银离子敷料治疗慢性感染伤口的Meta分析
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摘要
背景:银离子敷料具有良好的抗感染作用,但有关其对慢性感染伤口的治疗效果仍缺乏随机对照研究的证据。目的:系统评价银离子敷料用于治疗慢性感染伤口的效果。方法:应用计算机检索建库至2018年8月PubMed、Cochrane library、EMbase、Web of science、中文科技期刊全文数据库、中国期刊全文数据库、中国生物医学文献数据库、万方数据库及百度学术资源系统中,关于银离子敷料治疗慢性感染伤口的随机对照试验,经2名研究生筛选文献,提取资料与评价文献质量后,采用Revman5.3软件进行Meta分析。结果与结论:最终纳入9篇文献,共1268例患者,其中试验组采用银离子敷料进行治疗,对照组采用硅藻酸盐敷料、常规敷料、泡沫敷料、普通敷料、无菌纱布、凡士林纱布、灭菌纱布或聚维酮碘纱布中的一种进行治疗。Meta分析结果显示,试验组伤口愈合率高于对照组[OR=4.53,95%CI(2.87,7.15),P <0.000 01],伤口面积减少率高于对照组[MD=8.90,95%CI(2.05,15.76),P=0.01],换药次数少于对照组[MD=-8.91,95%CI(-14.33,-3.48),P=0.001],清创时间少于对照组[MD=-8.92,95%CI(-10.03,-7.81),P <0.000 01]。结果表明,银离子敷料能促进慢性感染伤口的愈合。
BACKGROUND: Silver dressings have good anti-infective effect, but there is still a lack of evidence from randomized controlled studies on the efficacy of silver dressings in the treatment of chronic infected wounds.OBJECTIVE: To systematically evaluate the efficacy of silver dressings in the treatment of chronic infected wounds.METHODS: Databases of PubMed, Cochrane Library, EMbase, Web of science, CNKI, CBM, WanFang and Baidu Scholar were searched for the randomized controlled trials reporting the efficacy of silver dressings on chronic infected wounds published before August 2018. Literature screening, data extraction and quality assessment were conducted by two researchers, and a meta-analysis was performed on RevMan 5.3 software.RESULTS AND CONCLUSION: Nine randomized controlled trials including 1 268 patients were enrolled. The trial group was treated with silver dressings, and the control group was treated with dialginate dressings, conventional dressings, foam dressings, general dressings,sterile gauze, vaseline gauze, sterilized gauze or povidone iodine gauze. The meta-analysis results showed that compared with the control group, the wound healing rate in the trial group was increased [OR=4.53, 95%CI(2.87, 7.15), P < 0.000 01], the rate of wound area reduction was increased [MD=8.90, 95%CI(2.05, 15.76), P=0.01], the times of dressing change was decreased [MD=-8.91, 95%CI(-14.33,-3.48),P=0.001], and the debridement time was shortened [MD=-8.92, 95%CI(-10.03,-7.81), P < 0.000 01]. To conclude, silver dressings can promote healing of chronic infected wounds.
BACKGROUND: Silver dressings have good anti-infective effect, but there is still a lack of evidence from randomized controlled studies on the efficacy of silver dressings in the treatment of chronic infected wounds.OBJECTIVE: To systematically evaluate the efficacy of silver dressings in the treatment of chronic infected wounds.METHODS: Databases of PubMed, Cochrane Library, EMbase, Web of science, CNKI, CBM, WanFang and Baidu Scholar were searched for the randomized controlled trials reporting the efficacy of silver dressings on chronic infected wounds published before August 2018. Literature screening, data extraction and quality assessment were conducted by two researchers, and a meta-analysis was performed on RevMan 5.3 software.RESULTS AND CONCLUSION: Nine randomized controlled trials including 1 268 patients were enrolled. The trial group was treated with silver dressings, and the control group was treated with dialginate dressings, conventional dressings, foam dressings, general dressings,sterile gauze, vaseline gauze, sterilized gauze or povidone iodine gauze. The meta-analysis results showed that compared with the control group, the wound healing rate in the trial group was increased [OR=4.53, 95%CI(2.87, 7.15), P < 0.000 01], the rate of wound area reduction was increased [MD=8.90, 95%CI(2.05, 15.76), P=0.01], the times of dressing change was decreased [MD=-8.91, 95%CI(-14.33,-3.48),P=0.001], and the debridement time was shortened [MD=-8.92, 95%CI(-10.03,-7.81), P < 0.000 01]. To conclude, silver dressings can promote healing of chronic infected wounds.
引文
[1]Swanson T,Angel D,Sussman G,et al.International Wound Infection Institute(IWII)Wound infection in clinical practice.Wounds International,2016.https://www.hud.ac.uk/ourstaff/profile/index.php?staffid=1395
[2]Korol E,Johnston K,Waser N,et al.A systematic review of risk factors associated with surgical site infections among surgica patients.PLo S One.2013;8(12):e83743.
