192.
[14]Flamm RK,Rhomberg PR,Simpson KM,etal.In vitro spectrum of pexigenan activity when tested against pathogens from diabetic foot infections and with selected resistance machanisms.Antimicrob Agents Chemother.2015;59(3):1751-1754.
[15]Shen Q,Lin D,Zhu H,et al.Clinical distribution and antimicrobial resistance analysis of 754 pathogenic bacteria in diabetic foot infection.Zhonghua Yi Xue Za Zhi.2014;94(12):889-894..
[16]乐忠宏,汤晓姣,崔婷婷,等.糖尿病足感染患者病原学特点及耐药性分析[J].中华医院感染学杂志,2017,27(3):590-592,601.
[17]陈美婉,吴红梅,刘长秀,等.不同纳米银制剂抑菌作用的实验研究[J].中国消毒学杂志,2009,26(2):132-134.
[18]马宁侠,周琴,吴庆芳,等.美皮康银离子敷料用于拔甲术后伤口的临床体会[J].中国医学创新,2010,7(35):178.
[19]Winter GD.Formation of the scab and the rate of epithelisation of superficial wounds in the skin of the young domestic pig.J Wound Care.1995;4(8):366-371.
[20]Hinman CD,Maibach H.Effect of air exposure and occlusion on experimental human skin wounds.Nature.1963;200(4904):377-378.
[21]Rustogi R,Mill J,Frasre JF,Kimble Rm.The use of acticoal inneonatal burns.Burns.2005;31:878-882.
[22]李东,张杰,牛星焘,等,密闭湿润环境与创面愈合[J].实用美容整形外科杂志,2000,11(3):142-145.
[23]毛庆龙.应用纳米银抗菌敷料治疗烧伤后期残余创面的观察[J].中国误诊学杂志,2009,24(9):848-849.
[24]J?rgensen B,Price P,Andersen K E,et al.The silver-releasing foam dressing,Contreet Foam,promotes faster healing of critically colonised venous leg ulcers:a randomised,controlled trial.Int Wound J.2005;2(1):64-73.
[25]Guili Y,Qiuxia L,Junjie L,et al.Synthesis and characteri-zation of dextran-capped silver nanoparticles with enhanced antibacterial activity.J Nanosci Nanotechnol.2012;12(5):3766-3774.
[26]何书连,李晓燕.湿性敷料在糖尿病足换药护理中的应用[J].现代预防医学,2012,39(15):4020-4021.
[27]Jemec GB,Kerihuel JC,Ousey K,et al.Cost-effective use of silver dressings for the treatment of hard-to-heal chronic venous leg ulcers.PLoS One.2014;9(6):1-6.
[28]Zweiker D,Horn S,Hoell A,et al.Semi-permanent skin staining associated with silver-coated wound dressing Acticoat.Ann Burns Fire Disasters.2014;27(4):197-200.
[29]Zou SB,Yoon WY,Han SK,et al.Cytotoxicity of silver dressings on diabetic fibroblasts.Int Wound J.2013;10:306-312.
[30]黄清泉,王蓉蓉,王春仁,等.纳米银医疗产品的体外细胞毒性比较[J].药物分析杂志,2009,29(12):2150-2153.
[31]李旭亚,丁惠萍.糖尿病足感染伤口治疗中使用银离子敷料的临床观察[J].护理实践与研究,2009,6(20):34-35.
[2]Woo KY,Botros M,Kuhnke J,etal.Best practices for the management of foot ulcers in people with diabetes.Adv Skin Wound Care.2013;26(11):512-524;quiz 225-6.
[3]International diabetes federation.IDF Diabetes Atlas-7th Edition.[RB/OL].http://www.idd.org,2015-11-30.
[4]光明日报.《中国居民营养与慢性病状况报告(2015)》发布[J].食品科技,2015,11(7):13-14.
[5]Wanger Jr WJ.The diabetic food.Orthopedics.1987;10(1):163-172.
[6]Alderson P,Green S,Higgins JPT,editors.Cochrane Reviewer,s Handbook 4.2.3[updated November 2004].In:The Cochrane Library,Issue1,2005.Chichester,UK:John Wiley&Sons,Ltd.
[7]Jude EB,Apelqvist J,Spraul M,et al.Prospective randomized controlled study of Hydrofiber?dressing containing ionic silver or calcium alginate dressings in non‐ischaemic diabetic foot ulcers.Diabet Med.2007;24(3):280-288.
