针对主要下肢截肢的预防性负压伤口治疗设备的系统审查和元分析
Megan Power Foley1, Ciara Fahey2, Anne-Marie Byrne2
1University of Galway, Galway, Ireland.
概括
负压伤口治疗 (NPWT) 在重大下肢截肢后显著减少伤口并发症和手术部位感染 (SSI). 这种疗法为改善这种高风险手术群体患者的治疗结果提供了一个有希望的方法.
科学领域:
- 伤口愈合和重建性手术.
- 在外科手术过程中控制感染.
- 血管外科手术的结果
背景情况:
- 主要的下肢截肢经常用于关键肢体缺血和严重感染.
- 接受这些截肢的患者,特别是患有血管障碍和糖尿病的患者,面临着术后伤口并发症的风险.
- 手术部位感染 (SSI) 在这个患者群体中是一个重大问题.
研究的目的:
- 系统地审查和分析预防性切口负压伤口治疗 (NPWT) 对主要下肢截肢后的结果的影响.
- 与标准护理相比,评估NPWT在减少伤口并发症和SSI中的有效性.
主要方法:
- 在包括PubMed,Scopus和Embase在内的主要数据库中进行了系统的文献搜索,并补充了会议摘要和试验注册表.
- 包括的研究比较了NPWT应用于封闭切口的传统干在经历重大截肢的患者.
- 分析评估了整体伤口并发症和SSI的相对风险,并使用既定标准 (MINORS,Cochrane,GRADE) 评估了偏差风险和结果确定性.
主要成果:
- 分析了9项涉及749名患者的研究 (3项RCT,6项队列研究);整体研究质量中等到差,结果确定性非常低.
- 预防性NPWT显示,与标准护理 (44.6%) 相比,伤口并发症的综合率明显较低 (16.0%).
- 与标准护理相比,NPWT与复合性伤口并发症率 (RR 0.42) 和SSI率 (RR 0.45) 的统计学显著降低有关.
结论:
- 尽管研究质量不同,但预防性NPWT似乎可以减少大截肢后的伤口并发症.
- 需要进一步进行高质量,充足的随机对照试验 (RCT),以确认这些好处并评估成本效益.
- 未来的研究应该澄清NPWT是否应该在经历重大截肢的患者中进行例行或选择性实施.
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