深度烧伤植皮术后创面应用负压封闭引流治疗效果的Meta分析

目的系统评价深度烧伤植皮术后创面应用负压封闭引流(vacuum sealing drainage,VSD)治疗的有效性。方法根据已制定的纳入与排除标准,用计算机检索1980年1月1日至2018年12月31日中国期刊全文数据库(中国知网)、中文科技期刊数据库(维普)、中国学术期刊数据库(万方数据)中关于VSD治疗深度烧伤植皮术后创面的随机对照试验的中文文献,并手工检索纳入文献中符合标准的参考文献。提取文献数据后采用国际Cochrane协作网推荐的RCT偏倚风险评价工具进行系统评价,Rev Man 5.3软件进行Meta分析。结果共纳入符合标准的文献9篇,包括628例患者。Meta分析结果显示:(1)深度烧伤植皮术后创面行VSD治疗的创面愈合时间明显短于常规换药及加压包扎WMD=-4.71,95%CI(-6.22,-4.71),P<0.00001];(2)深度烧伤植皮术后创面行VSD治疗的创面感染发生率明显低于常规换药及加压包扎OR=0.16,95%CI(0.07,0.40),P<0.0001],皮下积液发生率也明显低于常规换药及加压包扎OR=0.09,95%CI(0.01,0.70),P<0.0001]。结论基于现有证据,相比于常规换药与加压包扎,VSD更有助于促进深度烧伤植皮术后创面愈合,缩短创面愈合时间,并降低创面感染发生率及皮下积液发生率。但由于偏倚因素影响,期待未来能够有更高质量的相关研究为VSD在深度烧伤植皮术后创面中的应用提供更可靠的证据支持。

Meta-analysis of the Effect of Vacuum Sealing Drainage in the Treatment of the Wound after Skin Grafting for Deep Burn Treatment

Objective To systematically evaluate the effect of vacuum sealing drainage(VSD)in the treatment of wounds after skin grafting for deep burn treatment.Methods Chinese literature published from January 1,1980 to December 31,2018 on randomized controlled trails about the effect of VSD in the treatment of wounds after skin grafting for deep burn treatment were retrieved based on established inclusion and exclusion criteria with computers from Chinese journal fulltext database(CJFD),China Scientific Journal Database(CSJD)and China Science Periodical Database(CSPD).The references that meet the criteria were retrieved manually.After the extraction of literature data,systematic evaluation was made using the risk of bias tool for randomized controlled trails(RCT)recommended by The Cochrane Collaboration and meta-analysis was performed using RevMan 5.3 software.Results 9 literature that meet the criteria were included,involving 628 patients.Meta-analvsis results showed that:(1)The healing time of wound treated with VSD after skin grafting for deep burn treatment was significantly shorter than that with conventional dressing change and pressure dressingWMD=-4.71,95%CI(-6.22,-4.71),P<0.00001];(2)The infection incidence of wounds treated with VSD after skin grafting for deep burn treatment was significantly lower than that with conventional dressing change and pressure dressingOR=0.16,95%CI(0.07,0.40),P<0.0001]and incidence of subcutaneous effusion was also significantly lower than that with conventional dressing change and pressure dressingOR=0.09,95%CI(0.01,0.70),P<0.0001].Conclusion Based on the existing evidence,compared with conventional dressing change and pressure dressing,VSD is better in promoting the healing of wound after skin grafting for deep bum treatment,shortening the wound healing time,and reducing the incidence of wound infection and subcutaneous effusion.However,the above studies are affected by bias factors,so we look forward to having higher quality studies in the future to provide more reliable evidence for the application of VSD in the treatment of wound after skin grafting for deep burn.