六种敷料对全髋、膝关节置换后伤口安全性的系统评价  

Systematic evaluation of six dressings on wound safety following total hip and knee arthroplasty

作　　者：游艾佳 李文婕 周俊丽 李春[1] You Aijia;Li Wenjie;Zhou Junli;Li Chun(School of Nursing,Guangzhou University of Chinese Medicine,Guangzhou 510006,Guangdong Province,China)

机构地区：[1]广州中医药大学护理学院,广东省广州市510006

出　　处：《中国组织工程研究》2023年第3期486-492,共7页Chinese Journal of Tissue Engineering Research

基　　金：2020年度广东省普通高校特色创新项目(2020KTSCX025),项目名称:龟板提取物诱导毛囊干细胞结合多细胞Bio-3D打印组织工程皮肤研究,项目负责人:李春。

摘　　要：目的:近年来,全髋、膝关节置换手术率不断上升,术后伤口需要覆盖敷料以保护新生皮肤组织,选择一种安全性高的医用敷料是目前重点关注的问题。文章系统评价6种医用敷料对全髋、膝关节置换后伤口的安全性。方法:在中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library及Scopus数据库中,检索关于不同种医用敷料应用于全髋、膝关节置换术后伤口的研究,检索时限设为各数据库建库至2021年12月,由2名研究者分别独立进行文献的筛选和数据提取。运用Stata 16.0、RevMan 5.4软件对主要结局指标水疱率进行网状Meta分析,对次要结局指标感染率、换药次数、红斑进行荟萃分析。结果:①纳入20项研究,包括14项随机对照试验和6项队列研究,共6474例患者,涉及传统敷料、薄膜敷料、泡沫敷料、银离子敷料、亲水性纤维含银敷料、藻酸盐敷料6种敷料;②网状Meta分析结果显示,术后降低伤口水疱概率由高到低为:藻酸盐敷料(98.6%)>亲水性纤维含银敷料(75.4%)>薄膜敷料(45.0%)>泡沫敷料(37.4%)>银离子敷料(26.3%)>传统敷料(2.0%);③直接Meta分析结果显示,在减少术后伤口感染率和换药次数方面,亲水性纤维含银敷料优于传统敷料[OR=0.36,95%CI(0.23,0.58),P<0.05;MD=-1.85,95%CI(-2.40,-1.30),P<0.00001],两种敷料在减少术后伤口红斑方面比较差异无显著性意义(P>0.05)。结论:对于全髋、膝关节置换后患者,藻酸盐敷料在减少术后并发水疱率方面总体效果最佳,亲水性纤维含银敷料在减少术后伤口换药次数和感染率方面总体效果最好,因此全髋、膝关节置换后可优先考虑应用这两种敷料,此结论仍需更多高质量的临床随机对照试验来进一步论证。OBJECTIVE:In recent years,the operation rate of total hip and knee arthroplasty has been increasing,and postoperative wounds need to be covered with dressings to protect newborn skin tissues.Choosing a high-safety medical dressing is an important issue at present.This study systematically evaluated the safety of six kinds of medical dressings on wounds after total hip and knee arthroplasty.METHODS:The computer search was conducted on CNKI,Wanfang,VIP and China Biomedical Literature Database,PubMed,Embase,Web of Science,Cochrane Library and Scopus.Clinical studies of different medical dressings applied to wound after total hip and knee arthroplasty were collected.The search time was from the database establishment to December 2021.Two researchers independently screened the literature and extracted the data.Using Stata 16.0 and RevMan 5.4 software,the blister rate of the primary outcome measure was analyzed by network meta-analysis.The infection rate,dressing change times and erythema of the secondary outcome measures were analyzed by meta-analysis.RESULTS:(1)A total of 20 included studies contained 14 randomized controlled trials and 6 cohort studies involving 6474 patients and 6 dressings,i.e.,conventional dressings,thin film dressings,foam dressings,silver ion dressings,hydrophilic fiber silver-containing dressings,and alginate dressings.(2)The results of the network meta-analysis showed that in terms of reducing postoperative wound blister rate,which ranked as follows:alginate dressing(98.6%)>hydrophilic fiber silver dressing(75.4%)>film dressing(45.0%)>foam dressing(37.4%)>silver ion dressing(26.3%)>traditional dressing(2.0%).(3)The results of direct meta-analysis showed that hydrophilic fiber silver dressing was superior to traditional dressing in reducing postoperative wound infection rate and dressing change times[OR=0.36,95%CI(0.23,0.58),P<0.05;MD=-1.85,95%CI(-2.40,-1.30),P<0.00001].There was no statistical significance in reducing postoperative wound erythema(P>0.05).CONCLUSION:For patients after total hi

关 键 词：敷料 全髋关节置换 膝关节置换 伤口 系统评价 META分析 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学] R684.3