Beam Joel W
University of North Florida, Brooks College of Health, Athletic Training/PhysicalTherapy Department, 1 UNF Dr, Jacksonville, FL 32224-2673, USA.
J Athl Train. 2007 Jul-Sep;42(3):422-4.
REFERENCE/CITATION: Wiechula R. The use of moist wound-healing dressings in the management of split-thickness skin graft donor sites: a systematic review. Int J Nurs Pract. 2003; 9:S9-S17.
Do rates of healing, infection, and pain differ depending on whether nonmoist or moist dressings are used to manage superficial to partial-thickness wounds?
Investigations were identified by CINAHL, MEDLINE, Pre-MEDLINE, Cochrane Library, Current Contents, Health STAR, EMBASE, Expanded Academic Index, and Dissertation Abstracts International searches. The search terms included skin, graft, and donor. Additional searches were performed with reference lists and bibliographies of retrieved studies.
To be included in the review, each study had to fulfill the following criteria: it had to be an intraindividual or prospective randomized controlled trial of human subjects; it had to include patients with postharvest split-thickness skin graft donor sites; it had to evaluate the effectiveness of primary and secondary wound dressings; and it had to have outcome measures that included healing (objective), infection (subjective), and pain (objective).
Data extraction and study quality assessment procedures were developed specifically for this review based on Cochrane Collaboration, Centre for Reviews and Dissemination, and Joanna Briggs Institute protocols and were performed independently by the author. Details of the procedures were not fully explained. The principal outcome measures were healing (proportion of sites healed within the study period or time to complete healing), rate of infection, and pain scores. The studies were grouped according to broad dressing type (nonmoist and moist) and specific types of moist dressings (hydrocolloids and polyurethane semipermeable transparent films). When comparable, study results were pooled and analyzed with a fixed-effects model. Data within broader dressing categories (nonmoist and moist) were analyzed with a random-effects model. chi (2) analysis was used to determine heterogeneity among the studies. RevMan software (version 4.04; Cochrane Centre, Oxford, UK) was used for statistical analysis.
The searches identified 111 studies and 1 integrative review, of which 58 studies met the inclusion and exclusion criteria. Inconsistency and variation in outcome measures and incomplete reporting of results prevented analysis of many studies. Wound healing was measured by days to complete healing (when dressings could be removed without trauma and pain) and wounds healed by day X (removal of dressings at regular intervals). Wound infection was subjectively measured based on clinical signs of infection (edema, heat, pain, or smell). Visual analog scales were used to measure pain levels. Among the broad categories of nonmoist (sterile gauze, fine mesh gauze, Xerofoam [Tyco Healthcare Group LP, Mansfield, MA]) and moist (DuoDERM hydrocolloid [ConvaTec, Princeton, NJ], Tegaderm transparent film [3M Health Care, St Paul, MN], Opsite transparent film [Smith & Nephew, London, UK]) dressings, the outcomes of healing, infection, and pain were analyzed. In 6 studies, the findings significantly favored moist dressings, compared with nonmoist dressings, for days to complete healing (weighted mean difference [WMD] = -3.97, 95% confidence interval [CI] = -5.91, -2.02). In 9 studies, wounds healed by day X (day 7, 8, 9, 10, or 12) were analyzed. The results were varied and inconclusive because of a small number of trials and subjects. Among 10 studies, no significant difference was noted in infection rates between nonmoist and moist dressings (odds ratio [OR] = 0.41, 95% CI = 0.14, 1.18). Three studies using visual analog scales for the outcome of pain were converted into a uniform scale of 1 to 10 (10 representing most painful). The findings significantly favored moist dressings over nonmoist dressings (WMD = -1.75, 95% CI = -2.94, -0.56). Among nonmoist and specific types of moist dressings, a subset analysis was performed to examine the outcomes of healing, infection, and pain. For days to complete healing, 2 investigations significantly favored hydrocolloid dressings over nonmoist dressings (WMD = -2.19, 95% CI = -2.89, -1.49). Additionally, in 2 studies, hydrocolloid dressings were significantly favored over other moist dressings (semiocclusive hydrocolloid and transparent film) for days to complete healing (WMD = -1.45, 95% CI = -2.17, -0.74). In 3 studies, the data significantly favored polyurethane semipermeable transparent film dressings over nonmoist dressings for days to complete healing (WMD = -2.82, 95% CI = -3.58, -2.07). For infection rates, 4 studies significantly favored hydrocolloid dressings over nonmoist dressings (OR = 0.21, 95% CI = 0.07, 0.65). In 4 other studies, polyurethane semipermeable transparent film dressings were significantly favored over nonmoist dressings with regard to infection rates (OR = 0.28, 95% CI = 0.09, 0.91). For the outcome of pain, varied outcome measures and insufficient data prevented analysis among specific types of moist dressings.
Moist dressings decreased the days to complete healing and pain scores when compared with nonmoist dressings. Among the broad categories of nonmoist and moist dressings, no differences were found in infection rates. The data on specific types of moist dressings revealed that days to complete healing were decreased with hydrocolloid dressings compared with nonmoist and other moist dressings. Hydrocolloid dressings also decreased infection rates compared with nonmoist dressings. Polyurethane semipermeable transparent film dressings also decreased days to complete healing and infection rates compared with nonmoist dressings. Overall, the data indicated that hydrocolloid dressings are more effective than nonmoist dressings in terms of rates of healing, infection, and pain in the management of superficial to partial-thickness wounds. The variations in outcome measures among the included studies should be considered in interpreting these findings.
