Nelson E A, Bell-Syer S E, Cullum N A
Centre for Evidence Based Nursing, Department of Health Studies, University of York, Genesis 6, York, YO10 5DQ, UK, YO10 5DQ.
Cochrane Database Syst Rev. 2000(4):CD002303. doi: 10.1002/14651858.CD002303.
Up to 1% of adults will suffer from leg ulceration at some time. The majority of leg ulcers are venous in origin and are caused by high pressure in the veins due to blockage or weakness of the valves in the veins of the leg. Prevention and treatment of venous ulcers is aimed at reducing the pressure either by removing / repairing the veins, or by applying compression bandages / stockings to reduce the pressure in the veins. The vast majority of venous ulcers are healed using compression bandages. Once healed they often recur and so it is customary to continue applying compression in the form of bandages, tights, stockings or socks in order to prevent recurrence. Compression bandages or hosiery (tights, stockings, socks) are often applied for ulcer prevention.
To assess the effects of compression hosiery (socks, stockings, tights) or bandages in preventing the recurrence of venous ulcers. To determine whether there is an optimum pressure/type of compression to prevent recurrence of venous ulcers.
Searches of 19 databases including the Cochrane Wounds Group trials register and the Cochrane Controlled Trials Register, handsearching of journals, conference proceedings, and bibliographies up to June 2000.
Randomised controlled trials evaluating compression bandages or hosiery for prevention of venous leg ulcers.
Data extraction and assessment of study quality were undertaken by two reviewers independently.
No trials compared recurrence rates with and without compression. One trial (300 patients) compared high (UK Class 3) compression hosiery with moderate (UK Class 2) compression hosiery. A intention to treat analysis found no significant reduction in recurrence at five years follow up associated with high compression hosiery compared with moderate compression hosiery (relative risk of recurrence 0.82, 95% confidence interval 0.61 to 1.12). This analysis would tend to underestimate the effectiveness of the high compression hosiery because a significant proportion of people changed from high compression to medium compression hosiery. Compliance rates were significantly higher with medium compression than with high compression hosiery. One trial (166 patients) found no difference in recurrence between two types of medium (UK Class 2) compression hosiery (relative risk of recurrence with Medi was 0.74, 95% confidence interval 0.45 to 1.2). Both trials reported that not wearing compression hosiery was strongly associated with ulcer recurrence and this is circumstantial evidence that compression reduces ulcer recurrence. No trials were found which evaluated compression bandages for preventing ulcer recurrence.
REVIEWER'S CONCLUSIONS: No trials compared compression with vs no compression for prevention of ulcer recurrence. Not wearing compression was associated with recurrence in both studies identified in this review. This is circumstantial evidence of the benefit of compression in reducing recurrence. Recurrence rates may be lower in high compression hosiery than in medium compression hosiery and therefore patients should be offered the strongest compression with which they can comply. Further trials are needed to determine the effectiveness of hosiery prescribed in other settings, i.e. in the UK community, in countries other than the UK.
高达1%的成年人在一生中的某个阶段会患上腿部溃疡。大多数腿部溃疡起源于静脉，是由腿部静脉瓣膜堵塞或功能不全导致静脉压力升高引起的。静脉溃疡的预防和治疗旨在通过切除/修复静脉或使用加压绷带/弹力袜来降低压力。绝大多数静脉溃疡通过加压绷带得以愈合。一旦愈合，溃疡往往会复发，因此通常会继续使用绷带、紧身衣、弹力袜或短袜等形式进行加压，以防止复发。加压绷带或袜类（紧身衣、弹力袜、短袜）常被用于预防溃疡。
评估弹力袜（短袜、弹力袜、紧身衣）或绷带在预防静脉溃疡复发方面的效果。确定是否存在预防静脉溃疡复发的最佳压力/加压类型。
检索了19个数据库，包括Cochrane伤口组试验注册库和Cochrane对照试验注册库，手工检索了截至2000年6月的期刊、会议论文集和参考文献目录。
评估加压绷带或弹力袜预防下肢静脉溃疡的随机对照试验。
由两名评价员独立进行数据提取和研究质量评估。
没有试验比较使用和不使用加压措施时的复发率。一项试验（300例患者）比较了高压力（英国3级）弹力袜与中压力（英国2级）弹力袜。意向性分析发现，与中压力弹力袜相比，高压力弹力袜在五年随访时复发率没有显著降低（复发相对风险为0.82，95%置信区间为0.61至1.12）。由于相当一部分人从高压力弹力袜改为中压力弹力袜，该分析可能低估了高压力弹力袜的有效性。中压力弹力袜的依从率显著高于高压力弹力袜。一项试验（166例患者）发现两种中压力（英国2级）弹力袜在复发率上没有差异（使用Medi弹力袜时复发相对风险为0.74，95%置信区间为0.45至1.2）。两项试验均报告不穿弹力袜与溃疡复发密切相关，这间接证明加压可降低溃疡复发率。未发现评估加压绷带预防溃疡复发的试验。
没有试验比较加压与不加压预防溃疡复发的效果。本综述中确定的两项研究均表明不使用加压措施与复发有关。这间接证明了加压在降低复发率方面的益处。高压力弹力袜的复发率可能低于中压力弹力袜，因此应向患者提供他们能够耐受的最强压力的弹力袜。需要进一步的试验来确定在其他环境中（即英国社区、英国以外的国家）开具的弹力袜的有效性。
