敷料预防无创正压通气鼻面部压疮效果的网状Meta分析

目的采用网状Meta分析方法评价7种常用敷料预防无创正压通气(NIPPV)患者鼻面部压疮的效果。方法以压疮、正压通气、positive pressure pespiration、pressure ulcer等检索词检索PubMed、EMbase、Cochrane Library、Web of Science、CINAHL、中国生物医学文献数据库(CBM)、中国知网(CNKI)及万方数据库等中外文数据库,检索时间截止2015年7月,纳入对比敷料预防NIPPV患者鼻面部压疮的随机对照试验(RCT)。由2名研究者独立进行数据提取和质量评价,采用WinBugs、Stata软件分析数据。结果最终纳入27个RCT,共2 797例患者。网状Meta分析结果显示,7种敷料预防NIPPV患者鼻面部压疮效果均优于常规护理措施(均P0.05)。根据累积排序概率曲线下面积(SUCRA)排序结果,凝胶敷料、泡沫敷料是预防NIPPV患者鼻面部压疮的较优方案。结论基于网状Meta分析结果和SUCRA排序结果,凝胶敷料和泡沫敷料预防NIPPV患者鼻面部压疮效果优于其他敷料。未来研究应关注不同种类敷料间效果的直接比较及成本效果评价。     

老年糖尿病并消化性溃疡的临床特点

目的探讨老年糖尿病患者并消化性溃疡的临床特点。方法将237例老年消化性溃疡患者按是否患糖尿病分为观察组和对照组,比较两组的临床表现、溃疡部位、溃疡直径及HP感染情况。结果两组患者在临床症状、溃疡部位、溃疡直径及HP感染率等方面比较差异均有统计学意义(P<0.05)。结论与老年单纯性溃疡患者比较,老年糖尿病并消化性溃疡患者其腹痛和反酸、暖气等症状不明显,胃溃疡和复合溃疡发生率较高,溃疡直径较大,HP感染率较高。     

The burden of costs on health services from patients with venous leg ulcers in Singapore

Healthcare costs arising from venous leg ulcers (VLU) are expected to increase due to an aging population and increased prevalence of comorbidities. We aim to estimate the healthcare resources incurred by VLU patients, and to quantify the extent to which predictors explain variation in cost-related outcomes. Retrospective patient-level cohort data for VLU patients were analysed using generalised linear regression models. Data were extracted from a tertiary hospital registry in Singapore, between 2013 and 2017. The outcome variables were length of stay per admission; inpatient and outpatient bill per admission; whether a patient underwent a surgical treatment of the venous system; and, whether they visited the emergency department. Cost outcomes were reported in Singapore dollars (S$). A total of 162 VLU patients were included with a mean age of 67.5 (±14.4). For the inpatient setting the mean length of stay was 8.1 days and the mean inpatient bill was S$7886. For outpatients, the mean number of dressings was 29.4, and mean outpatient bill was S$6962. Heart disease patients incurred longer hospital stays and larger inpatient bills per admission and females had greater odds of undergoing a surgical procedure on the venous system. Certain VLU patient groups were found to be associated with larger cost outcomes.     

The relationship between vitamin D deficiency and diabetic foot ulcer: A meta-analysis

A meta-analysis investigation to measure the relationship between vitamin D deficiency (VDD) and diabetic foot ulcer (DFU). A comprehensive literature inspection till February 2023 was applied and 1765 interrelated investigations were reviewed. The 15 chosen investigations enclosed 2648 individuals with diabetes mellitus in the chosen investigations' starting point, 1413 of them were with DFUs, and 1235 were without DFUs. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the relationship between VDD and DFU by the dichotomous and continuous approaches and a fixed or random model. Individuals with DFUs had significantly lower vitamin D levels (VDL) (MD, −7.14; 95% CI, −8.83 to −5.44, P < 0.001) compared to those without DFU individuals. Individuals with DFUs had a significantly higher number of VDD individuals (OR, 2.27; 95% CI, 1.63-3.16, P < 0.001) compared to those without DFU individuals. Individuals with DFU had significantly lower VDL and a significantly higher number of VDD individuals compared to those without DFU individuals. However, caused of the small sample sizes of several chosen investigations for this meta-analysis, care must be exercised when dealing with its values.     

Validity and reliability of Chinese version of the new diabetic foot ulcer assessment scale

A specific assessment tool is urgently needed to guide effective wound care for diabetic foot ulcers. However, the tool has not been available in Chinese. We aimed to culturally translate and verify the validity and reliability of the new Diabetic Foot Ulcer Assessment Scale (DFUAS). The original scale was translated into Chinese according to the Brislin guidelines. Patients satisfying the inclusion and exclusion criteria were recruited. Each of the included foot ulcers was evaluated independently by two wound care specialists using the new DFUAS and by the third wound care specialists at the same time using the Bates-Jensen Wound Assessment Tool according to per guidelines. 210 diabetic foot ulcers were included for data analysis. The S-CVI of the Chinese version of the DFUAS was 0.96, and the I-CVIs ranged from 0.89 to 0.98. The total Cronbach's Alpha of the scale was 0.709, and the corrected item-total correlation of the items ranged from 0.4 to 0.872. The DFUAS had high inter-observer reliability of 0.997, and there were weak, moderate, and strong correlations between each pair of the items. The Bland–Altman plots showed a good agreement between the scale and the Bates-Jensen Wound Assessment Tool. We concluded that the Chinese version of the DFUAS showed good validity and reliability and is a reliable instrument for the assessment of diabetic foot ulcers.     

