负压创面疗法治疗压力性损伤的系统评价

发布时间：2018-03-29 07:39

本文选题：负压创面疗法　切入点：压力性损伤　出处：《吉林大学》2017年硕士论文

【摘要】：目的:应用系统评价的方法对负压创面疗法治疗压力性损伤的有效性、经济性和安全性进行分析。方法:根据研究目的制定文献检索策略,通过对Pub Med、EMBASE、Cochrane Library、Web of Science、Google Scholar、CINAHL、CNKI、万方数据库、VIP、JBI等数据库进行检索,检索时间截止至2016年12月。同时对会议论文、已注册的在研研究和相关学术网站等进行检索,获取所有负压创面疗法治疗压力性损伤的随机对照试验研究的文献,按照预先制定的纳入标准和排除标准筛选符合条件的文献,提取数据并对纳入的文献进行质量评价,并应用Revman软件对结局指标进行统计分析。结果:(1)本研究共检索到负压创面疗法治疗压力性损伤的相关文献1720篇,根据制定的纳入和排除标准,最终纳入29篇负压创面疗法治疗压力性损伤的研究,其中英文文献6篇、中文文献23篇,研究对象共1336名患者。根据JADAD量表对纳入文献进行偏倚风险评估,结果显示高质量文献13篇,低质量文献16篇。(2)共有11篇文献对负压创面疗法组与对照组治疗压力性损伤的治愈率进行对比,7篇文献对有效率进行对比,11篇文献对愈合时间进行对比,2篇文献对肉芽组织生成时间进行对比,6篇文献对住院时间进行对比,4篇文献对换药时间进行对比,2篇文献对抗生素使用时间进行对比,2篇文献对创面清洁时间进行对比,2篇文献对疼痛评分进行对比,2篇文献对创面植皮时间进行对比,3篇文献对不良反应进行对比,4篇文献对医疗费用进行对比。(3)对主要结局指标进行Meta分析的结果显示,负压创面疗法治疗压力性损伤的治愈率[OR=3.26,95%CI(2.19,4.84),P0.001]、有效率[OR=5.33,95%CI(2.63,10.80),P0.00001]、愈合时间[SMD=-3.63,95%CI(-4.92,-2.35),P0.001]、肉芽组织生成所需时间[SMD=-0.48,95%CI(-0.86,-0.09),P0.05]与对照组相比具有统计学意义。对次要结局指标进行Meta分析的结果显示,负压创面疗法治疗压力性损伤的住院时间[SMD=-2.59,95%CI(-3.64,-1.54),P0.001]、换药次数[SMD=-4.54,95%CI(-5.48,-3.60),P0.001]、应用抗生素时间[SMD=-4.68,95%CI(-7.23,-2.14),P0.001]、创面清洁时间[SMD=-2.81,95%CI(-3.60,-2.02),P0.001]、疼痛评分[SMD=-2.77,95%CI(-3.37,-2.17),P0.001]、创面植皮时间[SMD=-6.27,95%CI(-12.21,-0.32),P0.05]、医疗费用[SMD=-1.34,95%CI(-2.18,-0.49),P0.01]与对照组相比具有统计学意义。而负压创面疗法治疗压力性损伤的不良反应与对照组相比没有统计学意义[OR=0.83,95%CI(0.19,3.56),P0.05]。结论:负压创面疗法可提高压力性损伤患者创面的治愈率、有效率;可减少压力性损伤患者创面的愈合时间、肉芽组织生成所需时间、换药次数、创面清洁时间、创面植皮时间,并可缩短患者的住院时间、应用抗生素时间、降低疼痛评分、医疗费用;不会增加压力性损伤患者的不良反应,是一种有效、经济且安全的创面疗法。
[Abstract]:Objective: to analyze the efficacy, economy and safety of negative pressure wound therapy in the treatment of pressure-induced injury by means of systematic evaluation. Through the retrieval of Pub Medus EMBASE Pub of Science Library, Pub Scholarn CINAHLN CNKI, Wanfang database VIPN JBI and so on, the retrieval time is up to December 2016. At the same time, the papers of the conference, the registered research sites in research and related academic websites, etc., have been searched, and so on. To obtain all the literatures of the randomized controlled trial on the treatment of stress injury by negative pressure wound therapy, and to screen the eligible documents according to the pre-established inclusion criteria and exclusion criteria, and to extract the data and evaluate the quality of the included literature. Revman software was used to analyze the outcome index. Results: a total of 1720 articles about the treatment of pressure injury with negative pressure wound therapy were found in this study, according to the criteria of inclusion and exclusion. Finally, 29 studies on the treatment of stress injury with negative pressure wound therapy were included, of which 6 were in Chinese and 6 in Chinese, and a total of 1336 patients were included in the study. The risk of bias was assessed according to the JADAD scale. The results showed that 13 articles were of high quality. A total of 11 articles compared the cure rate of the negative pressure wound therapy group with that of the control group in the treatment of stress injury. 7 articles compared the effective rate. 11 articles compared the healing time and 2 articles. The time of granulation tissue formation was compared. 6 articles were compared with the time of hospitalization. 4 articles compared the time of dressing change. 2 articles compared the time of antibiotic use and 2 articles compared the cleaning time of wound surface. 2 articles were compared with pain score and 2 articles were used to compare the time of skin grafting on the wound. 3 articles were compared on adverse reactions. 4 articles were compared with the medical expenses. 3) the results of Meta analysis on the main outcome indexes were found. The cure rate of negative pressure wound therapy for pressure-induced injury [OR3.2695CI2.194.84 / P0.001], the effective rate [OR5.3395CI2.63310.80], the healing time [SMD-3.6395CI-4.92-2.35P0.001], the time of granulation tissue formation [SMD-0.4895CI-0.868-0.09] were statistically significant compared with those of the control group. The length of stay in hospital [SMD-2.5995CI-3.64CI-1.54 P0.001], the times of dressing change [SMD-4.545CI-5.48-3.60P0.001], the time of application of antibiotics [SMD-4.6895CI-7.23-2.14C0.001], the time of wound cleaning [SMD-2.81CI-3.60-2.02P0.001], the pain score [SMD-2.795CI-3.377CI-2.17P0.001], the time of skin grafting [SMD-6.2795CI-12.21- 0.320.320.32] [SMD-2.81CI-3.60-2.02P0.001], the pain score [SMD-2.795 CI-3.377-CI-2.17p0.001], the time of skin grafting [SMD-6.2795CI-12.21- 0.320.32] [SMD-2.895 CI-3.60-2.02P0.001] and the pain score [SMD-2.795 CI-3.377-2.17P0.001], [SMD-2.895 CI-3.60-2.02P0.001], [SMD-2.795 CI-3.375-2.17], [SMD-6.2795CI-12.21-0.320.32], [SMD-2.895 CI-3.60-2.02P0.001]; However, there was no significant difference between negative pressure wound therapy and control group in the treatment of stress injury. Conclusion: negative pressure wound therapy can improve the healing rate of the patients with pressure injury, but there is no significant difference between the treatment group and the control group [ORO 0.8395] .Conclusion: negative pressure wound therapy can improve the healing rate of the patients with pressure injury. The effective rate can reduce wound healing time, granulation tissue formation time, times of dressing change, wound cleaning time, wound skin grafting time, hospital stay time and antibiotic application time. Reducing pain scores, medical costs, and not increasing adverse reactions in patients with stress injuries is an effective, economical and safe wound therapy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R641

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