功能性敷料治疗供皮区创面效果的Meta分析
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摘要
[目的]应用Meta分析方法评价功能性敷料治疗供皮区创面的临床效果。[方法]计算机检索PubMed、Cochrane Library、Web of Science、EBSCO、中国学术期刊全文数据库、万方数据平台、维普中文科技期刊数据库中建库至2018年12月公开发表的有关功能性敷料治疗供皮区创面的文献。以创面愈合时间、创面感染率、创面疼痛程度、创面瘢痕生长情况为结局指标,应用RevMan 5.3软件进行Meta分析。[结果]共纳入13篇文献,包括1 057个创面。Meta分析结果显示:功能性敷料组创面愈合时间短于传统敷料组,两组相比差异有统计学意义[MD=-2.20,95%CI(-2.56,-1.84),P<0.000 01],功能性敷料组创面感染率低于传统敷料组,两组相比差异有统计学意义[RR=0.22,95%CI(0.10,0.51),P=0.000 4],功能性敷料组创面瘢痕评分低于传统敷料组,两组比较差异有统计学意义[MD=-1.60,95%CI(-2.31,-0.89),P<0.000 01]。[结论]现有证据表明:与传统敷料相比,功能性敷料能促进供皮区创面愈合,减少感染发生及瘢痕增生。但受纳入研究数量和质量限制,上述结论仍需开展更多高质量研究予以验证。
Objective:To evaluate the clinical effect on functional dressing for donor-site wounds by using Meta-analysis method.Methods:Databases including PubMed,Cochrane Library,Web of Science,EBSCO,CNKI,Wanfang Data and VIP were searched by computer for published literatures on functional dressing in the treatment of donor-site wounds from inception to December 2018.The outcome indexes were wound healing time,wound infection rate,wound pain degree and scar growth.Then,Meta-analysis was performed by using RevMan 5.3 software.Results:A total of 13 literatures including 1 057 wounds were included.The results of Meta-analysis showed that the wound healing time in functional dressings group was shorter than that in traditional dressings group.There was significant difference between the two groups[MD=-2.20,95%CI(-2.56,-1.84),P<0.000 01].The wound infection rate in functional dressings group was lower than that in traditional dressings group.There was significant difference between the two groups[RR=0.22,95%CI(0.10,0.51),P=0.000 4].The score of scar growth in functional dressings group was higher than that in traditional dressings group.There was significant difference between the two groups [MD=-1.60,95%CI(-2.31,-0.89),P<0.000 01].Conclusions:Present evidences showed that compared with traditional dressings,functional dressings could promote wound healing in donor site,reduce infection and scar hyperplasia.However,due to the limitation of the quantity and quality of the included studies,more high-quality studies were needed to verify the above conclusions.
Objective:To evaluate the clinical effect on functional dressing for donor-site wounds by using Meta-analysis method.Methods:Databases including PubMed,Cochrane Library,Web of Science,EBSCO,CNKI,Wanfang Data and VIP were searched by computer for published literatures on functional dressing in the treatment of donor-site wounds from inception to December 2018.The outcome indexes were wound healing time,wound infection rate,wound pain degree and scar growth.Then,Meta-analysis was performed by using RevMan 5.3 software.Results:A total of 13 literatures including 1 057 wounds were included.The results of Meta-analysis showed that the wound healing time in functional dressings group was shorter than that in traditional dressings group.There was significant difference between the two groups[MD=-2.20,95%CI(-2.56,-1.84),P<0.000 01].The wound infection rate in functional dressings group was lower than that in traditional dressings group.There was significant difference between the two groups[RR=0.22,95%CI(0.10,0.51),P=0.000 4].The score of scar growth in functional dressings group was higher than that in traditional dressings group.There was significant difference between the two groups [MD=-1.60,95%CI(-2.31,-0.89),P<0.000 01].Conclusions:Present evidences showed that compared with traditional dressings,functional dressings could promote wound healing in donor site,reduce infection and scar hyperplasia.However,due to the limitation of the quantity and quality of the included studies,more high-quality studies were needed to verify the above conclusions.
引文
[1] 李颖.新型敷料在供皮区创面的应用[J].中国美容医学,2010,19(5):770-772.
[2] JANSEN P,STOFFELS I,KLODE J,et al.Postsurgical treatment of split skin graft donor sites in dermatological departments[J].International Journal of Lower Extremity Wounds,2018,17(1):22-29.