参考文献/引用文献：Wiechula R. 湿性伤口愈合敷料在中厚皮片供皮区处理中的应用：系统评价。《国际护理实践杂志》。2003年；9：S9 - S17。
使用非湿性或湿性敷料处理浅度至部分厚度伤口时，愈合、感染和疼痛发生率是否存在差异？
通过CINAHL、MEDLINE、Pre - MEDLINE、Cochrane图书馆、《现刊目次》、Health STAR、EMBASE、《扩展学术索引》以及《国际学位论文文摘》检索确定研究。检索词包括皮肤、移植和供体。还通过检索纳入研究的参考文献列表和书目进行了其他检索。
要纳入该综述，每项研究必须符合以下标准：必须是人体受试者的个体内或前瞻性随机对照试验；必须纳入中厚皮片供皮区术后患者；必须评估一级和二级伤口敷料的有效性；并且必须有包括愈合（客观）、感染（主观）和疼痛（客观）的结局指标。
基于Cochrane协作网、综述与传播中心以及乔安娜·布里格斯研究所的方案，专门为该综述制定了数据提取和研究质量评估程序，由作者独立进行。程序细节未完全说明。主要结局指标为愈合（研究期间愈合的部位比例或完全愈合时间）、感染率和疼痛评分。研究根据宽泛的敷料类型（非湿性和湿性）以及湿性敷料的具体类型（水胶体和聚氨酯半透性透明薄膜）进行分组。当具有可比性时，将研究结果合并并用固定效应模型进行分析。在更宽泛的敷料类别（非湿性和湿性）内的数据用随机效应模型进行分析。采用卡方分析确定研究间的异质性。使用RevMan软件（版本4.04；英国牛津Cochrane中心）进行统计分析。
检索确定了111项研究和1篇综合综述，其中58项研究符合纳入和排除标准。结局指标的不一致性和变异性以及结果报告不完整妨碍了对许多研究的分析。伤口愈合通过完全愈合天数（敷料可在无创伤和疼痛情况下去除时）以及在第X天愈合的伤口（定期去除敷料）来衡量。伤口感染根据感染的临床体征（水肿、发热、疼痛或异味）进行主观测量。使用视觉模拟量表测量疼痛程度。在非湿性（无菌纱布、细网纱布、Xerofoam [泰科医疗集团有限公司，马萨诸塞州曼斯菲尔德]）和湿性（多爱肤水胶体[康维德公司，新泽西州普林斯顿]、德湿可透明薄膜[3M医疗保健公司，明尼苏达州圣保罗]、优赛透明薄膜[施乐辉公司，英国伦敦]）敷料的宽泛类别中，对愈合、感染和疼痛的结局进行了分析。在6项研究中，与非湿性敷料相比，湿性敷料在完全愈合天数方面的结果显著更优（加权平均差[WMD] = -3.97，95%置信区间[CI] = -5.91， -2.02）。在9项研究中，分析了在第X天（第7、8、9、10或12天）愈合的伤口。由于试验和受试者数量较少，结果各异且无定论。在10项研究中，非湿性和湿性敷料的感染率无显著差异（优势比[OR] = 0.41，95% CI = 0.14，1.18）。3项使用视觉模拟量表评估疼痛结局的研究被转换为统一的1至10分制（10分表示最疼痛）。结果显示湿性敷料显著优于非湿性敷料（WMD = -1.75，95% CI = -2.94， -0.56）。在非湿性和特定类型的湿性敷料中，进行了亚组分析以检查愈合、感染和疼痛的结局。对于完全愈合天数，2项研究显示水胶体敷料显著优于非湿性敷料（WMD = -2.19，95% CI = -2.89， -1.49）。此外，在2项研究中，在完全愈合天数方面，水胶体敷料显著优于其他湿性敷料（半封闭水胶体和透明薄膜）（WMD = -1.45，95% CI = -2.17， -0.74）。在3项研究中，对于完全愈合天数，数据显示聚氨酯半透性透明薄膜敷料显著优于非湿性敷料（WMD = -2.82，95% CI = -3.58， -2.07）。对于感染率，4项研究显示水胶体敷料显著优于非湿性敷料（OR = 0.21，95% CI = 0.07，0.65）。在其他4项研究中，聚氨酯半透性透明薄膜敷料在感染率方面显著优于非湿性敷料（OR = 0.28，95% CI = 0.09，0.91）。对于疼痛结局，结局测量方法各异且数据不足，妨碍了对特定类型湿性敷料的分析。
与非湿性敷料相比，湿性敷料可减少完全愈合天数和疼痛评分。在非湿性和湿性敷料的宽泛类别中，感染率无差异。关于特定类型湿性敷料的数据显示，与非湿性和其他湿性敷料相比，水胶体敷料可减少完全愈合天数。与非湿性敷料相比，水胶体敷料也可降低感染率。与非湿性敷料相比，聚氨酯半透性透明薄膜敷料也可减少完全愈合天数和感染率。总体而言，数据表明在处理浅度至部分厚度伤口时，就愈合、感染和疼痛发生率而言，水胶体敷料比非湿性敷料更有效。在解释这些结果时应考虑纳入研究中结局测量方法的差异。
