Rashaan Zjir M, Krijnen Pieta, Klamer Rachel R M, Schipper Inger B, Dekkers Olaf M, Breederveld Roelf S
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Burn Center, Red Cross Hospital Beverwijk, Beverwijk, The Netherlands.
Wound Repair Regen. 2014 Jul-Aug;22(4):473-82. doi: 10.1111/wrr.12196.
The evidence for application of silver-containing dressings and topicals in the treatment of partial-thickness burns in pediatric patients is largely based on clinical trials involving adult patients despite the important differences between the skin of children and adults. A systematic review and meta-analysis was performed of all randomized controlled trials comparing nonsilver treatment with silver-containing dressings and silver topical agents in children with partial-thickness burns in the acute stage. Endpoints were wound healing, grafting, infection, pain, number of dressing changes, length of hospital stay, and scarring. Seven randomized controlled trials were included involving 473 participants. All trials used silver sulfadiazine as control in comparison with five different nonsilver treatments. Most trials were of moderate quality with high risk of bias. Use of nonsilver treatment led to shorter wound healing time (weighted mean difference: -3.43 days, 95% confidence interval: -4.78, -2.07), less dressing changes (weighted mean difference: -19.89 dressing changes, 95% confidence interval: -38.12, -1.66), and shorter length of hospital stay (weighted mean difference: -2.07 days, 95% confidence interval: -2.63, -1.50) compared with silver sulfadiazine treatment, but no difference in the incidence of wound infection or grafting was found. In conclusion, nonsilver treatment may be preferred over silver sulfadiazine, but high-quality randomized controlled trials are needed to validly confirm the effectiveness of silver containing preparations, in particular silver-containing dressings, above nonsilver treatments.
尽管儿童和成人的皮肤存在重要差异,但含银敷料和外用剂在治疗小儿患者浅度烧伤方面的证据很大程度上基于涉及成人患者的临床试验。对所有比较非银治疗与含银敷料及银外用剂治疗急性期小儿浅度烧伤的随机对照试验进行了系统评价和荟萃分析。观察终点包括伤口愈合、植皮、感染、疼痛、换药次数、住院时间和瘢痕形成。纳入了7项随机对照试验,共473名参与者。所有试验均使用磺胺嘧啶银作为对照,与5种不同的非银治疗方法进行比较。大多数试验质量中等,存在高偏倚风险。与磺胺嘧啶银治疗相比,使用非银治疗可缩短伤口愈合时间(加权平均差:-3.43天,95%置信区间:-4.78,-2.07)、减少换药次数(加权平均差:-19.89次换药,95%置信区间:-38.12,-1.66)并缩短住院时间(加权平均差:-2.07天,95%置信区间:-2.63,-1.50),但在伤口感染或植皮发生率方面未发现差异。总之,非银治疗可能比磺胺嘧啶银更可取,但需要高质量的随机对照试验来有效证实含银制剂(特别是含银敷料)优于非银治疗的有效性。