Gilligan Adrienne M, Waycaster Curtis R, Bizier Richard, Chu Bong-Chul, Carter Marissa J, Fife Caroline E
Truven Health Analytics, Houston, Texas.
Smith & Nephew, Fort Worth, Texas.
Adv Wound Care (New Rochelle). 2017 Apr 1;6(4):125-134. doi: 10.1089/wound.2016.0720.
Compare enzymatic debridement using clostridial collagenase ointment (CCO) with autolytic debridement using medicinal honey in the hospital outpatient setting for treating pressure ulcers (PUs). Retrospective deidentified electronic health records from 2007-2013 were extracted from the U.S. Wound Registry. Propensity score matching followed by multivariable analyses was used to adjust for selection bias and assess treatment effects comparing CCO-treated versus honey-treated PUs. Key outcomes included 100% granulation and epithelialization at 1 year. Five hundred seventeen CCO-treated PUs (446 patients) were matched to corresponding honey-treated PUs (341 patients). The majority of PUs were stage III (CCO 56%, honey 55%). CCO users had significantly fewer total visits (9.1 vs. 12.6; < 0.001), fewer total selective sharp debridements (2.7 vs. 4.4; < 0.001), and fewer PUs receiving negative pressure wound therapy (29% vs. 38%; = 0.002) compared with honey. CCO-treated PUs were 38% more likely to achieve 100% granulation compared to honey-treated PUs at 1 year, = 0.018. Mean days to 100% granulation were significantly lower for CCO-treated PUs (255 vs. 282 days, < 0.001). CCO-treated PUs were 47% ( = 0.024) more likely to epithelialize at 1 year compared to PUs treated with honey. Mean days to epithelialization were significantly lower for PUs treated with CCO at 1 year (288 vs. 308 days; = 0.011). All stages of PUs treated with CCO achieved faster rates of granulation and subsequent epithelialization compared to PUs treated with medicinal honey as measured by real-world data collected in the hospital outpatient department care setting.
在医院门诊环境中，比较使用梭状芽孢杆菌胶原酶软膏（CCO）进行酶清创与使用药用蜂蜜进行自溶性清创治疗压疮（PU）的效果。从美国伤口登记处提取了2007 - 2013年去识别化的回顾性电子健康记录。采用倾向得分匹配法，随后进行多变量分析，以调整选择偏倚，并评估比较CCO治疗组与蜂蜜治疗组压疮的治疗效果。主要结局包括1年时达到100%肉芽组织形成和上皮化。517例接受CCO治疗的压疮（446例患者）与相应的接受蜂蜜治疗的压疮（341例患者）进行匹配。大多数压疮为III期（CCO组56%，蜂蜜组55%）。与蜂蜜治疗组相比，使用CCO的患者总就诊次数显著更少（9.1次对12.6次；<0.001），总选择性锐性清创次数更少（2.7次对4.4次；<0.001），接受负压伤口治疗的压疮更少（29%对38%；=0.002）。在1年时，与蜂蜜治疗组相比，CCO治疗组的压疮达到100%肉芽组织形成的可能性高38%，=0.018。CCO治疗组压疮达到100%肉芽组织形成的平均天数显著更低（255天对282天，<0.001）。与蜂蜜治疗的压疮相比，CCO治疗组的压疮在1年时上皮化的可能性高47%（=0.024）。在1年时，CCO治疗的压疮上皮化的平均天数显著更低（288天对308天；=0.011）。根据医院门诊护理环境中收集的实际数据衡量，与药用蜂蜜治疗的压疮相比，CCO治疗的所有阶段压疮均实现了更快的肉芽组织形成速度和随后的上皮化速度。