腹腔镜行消化性溃疡急性穿孔修补手术的临床研究

目的探讨腹腔镜治疗消化性溃疡急性穿孔的临床价值。方法对腹腔镜手术组（腔镜组）53例和开腹手术组（开腹组）54例患者的手术时间、术中出血量、肠鸣音恢复时间、住院时间、使用镇痛剂例数、住院费用、术后切口及腹腔感染例数等指标进行比较。结果腔镜组术中出血量、术后肠鸣音恢复时间、住院时间、使用镇痛剂等指标均显著小于开腹组（P〈0．05）。结论腹腔镜手术具有侵袭性小、腹腔干扰小、术后痛苦小、肠功能恢复快、住院时间短等优点，可成为治疗消化性溃疡急性穿孔优先选择的治疗方法。     

A systematic review of the effectiveness of negative pressure wound therapy in the management of diabetes foot ulcers

Foot ulcers are a common complication in patients with diabetes. Negative pressure wound therapy (NPWT) is a wound care therapy that is being increasingly used in the management of foot ulcers. This article presents a systematic review examining the effectiveness of this therapy. The review question is how effective is NPWT in achieving wound healing in diabetes foot ulcers? The primary outcome for this study was the number of patients achieving complete wound healing (secondary outcomes, other markers of wound healing, adverse events and patient satisfaction). A systematic literature review and tabulative synthesis of randomised controlled trials (RCTs). The review identified four RCTs of weak to moderate quality. Only one study examining NPWT in postamputation wound healing reported data on the primary outcome. These data show a 20% improvement in wound healing [odds ratios = 2·0%, confidence interval (CI) ?1·0 to 4·0] and number needed to treat = 6 (CI 4–64). No serious treatment‐related complications were reported by any of the studies. One study suggested a reduction in the risk of secondary amputation (absolute risk reduction = 7·9%, CI 0·5–15·43). Studies also reported an increase in granulation and wound‐healing rates in patients treated with NPWT therapy. No data on patient satisfaction or experience were reported. While all the studies included in the review indicated that the NPWT therapy is more effective than conventional dressings, the quality of the studies were weak and the nature of the inquiries in terms of outcome and patient selection divergent. There is a strong need for larger trials to assess NPWT therapy in diabetes care with different groups of patients and in relation to different clinical objectives and parameters.     

Definition of efficiency in vacuum therapy – a randomised controlled trial comparing Redon drains with V.A.C.® Therapy™

Redon drains are still used to suction wounds for vacuum sealing. Vacuum‐assisted closure (V.A.C.^®; Kinetic Concepts Inc, San Antonio, TX) is a computer‐controlled therapy system for delivering topical negative pressure therapy. The efficiency of V.A.C. in the treatment of pressure ulcers was prospectively studied in a randomised controlled trial in which patients with pressure ulcers were randomly assigned to negative pressure wound therapy (NPWT) using either V.A.C. or Redon bottles. The target parameters were absolute and relative proportion of wound area consists of granulation tissue, fibrin and necrosis. Other outcome measures were the number of dressing changes and time invested using each system. The study was terminated after a post hoc analysis after inclusion of ten patients because of the significantly better results when using V.A.C., and the substantially larger care effort needed in the Redon group compared with the V.A.C. group. An increase in surface granulation tissue of 54% was observed in the V.A.C. group, and a reduction in the Redon group (P = 0·001). The Redon group showed an increase in fibrin tissue at the wound base of 21·8%, whereas in the V.A.C group, a 27% reduction was observed (P = 0·035). Necrosis was reduced in the V.A.C. group, but this difference did not reach significance. Redon bottles are not a good alternative for V.A.C. therapy for delivering NPWT.     

MEBO治疗慢性难愈性皮肤溃疡的临床疗效观察

目的观察湿润烧伤膏(Moist Exposed Burn Ointment,MEBO)治疗慢性难愈性皮肤溃疡的临床疗效。方法对2010年1月-2014年12月收治的344例慢性难愈性皮肤溃疡患者创面采用"药刀结合"的方法治疗,药即MEBO,刀即外科清创术、植皮术等。患者初诊时尽量清除创面坏死组织,不能耐受一次性清创者行蚕食疗法;清创后创面均匀涂抹MEBO并外敷MEBO药纱包扎治疗,存在潜腔的创面用MEBO药纱填塞引流,待肉芽组织填满创面后行肉芽创面游离植皮术。观察患者创面愈合时间及愈合情况。结果344例患者中除38例患者好转后自动出院,3例患者死于基础疾病外,其余303例患者创面均完全愈合,愈合率达88.1%,创面平均愈合时间为80.4 d±15.8 d。其中,193例患者经MEBO换药治疗后创面自行愈合(56.1%);48例合并趾骨坏死的糖尿病足患者进行了坏死组织剜除术(14.0%);34例骨外露创面进行了钻孔术(9.9%);54例患者进行了肉芽创面植皮术(包括接受趾骨剜除术及骨钻孔术后的创面)。89例烧伤残余创面愈合较快,最短为7 d,最长为29 d,平均愈合时间为18.8 d±4.9 d。结论MEBO可有效控制创面感染,促进坏死组织液化脱落及肉芽组织生长,缩短创面愈合时间,减轻患者疼痛,适时配合"刀法"还可进一步加速坏死组织脱落,促进肉芽组织生长,及时封闭创面,减少瘢痕增生,是治疗慢性难愈性皮肤溃疡的理想方法。