Elraiyah Tarig, Domecq Juan Pablo, Prutsky Gabriela, Tsapas Apostolos, Nabhan Mohammed, Frykberg Robert G, Hasan Rim, Firwana Belal, Prokop Larry J, Murad Mohammad Hassan
Evidence-based Practice Center, Mayo Clinic, Rochester, Minn.
Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru.
J Vasc Surg. 2016 Feb;63(2 Suppl):37S-45S.e1-2. doi: 10.1016/j.jvs.2015.10.002.
Several methods of débridement of diabetic foot ulcers are currently used. The relative efficacy of these methods is not well established.
This systematic review and meta-analysis was conducted to find the best available evidence for the effect of débridement on diabetic foot wound outcomes. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus through October 2011 for randomized controlled studies (RCTs) and observational comparative studies.
We identified 11 RCTs and three nonrandomized studies reporting on 800 patients. The risk of bias was moderate overall. Meta-analysis of three RCTs showed that autolytic débridement significantly increased the healing rate (relative risk [RR], 1.89; 95% confidence interval [CI] 1.35-2.64). Meta-analysis of four studies (one RCT) showed that larval débridement reduced amputation (RR, 0.43; 95% CI, 0.21-0.88) but did not increase complete healing (RR, 1.27; 95% CI, 0.84-1.91). Surgical débridement was associated with shorter healing time compared with conventional wound care (one RCT). Insufficient evidence was found for comparisons between autolytic and larval débridement (one RCT), between ultrasound-guided and surgical débridement, and between hydrosurgical and surgical débridement.
The available literature supports the efficacy of several débridement methods, including surgical, autolytic, and larval débridement. Comparative effectiveness evidence between these methods and supportive evidence for other methods is of low quality due to methodologic limitations and imprecision. Hence, the choice of débridement method at the present time should be based on the available expertise, patient preferences, the clinical context and cost.
目前有多种方法用于糖尿病足溃疡的清创。这些方法的相对疗效尚未明确。
进行本系统评价和荟萃分析，以寻找关于清创对糖尿病足伤口结局影响的最佳现有证据。我们检索了截至2011年10月的MEDLINE、Embase、Cochrane对照试验中心注册库、科学引文索引和Scopus，以查找随机对照试验（RCT）和观察性比较研究。
我们确定了11项RCT和3项非随机研究，共涉及800例患者。总体偏倚风险为中等。三项RCT的荟萃分析表明，自溶性清创显著提高了愈合率（相对危险度[RR]，1.89；95%置信区间[CI]，1.35 - 2.64）。四项研究（一项RCT）的荟萃分析表明，蛆虫清创减少了截肢（RR，0.43；95%CI，0.21 - 0.88），但未增加完全愈合率（RR，1.27；95%CI，0.84 - 1.91）。与传统伤口护理相比，手术清创的愈合时间更短（一项RCT）。关于自溶性清创与蛆虫清创（一项RCT）、超声引导清创与手术清创以及水刀清创与手术清创之间的比较，证据不足。
现有文献支持包括手术、自溶性和蛆虫清创在内的多种清创方法的疗效。由于方法学局限性和不精确性，这些方法之间的比较有效性证据以及其他方法的支持性证据质量较低。因此，目前清创方法的选择应基于现有专业知识、患者偏好、临床背景和成本。
