“创面床准备”理论实施的系统评价

目的 评价“创面床准备”理论的实施对慢性创面的治疗效果,从而得出一个系统、规范、科学的慢性创面治疗原则.方法 采用Cochrane系统评价方法,检索万方,中国期刊网(CNKI)、中国生物医学文献光盘数据库(CBM)和PubMed等电子数据库,对国内外公开发表的有关“创面床准备”理论实施的研究文献进行荟萃分析.结果 共纳入65个研究、3989例各种慢性创面疾病患者.干预措施包括不同时期选择合适新型敷料、各种生长因子,清创及封闭式负压引流.按测量指标和干预措施进行亚组分析,得出结果:实施“创面床准备”理论,其创面的愈合率0R=2.12,95％ CI( 1.79,2.52)]、愈合时间WMD =-12.38,95％ CI(-15.14,-9.62)]、换药次数WMD=-15.56,95％CI(-20.57,-10.56)]、需要植皮手术的例数 0R=0.26,95％ CI (0.10,0.66)]、缩小创面面积WMD=8.97, 95％ CI( 1.04,16.91)]、植皮手术成功率0R=5.69,95％CI(2.19,14.82)]均优于对照组,治疗费用WMD=- 1.53,95％CI(-10.38,7.33)]与对照组差异无统计学意义.结论 实施“创面床准备”理论指导治疗,可以提高创面的愈合率,减少创面愈合时间,加速缩小创面面积,减少换药次数,减少需要植皮手术率,提高植皮手术成功率,并且不增加治疗费用.

Clinical outcomes of wound bed preparation: a systematic review

Objective To assess the efficacy of “wound bed preparation” theory in the treatment of chronic wounds,and to provide systematic,standardized and scientific principles for treatment of chronic wounds.Methods Relevant studies on clinical use of wound bed preparation published worldwide were search in Cochrane Library,Wanfang,CNKI,CBM and PubMed databases.The quality of these studies was evaluated in meta- analysis.Results Sixty- five studies recruiting 3989 cases of chronic wound were included.The interventions at different stages included proper use of novel dressings,growth factors,debridement and negative pressure wound therapy.Meta- analysis showed that use of “wound bed preparation” theory was associated with favorable outcomes in healing rate OR=2.12,95％ CI (1.79,2.52) ],healing time WMD=-12.38,95％ CI ( -15.14,-9.62) ],frequency of wound dressing WMD=-15.56,95％ CI (-20.57,-10.56) ],the need for skin-grafting OR=0.26,95％ CI(0.I0,0.66) ],wound area reduction WMD=8.97,95％CI (1.04,16.91)] and successful skin-grafting 0R=5.69,95％ CI(2.19,14.82) ] but with comparable medical cost WMD=-l.53,95％ CI(-10.38,7.33) ] compared with the control group.Conclusion Use of “wound bed preparation” theory may provide guidance for treatment and lead to higher healing rate,quicker wound-healing and wound area reduction,less frequent wound dressing,less need and higher success rate for skin-grafting,but not more medical expenses.