Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland, USA.
J Am Acad Dermatol. 2012 May;66(5):e159-65. doi: 10.1016/j.jaad.2010.06.014. Epub 2010 Aug 17.
For decades silver-containing antibiotics such as silver sulfadiazine (SSD) have been applied as standard topical therapy for patients with partial-thickness burns and venous stasis ulcers. This evidence-based review intends to answer the following research question: in ambulatory patients with partial-thickness burns or stasis dermatitis ulcers, does the use of topical SSD compared with nonantibiotic dressings improve mortality, wound healing, re-epithelialization, or infection rates?
MEDLINE, EMBASE, Cochrane Library, and other databases were searched. We considered trials that enrolled patients of any age with partial-thickness burns or venous stasis ulcers and randomized them to either topical SSD or placebo, saline-soaked gauze, paraffin gauze, sterile dry dressing, or nonantibiotic moist dressing. Outcomes included mortality, wound healing, speed of re-epithelialization, and infection rates.
For burns, our search revealed 400 potential articles. No human studies met the inclusion criteria. Only 7 animal studies (1 mouse, 4 rat, and 2 pig) were relevant to the proposed question. These animal studies provided conflicting results. Whereas some support the use of SSD for treatment of partial-thickness burns, others question its effectiveness. For stasis dermatitis ulcer, the search identified 50 articles for review, of which 20 abstracts were reviewed, and one article met the inclusion criteria. This study did not show any significant improvement in the rate of complete healing in SSD group compared with placebo either at 4 weeks (relative risk 6.2, 95% confidence interval 0.8-48) or at 1 year (relative risk 5.2, 95% confidence interval 0.6-41.6) of follow-up.
There is insufficient evidence to either support or refute the routine use of SSD for ambulatory patients with either partial-thickness burns or stasis dermatitis ulcers to decrease mortality, prevent infection, or augment wound healing in human beings.
几十年来，含银抗生素（如磺胺嘧啶银）一直被用作治疗部分厚度烧伤和静脉淤滞性溃疡患者的标准局部治疗方法。本循证综述旨在回答以下研究问题：在门诊部分厚度烧伤或淤滞性皮炎溃疡患者中，与非抗生素敷料相比，使用局部磺胺嘧啶银是否能提高死亡率、伤口愈合、再上皮化或感染率？
检索 MEDLINE、EMBASE、Cochrane 图书馆和其他数据库。我们考虑了招募任何年龄的部分厚度烧伤或静脉淤滞性溃疡患者并将其随机分配到局部磺胺嘧啶银或安慰剂、盐水浸泡纱布、石蜡纱布、无菌干敷料或非抗生素湿润敷料的试验。结果包括死亡率、伤口愈合、再上皮化速度和感染率。
对于烧伤，我们的搜索显示有 400 篇潜在文章。没有符合纳入标准的人类研究。只有 7 项动物研究（1 项小鼠、4 项大鼠和 2 项猪）与提出的问题相关。这些动物研究提供了相互矛盾的结果。虽然一些研究支持使用磺胺嘧啶银治疗部分厚度烧伤，但其他研究则对其有效性提出质疑。对于淤滞性皮炎溃疡，搜索确定了 50 篇文章进行综述，其中 20 篇摘要进行了综述，有 1 篇文章符合纳入标准。这项研究没有显示在 4 周（相对风险 6.2，95%置信区间 0.8-48）或 1 年（相对风险 5.2，95%置信区间 0.6-41.6）的随访中，磺胺嘧啶银组在完全愈合率方面有任何显著改善。
没有足够的证据支持或反驳常规使用磺胺嘧啶银治疗门诊部分厚度烧伤或淤滞性皮炎溃疡患者以降低死亡率、预防感染或加速人类伤口愈合。