[3] CALIOT J,BODIN F,CHIRIAC S,et al.Split-thickness skin graft donor site:which dressing use?[J].Ann Chir Plast Esthet,2015,60(2):140-147.
[4] GEARY P M,TIERNAN E.Management of split skin graft donor sites-results of a national survey[J].Journal of Plastic Reconstructive & Aesthetic Surgery,2009,62(12):1677-1683.
[5] 付小兵,吴志谷.现代创伤敷料理论与实践[M].北京:化学工业出版社,2007:669-672.
[6] 刘海兵,唐丹,曹海燕,等.温哥华瘢痕量表的信度研究[J].中国康复医学杂志,2006,21(3):240-242.
[7] OREMUS M,WOLFSON C,PERRAULT A,et al.Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer′s disease drug trials[J].Dementia & Geriatric Cognitive Disorders,2001,12(3):232-236.
[8] 陈炯,苏国良,李强,等.不同敷料组合对烧伤患者供皮区创面微环境的影响[J].中华烧伤杂志,2009,25(3):218-221.
[9] 井维斌,张景华,刘振宝.藻酸钙敷料在供皮区创面的应用[J].中国继续医学教育,2015,7(30):147-148.
[10] 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.
[11] 汪乐,林雪松,黄璐.痊愈妥敷料在烧伤患者刃厚皮供皮区的应用[J].实用医学杂志,2011,27(22):4178-4179.
[12] 吴祖煌,刘敏,王煜,等.湿性敷料促进供皮区创面愈合的临床研究[J].中国实用美容整形外科杂志,2004,15(5):251-252.
[13] 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.
[14] 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.
[15] 张洁,牛星焘,李东.密闭性敷料与凡士林油纱对皮片供皮区创面愈合的比较研究[J].中华整形外科杂志,2000,16(6):351-363.
[16] PANNIER M,MARTINOT V,CASTEDE J C,et al.Efficacy and tolerance of algosteril (calcium alginate) versus jelonet (paraffin gauze) in the treatment of scalp graft donor sites in children.Results of a randomized study[J].Ann Chir Plast Esthét,2002,47(4):285-290.
[17] KERSTIN P,LARS S.How to dress donor sites of split thickness skin grafts:a prospective,randomised study of four dressings[J].Scandinavian Journal of Plastic & Reconstructive Surgery & Hand Surgery,2000,34(1):55-59.
[18] WEBER R S,HANKINS P,LIMITONE E,et al.Split-thickness skin graft donor site management.A randomized prospective trial comparing a hydrophilic polyurethane absorbent foam dressing with a petrolatum gauze dressing[J].Arch Otolaryngol Head Neck Surg,1995,121(10):1145-1149.
[19] BIAN Y,SUN C,ZHANG X,et al.Wound-healing improvement by resurfacing split-thickness skin donor sites with thin split-thickness grafting[J].Burns,2016,42(1):123-130.
[20] BR?LMANN F E,ESKES A M,GOSLINGS J C,et al.Randomized clinical trial of donor-site wound dressings after split-skin grafting[J].British Journal of Surgery,2013,100(5):619-627.
[21] SEREBRAKIAN A T,PICKRELL B B,VARON D E,et al.Meta-analysis and systematic review of skin graft donor-site dressings with future guidelines[J].Plast Reconstr Surg Glob Open,2018,6(9):e1928.
[22] BROWN J E,HOLLOWAY S L.An evidence-based review of split-thickness skin graft donor site dressings[J].Int Wound J,2018,15(6):1000-1009.
[23] WIECHULA R.The use of moist wound-healing dressings in the management of split-thickness skin graft donor sites:a systematic review[J].International Journal of Nursing Practice,2003,9(2):S9-S17.
[24] VOINESKOS S H,AYENI O A,MC KNIGHT L,et al.Systematic review of skin graft donor-site dressings[J].Plastic & Reconstructive Surgery,2009,124(1):298-306.
[25] RAKEL B A,BERMEL M A,ABBOTT L I,et al.Split-thickness skin graft donor site care:a quantitative synthesis of the research[J].Journal of Wocn,1998,27(1):A12.
[26] 胡爱玲,郑美春,李伟娟.现代伤口与肠造口临床护理实践[M].北京:中国协和医科大学出版社,2010:54-60.