[8]陆新虹,温玉洁,胡欣.含银离子敷料慷舒灵治疗糖尿病足疗效观察[J].临床医药实践,2009,18(17):1810-1811.
[9]张俐,马建新,张会峰.银离子敷料联合水凝胶与湿疗伤口敷料治疗糖尿病足感染疗效比较[J].中华医院感染学杂志,2012,22(18):4002-4003.
[10]陈志雄.银离子敷料联合水凝胶治疗糖尿病足的效果观察[J].现代医院,2015,15(3):82-83.
[11]李帅.银离子敷料联合水凝胶治疗糖尿病足的疗效分析[J].中国现代药物应用,2016,10(19):222-223.
[12]贺万强,罗伟华,李磊,等.银离子敷料治疗糖尿病足溃疡的疗效观察[J].中国循证医学杂志,2016,16(5):510-512.
[13]吴文娜,陈庚,方亿琼.探究银离子抗菌敷料在糖尿病足溃疡创面护理中的应用疗效[J].中国卫生标准管理,2017,8(24):191-192.
[14]Flamm RK,Rhomberg PR,Simpson KM,etal.In vitro spectrum of pexigenan activity when tested against pathogens from diabetic foot infections and with selected resistance machanisms.Antimicrob Agents Chemother.2015;59(3):1751-1754.
[15]Shen Q,Lin D,Zhu H,et al.Clinical distribution and antimicrobial resistance analysis of 754 pathogenic bacteria in diabetic foot infection.Zhonghua Yi Xue Za Zhi.2014;94(12):889-894..
[16]乐忠宏,汤晓姣,崔婷婷,等.糖尿病足感染患者病原学特点及耐药性分析[J].中华医院感染学杂志,2017,27(3):590-592,601.
[17]陈美婉,吴红梅,刘长秀,等.不同纳米银制剂抑菌作用的实验研究[J].中国消毒学杂志,2009,26(2):132-134.
[18]马宁侠,周琴,吴庆芳,等.美皮康银离子敷料用于拔甲术后伤口的临床体会[J].中国医学创新,2010,7(35):178.
[19]Winter GD.Formation of the scab and the rate of epithelisation of superficial wounds in the skin of the young domestic pig.J Wound Care.1995;4(8):366-371.
[20]Hinman CD,Maibach H.Effect of air exposure and occlusion on experimental human skin wounds.Nature.1963;200(4904):377-378.
[21]Rustogi R,Mill J,Frasre JF,Kimble Rm.The use of acticoal inneonatal burns.Burns.2005;31:878-882.
[22]李东,张杰,牛星焘,等,密闭湿润环境与创面愈合[J].实用美容整形外科杂志,2000,11(3):142-145.
[23]毛庆龙.应用纳米银抗菌敷料治疗烧伤后期残余创面的观察[J].中国误诊学杂志,2009,24(9):848-849.
[24]J?rgensen B,Price P,Andersen K E,et al.The silver-releasing foam dressing,Contreet Foam,promotes faster healing of critically colonised venous leg ulcers:a randomised,controlled trial.Int Wound J.2005;2(1):64-73.
[25]Guili Y,Qiuxia L,Junjie L,et al.Synthesis and characteri-zation of dextran-capped silver nanoparticles with enhanced antibacterial activity.J Nanosci Nanotechnol.2012;12(5):3766-3774.
[26]何书连,李晓燕.湿性敷料在糖尿病足换药护理中的应用[J].现代预防医学,2012,39(15):4020-4021.
[27]Jemec GB,Kerihuel JC,Ousey K,et al.Cost-effective use of silver dressings for the treatment of hard-to-heal chronic venous leg ulcers.PLoS One.2014;9(6):1-6.
[28]Zweiker D,Horn S,Hoell A,et al.Semi-permanent skin staining associated with silver-coated wound dressing Acticoat.Ann Burns Fire Disasters.2014;27(4):197-200.
[29]Zou SB,Yoon WY,Han SK,et al.Cytotoxicity of silver dressings on diabetic fibroblasts.Int Wound J.2013;10:306-312.
[30]黄清泉,王蓉蓉,王春仁,等.纳米银医疗产品的体外细胞毒性比较[J].药物分析杂志,2009,29(12):2150-2153.
[31]李旭亚,丁惠萍.糖尿病足感染伤口治疗中使用银离子敷料的临床观察[J].护理实践与研究,2009,6(20):34-35.