[3]Collier M.Recognition and management of wound infections.World Wide Wounds.2004.
[4]Eberlein T,Assadian O.Clinical use of polihexanide on acute and chronic wounds for antisepsis and decontamination.Skin Pharmacol Physiol.2010;23 Suppl:45-51.
[5]Sibbald RG,Orsted H,Schultz GS,et al.Preparing the wound bed 2003:focus on infection and inflammation.Ostomy Wound Manage.2003;49(11):24-51.
[6]Meaume S,Vallet D,Morere MN,et al.Evaluation of a silver-releasing hydroalginate dressing in chronic wounds with signs of local infection.J Wound Care.2005;14(9):411-419.
[7]Emmerson AM,Enstone JE,Griffin M,et al.The Second National Prevalence Survey of infection in hospitals--overview of the results.J Hosp Infect.1996;32(3):175-190.
[8]Plowman R.The socioeconomic burden of hospital acquired infection.Euro Surveill.2000;5(4):49-50.
[9]Mitura K,Oslowska J,Mitura A.A change of traditional methodof treatment of partial thickness burn with hydrofibre dressings.Pol Przegl Chir.2015;87(2):91-96.
[10]Glat PM,Zhang SH,Burkey BA,et al.Clinical evaluation of a silver-impregnated foam dressing in paediatric partial-thickness burns.J Wound Care.2015;24 Suppl 4a:S4-S10.
[11]Munter KC,Beele H,Russell L,et al.Effect of a sustained silver-releasing dressing on ulcers with delayed healing:the CONTOP study.J Wound Care.2006;15(5):199-206.
[12]Jorgensen B,Price P,Andersen KE,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.
[13]吴玉琴,卢姝姝,金磊磊.等.银离子抗菌敷料在压疮感染性伤口中的应用与效果观察[J].中华医院感染学杂志,2013,23(9):2079-2081.
[14]戴燕,向利娟,石玉兰.基于多维效益银敷料治疗感染伤口临床效果对比研究[J].四川医学,2014,35(5):619-620.
[15]王永勤.银离子抗菌敷料在压疮感染性伤口中的应用与效果观察[J].中国实用医药,2015,10(4):211-212.
[16]陈晓林,冉春玲.银离子抗菌敷料在骨科感染伤口中的应用与效果观察[J].现代医药卫生,2016,32(4):599-600.
[17]周惠珍.纳米银离子敷料在慢性感染伤口护理中的临床价值[J].中国医药科学,2017,7(21):118-120.
[18]赵丽萍.银离子抗菌敷料在压疮感染性伤口中的应用与效果观察[J].中国医疗器械信息,2018,24(3):149-150.
[19]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.
[20]Meekul J,Chotirosniramit A,Himakalasa W,et al.ARandomized Controlled Trial on the Outcome in Comparing an Alginate Silver Dressing With a Conventional Treatment of a Necrotizing Fasciitis Wound.Int J Low Extrem Wounds.2017;16(2):108-113.
[21]World Union of Wound Healing Societies.Principles of best practice:Minimising pain at wound dressing-related procedures.A consensus document.London:MEP Ltd,2004.
[22]Caruso DM,Foster KN,Blome-Eberwein SA,et al.Randomized clinical study of Hydrofiber dressing with silver or silver sulfadiazine in the management of partial thickness burns.JBurn Care Res.2006;27(3):298-309.
[23]Opasanon S,Muangman P,Namviriyachote N.Clinical effectiveness of alginate silver dressing in outpatient management of partial-thickness burns.Int Wound J.2010;7(6):467-471.
[24]Paddock HN,Fabia R,Giles S,et al.A silver impregnated antimicrobial dressing reduces hospital costs for pediatric burn patients.J Paediatr Surg.2007;42(1):211-213.
[25]Leaper D,Drake R.Should one size fit all?An overview and critique of the VULCAN study on silver dressings.Int Wound J.2011;8(1):1-4.
[26]Gottrup F,Apelqvist J.The challenge of using randomized trials in wound healing.Br J Surg.2010;97(3):303-304.
[27]Leaper D.Evidence-based Wound Care in the UK.Int Wound J.2009;6(2):89-91.
[28]Leaper D.Cochrane:Hands Off Wound Care.Int Wound J.2009;6(4):309-310.
[29]Gottrup F,Apelqvist J.Present and new techniques and devices in the treatment of DFU:a critical review of evidence.Diabetes Metab Res Rev.2012;28 Suppl 1:64-71.
[30]Tomaselli N.The role of topical silver preparation in wound healing.J Wound Ostomy Continence Nurs.2006;33(4):367-380.
[31]Bergin SM,Wraight P.Silver Based wound dressings and topical agents for treating diabetic foot ulcers.Cochrane Database Syst Rev.2006;(1):CD005082.