[2] JANSEN P,STOFFELS I,KLODE J,et al.Postsurgical treatment of split skin graft donor sites in dermatological departments[J].International Journal of Lower Extremity Wounds,2018,17(1):22-29.
[3] CALIOT J,BODIN F,CHIRIAC S,et al.Split-thickness skin graft donor site:which dressing use?[J].Ann Chir Plast Esthet,2015,60(2):140-147.
[4] GEARY P M,TIERNAN E.Management of split skin graft donor sites-results of a national survey[J].Journal of Plastic Reconstructive & Aesthetic Surgery,2009,62(12):1677-1683.
[5] 付小兵,吴志谷.现代创伤敷料理论与实践[M].北京:化学工业出版社,2007:669-672.
[6] 刘海兵,唐丹,曹海燕,等.温哥华瘢痕量表的信度研究[J].中国康复医学杂志,2006,21(3):240-242.
[7] OREMUS M,WOLFSON C,PERRAULT A,et al.Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer′s disease drug trials[J].Dementia & Geriatric Cognitive Disorders,2001,12(3):232-236.
[8] 陈炯,苏国良,李强,等.不同敷料组合对烧伤患者供皮区创面微环境的影响[J].中华烧伤杂志,2009,25(3):218-221.
[9] 井维斌,张景华,刘振宝.藻酸钙敷料在供皮区创面的应用[J].中国继续医学教育,2015,7(30):147-148.
[10] 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.
[11] 汪乐,林雪松,黄璐.痊愈妥敷料在烧伤患者刃厚皮供皮区的应用[J].实用医学杂志,2011,27(22):4178-4179.
[12] 吴祖煌,刘敏,王煜,等.湿性敷料促进供皮区创面愈合的临床研究[J].中国实用美容整形外科杂志,2004,15(5):251-252.
[13] 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.
[14] 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.
[15] 张洁,牛星焘,李东.密闭性敷料与凡士林油纱对皮片供皮区创面愈合的比较研究[J].中华整形外科杂志,2000,16(6):351-363.
[16] PANNIER M,MARTINOT V,CASTEDE J C,et al.Efficacy and tolerance of algosteril (calcium alginate) versus jelonet (paraffin gauze) in the treatment of scalp graft donor sites in children.Results of a randomized study[J].Ann Chir Plast Esthét,2002,47(4):285-290.
[17] KERSTIN P,LARS S.How to dress donor sites of split thickness skin grafts:a prospective,randomised study of four dressings[J].Scandinavian Journal of Plastic & Reconstructive Surgery & Hand Surgery,2000,34(1):55-59.
[18] WEBER R S,HANKINS P,LIMITONE E,et al.Split-thickness skin graft donor site management.A randomized prospective trial comparing a hydrophilic polyurethane absorbent foam dressing with a petrolatum gauze dressing[J].Arch Otolaryngol Head Neck Surg,1995,121(10):1145-1149.
[19] BIAN Y,SUN C,ZHANG X,et al.Wound-healing improvement by resurfacing split-thickness skin donor sites with thin split-thickness grafting[J].Burns,2016,42(1):123-130.
[20] BR?LMANN F E,ESKES A M,GOSLINGS J C,et al.Randomized clinical trial of donor-site wound dressings after split-skin grafting[J].British Journal of Surgery,2013,100(5):619-627.
[21] SEREBRAKIAN A T,PICKRELL B B,VARON D E,et al.Meta-analysis and systematic review of skin graft donor-site dressings with future guidelines[J].Plast Reconstr Surg Glob Open,2018,6(9):e1928.
[22] BROWN J E,HOLLOWAY S L.An evidence-based review of split-thickness skin graft donor site dressings[J].Int Wound J,2018,15(6):1000-1009.
[23] WIECHULA R.The use of moist wound-healing dressings in the management of split-thickness skin graft donor sites:a systematic review[J].International Journal of Nursing Practice,2003,9(2):S9-S17.
[24] VOINESKOS S H,AYENI O A,MC KNIGHT L,et al.Systematic review of skin graft donor-site dressings[J].Plastic & Reconstructive Surgery,2009,124(1):298-306.
[25] RAKEL B A,BERMEL M A,ABBOTT L I,et al.Split-thickness skin graft donor site care:a quantitative synthesis of the research[J].Journal of Wocn,1998,27(1):A12.
[26] 胡爱玲,郑美春,李伟娟.现代伤口与肠造口临床护理实践[M].北京:中国协和医科大学出版社,2010:54-60.