Dumville Jo C, O'Meara Susan, Deshpande Sohan, Speak Katharine
Department of Health Sciences, University of York, York, UK, YO10 5DD.
Cochrane Database Syst Rev. 2011 Sep 7(9):CD009101. doi: 10.1002/14651858.CD009101.pub2.
Foot ulcers in people with diabetes are a prevalent and serious global health issue. Dressings form a key part of ulcer treatment, with clinicians and patients having many different types to choose from including hydrogel dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use.
To assess the effects of hydrogel wound dressings compared with alternative dressings or none on the healing of foot ulcers in people with diabetes.
We searched the Cochrane Wounds Group Specialised Register (searched 10 June 2011); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2); Ovid MEDLINE (1950 to June Week 1 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, June 8, 2011); Ovid EMBASE (1980 to 2011 Week 22) and EBSCO CINAHL (1982 to 3 June 2011). There were no restrictions based on language or date of publication.
Published or unpublished randomised controlled trials (RCTs) that have compared the effects on ulcer healing of hydrogel with alternative wound dressings or no dressing in the treatment of foot ulcers in people with diabetes.
Two review authors independently performed study selection, risk of bias assessment and data extraction.
We included five studies (446 participants) in this review. Meta analysis of three studies comparing hydrogel dressings with basic wound contract dressings found significantly greater healing with hydrogel: risk ratio (RR) 1.80, 95% confidence interval (CI) 1.27 to 2.56. The three pooled studies had different follow-up times (12 weeks, 16 weeks and 20 weeks) and also evaluated ulcers of different severities (grade 3 and 4; grade 2 and grade unspecified). One study compared a hydrogel dressing with larval therapy and found no statistically significant difference in the number of ulcers healed and another found no statistically significant difference in healing between hydrogel and platelet-derived growth factor. There was also no statistically significant difference in number of healed ulcers between two different brands of hydrogel dressing. All included studies were small and at unclear risk of bias and there was some clinical heterogeneity with studies including different ulcer grades. No included studies compared hydrogel with other advanced wound dressings.
AUTHORS' CONCLUSIONS: There is some evidence to suggest that hydrogel dressings are more effective in healing (lower grade) diabetic foot ulcers than basic wound contact dressings however this finding is uncertain due to risk of bias in the original studies. There is currently no research evidence to suggest that hydrogel is more effective than larval therapy or platelet-derived growth factors in healing diabetic foot ulcers, nor that one brand of hydrogel is more effective than another in ulcer healing. No RCTs comparing hydrogel dressings with other advanced dressing types were found.
糖尿病患者足部溃疡是一个普遍且严重的全球健康问题。敷料是溃疡治疗的关键部分，临床医生和患者有许多不同类型可供选择，包括水凝胶敷料。需要对当前证据进行清晰且最新的概述，以促进关于敷料使用的决策。
评估水凝胶伤口敷料与其他敷料或不使用敷料相比，对糖尿病患者足部溃疡愈合的影响。
我们检索了Cochrane伤口小组专业注册库（检索日期为2011年6月10日）；Cochrane对照试验中央注册库（CENTRAL）（《Cochrane图书馆》2011年第2期）；Ovid MEDLINE（1950年至2011年6月第1周）；Ovid MEDLINE（在研及其他未索引文献，2011年6月8日）；Ovid EMBASE（1980年至2011年第22周）以及EBSCO CINAHL（1982年至2011年6月3日）。检索未受语言或出版日期限制。
已发表或未发表的随机对照试验（RCT），这些试验比较了水凝胶与其他伤口敷料或不使用敷料对糖尿病患者足部溃疡治疗中溃疡愈合的影响。
两位综述作者独立进行研究选择、偏倚风险评估和数据提取。
本综述纳入了五项研究（446名参与者）。对三项比较水凝胶敷料与基本伤口接触敷料的研究进行荟萃分析发现，水凝胶敷料的愈合效果显著更好：风险比（RR）为1.80，95%置信区间（CI）为1.27至2.56。这三项汇总研究有不同的随访时间（12周、16周和20周），且评估了不同严重程度的溃疡（3级和4级；2级及未明确分级）。一项研究比较了水凝胶敷料与蛆虫疗法，发现愈合溃疡的数量无统计学显著差异，另一项研究发现水凝胶与血小板衍生生长因子在愈合方面无统计学显著差异。两种不同品牌的水凝胶敷料在愈合溃疡数量上也无统计学显著差异。所有纳入研究规模较小且偏倚风险不明确，并且存在一些临床异质性，因为研究纳入了不同等级的溃疡。没有纳入的研究将水凝胶与其他高级伤口敷料进行比较。
有一些证据表明，水凝胶敷料在愈合（较低等级）糖尿病足溃疡方面比基本伤口接触敷料更有效，但由于原始研究存在偏倚风险，这一发现并不确定。目前没有研究证据表明水凝胶在愈合糖尿病足溃疡方面比蛆虫疗法或血小板衍生生长因子更有效，也没有证据表明一种品牌的水凝胶在溃疡愈合方面比另一种更有效。未发现比较水凝胶敷料与其他高级敷料类型的随机对照试验。