[2]Korol E,Johnston K,Waser N,et al.A systematic review of risk factors associated with surgical site infections among surgica patients.PLo S One.2013;8(12):e83743.
[3]Collier M.Recognition and management of wound infections.World Wide Wounds.2004.
[4]Eberlein T,Assadian O.Clinical use of polihexanide on acute and chronic wounds for antisepsis and decontamination.Skin Pharmacol Physiol.2010;23 Suppl:45-51.
[5]Sibbald RG,Orsted H,Schultz GS,et al.Preparing the wound bed 2003:focus on infection and inflammation.Ostomy Wound Manage.2003;49(11):24-51.
[6]Meaume S,Vallet D,Morere MN,et al.Evaluation of a silver-releasing hydroalginate dressing in chronic wounds with signs of local infection.J Wound Care.2005;14(9):411-419.
[7]Emmerson AM,Enstone JE,Griffin M,et al.The Second National Prevalence Survey of infection in hospitals--overview of the results.J Hosp Infect.1996;32(3):175-190.
[8]Plowman R.The socioeconomic burden of hospital acquired infection.Euro Surveill.2000;5(4):49-50.
[9]Mitura K,Oslowska J,Mitura A.A change of traditional methodof treatment of partial thickness burn with hydrofibre dressings.Pol Przegl Chir.2015;87(2):91-96.
[10]Glat PM,Zhang SH,Burkey BA,et al.Clinical evaluation of a silver-impregnated foam dressing in paediatric partial-thickness burns.J Wound Care.2015;24 Suppl 4a:S4-S10.
[11]Munter KC,Beele H,Russell L,et al.Effect of a sustained silver-releasing dressing on ulcers with delayed healing:the CONTOP study.J Wound Care.2006;15(5):199-206.
[12]Jorgensen B,Price P,Andersen KE,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.
[13]吴玉琴,卢姝姝,金磊磊.等.银离子抗菌敷料在压疮感染性伤口中的应用与效果观察[J].中华医院感染学杂志,2013,23(9):2079-2081.
[14]戴燕,向利娟,石玉兰.基于多维效益银敷料治疗感染伤口临床效果对比研究[J].四川医学,2014,35(5):619-620.
[15]王永勤.银离子抗菌敷料在压疮感染性伤口中的应用与效果观察[J].中国实用医药,2015,10(4):211-212.
[16]陈晓林,冉春玲.银离子抗菌敷料在骨科感染伤口中的应用与效果观察[J].现代医药卫生,2016,32(4):599-600.
[17]周惠珍.纳米银离子敷料在慢性感染伤口护理中的临床价值[J].中国医药科学,2017,7(21):118-120.
[18]赵丽萍.银离子抗菌敷料在压疮感染性伤口中的应用与效果观察[J].中国医疗器械信息,2018,24(3):149-150.
[19]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.
[20]Meekul J,Chotirosniramit A,Himakalasa W,et al.ARandomized Controlled Trial on the Outcome in Comparing an Alginate Silver Dressing With a Conventional Treatment of a Necrotizing Fasciitis Wound.Int J Low Extrem Wounds.2017;16(2):108-113.
[21]World Union of Wound Healing Societies.Principles of best practice:Minimising pain at wound dressing-related procedures.A consensus document.London:MEP Ltd,2004.
[22]Caruso DM,Foster KN,Blome-Eberwein SA,et al.Randomized clinical study of Hydrofiber dressing with silver or silver sulfadiazine in the management of partial thickness burns.JBurn Care Res.2006;27(3):298-309.
[23]Opasanon S,Muangman P,Namviriyachote N.Clinical effectiveness of alginate silver dressing in outpatient management of partial-thickness burns.Int Wound J.2010;7(6):467-471.
[24]Paddock HN,Fabia R,Giles S,et al.A silver impregnated antimicrobial dressing reduces hospital costs for pediatric burn patients.J Paediatr Surg.2007;42(1):211-213.
[25]Leaper D,Drake R.Should one size fit all?An overview and critique of the VULCAN study on silver dressings.Int Wound J.2011;8(1):1-4.
[26]Gottrup F,Apelqvist J.The challenge of using randomized trials in wound healing.Br J Surg.2010;97(3):303-304.
[27]Leaper D.Evidence-based Wound Care in the UK.Int Wound J.2009;6(2):89-91.
[28]Leaper D.Cochrane:Hands Off Wound Care.Int Wound J.2009;6(4):309-310.
[29]Gottrup F,Apelqvist J.Present and new techniques and devices in the treatment of DFU:a critical review of evidence.Diabetes Metab Res Rev.2012;28 Suppl 1:64-71.
[30]Tomaselli N.The role of topical silver preparation in wound healing.J Wound Ostomy Continence Nurs.2006;33(4):367-380.
[31]Bergin SM,Wraight P.Silver Based wound dressings and topical agents for treating diabetic foot ulcers.Cochrane Database Syst Rev.2006;(1):CD005082.