Dymarek Robert, Halski Tomasz, Ptaszkowski Kuba, Slupska Lucyna, Rosinczuk Joanna, Taradaj Jakub
Department of Nervous System Diseases, University of Medicine in Wroclaw, Wroclaw, Poland.
Institute of Public Higher Professional Medical School, Opole, Poland.
Ostomy Wound Manage. 2014 Jul;60(7):26-39.
Standard care procedures for complex wounds are sometimes supported and reinforced by physical treatment modalities such as extracorporeal shock wave therapy (ESWT). To evaluate available evidence of ESWT effectiveness in humans, a systematic review of the literature was conducted using MEDLINE, PubMed, Scopus, EBSCOhost, and PEDro databases. Of the 393 articles found, 13 met the publication date (year 2000-2013), study type (clinical study), language (English only), and abstract availability (yes) criteria. The 13 studies (n = 919 patients with wounds of varying etiologies) included seven randomized controlled trials that were evaluated using Cochrane Collaboration Group standards. Only studies with randomization, well prepared inclusion/exclusion criteria protocol, written in English, and full version available were analyzed. An additional six publications reporting results of other clinical studies including a total of 523patients were identified and summarized. ESWT was most commonly applied once or twice a week using used low or medium energy, focused or defocused generator heads (energy range 0.03 to 0.25 mJ/mm2; usually 0.1 mJ/mm2), and electrohydraulic or electromagnetic sources. Few safety concerns were reported, and in the controlled clinical studies statistically significant differences in rates of wound closure were reported compared to a variety of standard topical treatment modalities, sham ESWT treatment, and hyperbaric oxygen therapy. Based on this analysis, ESWT can be characterized as noninvasive, mostly painless, and safe. Controlled, randomized, multicenter, blind clinical trials still are required to evaluate the efficacy and cost-effectiveness of ESWT compared to sham control, other adjunctive treatments, and commonly used moisture-retentive dressings. In the future, ESWT may play an important role in wound care once evidence-based practice guidelines are developed.
复杂伤口的标准护理程序有时会通过体外冲击波疗法（ESWT）等物理治疗方式得到支持和加强。为了评估ESWT对人体有效性的现有证据，我们使用MEDLINE、PubMed、Scopus、EBSCOhost和PEDro数据库对文献进行了系统综述。在找到的393篇文章中，有13篇符合发表日期（2000 - 2013年）、研究类型（临床研究）、语言（仅英语）和摘要可用性（是）标准。这13项研究（共919例病因各异的伤口患者）包括7项使用Cochrane协作组标准评估的随机对照试验。仅分析了具有随机化、精心制定的纳入/排除标准方案、用英语撰写且有完整版的研究。另外还识别并总结了6篇报告其他临床研究结果的出版物，这些研究共涉及523例患者。ESWT最常每周应用一次或两次，使用低能量或中等能量、聚焦或散焦的发生器探头（能量范围为0.03至0.25 mJ/mm²；通常为0.1 mJ/mm²），以及电液压或电磁源。报告的安全问题较少，在对照临床研究中，与多种标准局部治疗方式、假ESWT治疗和高压氧治疗相比，伤口闭合率有统计学显著差异。基于此分析，ESWT可被描述为无创、基本无痛且安全。仍需要进行对照、随机、多中心、盲法临床试验，以评估ESWT与假对照、其他辅助治疗以及常用的保湿敷料相比的疗效和成本效益。未来，一旦制定基于证据的实践指南，ESWT可能在伤口护理中发挥重要作用。
