Evans D, Land L
Health and Social Care Research Centre, University of Central England (UCE), Ravensbury House, Westbourne Road, Birmingham, West Midlands, UK, B15 3TN.
Cochrane Database Syst Rev. 2001(1):CD001898. doi: 10.1002/14651858.CD001898.
Chronic wounds mainly affect the elderly and those with multiple health problems. Despite the use of modern dressings, some of these wounds take a long time to heal, fail to heal, or recur, causing significant pain and discomfort to the person and cost to health services. Topical negative pressure is used to promote healing of surgical wounds by using suction to drain excess fluid from wounds.
To assess the effectiveness of topical negative pressure (TNP) in treating people with chronic wounds and to identify an optimum TNP regimen.
The Cochrane Wounds Group Specialised Trials Register was searched until July 2000. Experts in the field and relevant companies were contacted to enquire about ongoing and recently completed relevant trials. In addition citations within obtained papers were scrutinised to identify additional studies.
All randomised controlled trials which evaluated the effectiveness of TNP in treating chronic wounds were considered.
Eligibility for inclusion, data extraction and details of trial quality was conducted by two reviewers independently. A narrative synthesis of results was undertaken as only two small trials fulfilled the selection criteria and they used different outcome measures.
Two small trials with a total of 34 participants evaluated the effectiveness of TNP on chronic wound healing. Trial 1 considered patients with any type of chronic wound; Trial 2 considered patients with diabetic foot ulcers only. The trials compared TNP (as open cell foam dressing with continuous suction) for the first 48 hours with saline gauze dressings. Trial 1 reported a statistically significant reduction in wound volume at 6 weeks in favour of TNP. Trial 2 (continuous suction, followed by intermittent suction after 48 hours) reported a reduction in the number of days to healing and a reduction in wound surface area at 2 weeks in favour of TNP, - although no statistical analysis was reported.
REVIEWER'S CONCLUSIONS: The two small trials provide weak evidence suggesting that TNP may be superior to saline gauze dressings in healing chronic human wounds. However, due to the small sample sizes and methodological limitations of these trials, the findings must be interpreted with extreme caution. The effect of TNP on cost, quality of life, pain and comfort was not reported. It was not possible to determine which was the optimum TNP regimen.
慢性伤口主要影响老年人以及患有多种健康问题的人群。尽管使用了现代敷料，但其中一些伤口愈合时间长、无法愈合或反复出现，给患者带来极大痛苦和不适，同时也给医疗服务带来成本负担。局部负压通过吸引排出伤口多余液体，用于促进手术伤口愈合。
评估局部负压（TNP）治疗慢性伤口患者的有效性，并确定最佳TNP方案。
检索Cochrane伤口小组专业试验注册库至2000年7月。联系该领域专家和相关公司，询问正在进行和最近完成的相关试验。此外，对所获论文中的参考文献进行审查以识别其他研究。
纳入所有评估TNP治疗慢性伤口有效性的随机对照试验。
两名评价员独立进行纳入资格、数据提取及试验质量细节评估。由于仅有两项小型试验符合入选标准且采用不同结局指标，因此对结果进行叙述性综合分析。
两项共纳入34名参与者的小型试验评估了TNP对慢性伤口愈合的有效性。试验1纳入任何类型慢性伤口患者；试验2仅纳入糖尿病足溃疡患者。试验将前48小时使用TNP（开孔泡沫敷料持续吸引）与盐水纱布敷料进行比较。试验1报告6周时伤口体积在统计学上显著减小，TNP组更优。试验2（持续吸引，48小时后改为间歇吸引）报告愈合天数减少，2周时伤口表面积减小，TNP组更优——尽管未报告统计学分析结果。
两项小型试验提供的证据薄弱，提示TNP在愈合慢性人体伤口方面可能优于盐水纱布敷料。然而，由于这些试验样本量小且存在方法学局限性，对研究结果的解读必须极为谨慎。未报告TNP对成本、生活质量、疼痛和舒适度的影响。无法确定哪种TNP方案最佳。
