Liu Si, He Chao-Zhu, Cai Yan-Ting, Xing Qiu-Ping, Guo Ying-Zhen, Chen Zhi-Long, Su Ji-Liang, Yang Li-Ping
School of Nursing, Nanchang University.
Department of Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Ther Clin Risk Manag. 2017 Apr 18;13:533-544. doi: 10.2147/TCRM.S131193. eCollection 2017.
The aim of this study was to perform an updated systematic review and meta-analysis to assess the clinical efficacy, safety, and cost-effectiveness of negative-pressure wound therapy (NPWT) in the treatment of diabetic foot ulcers (DFUs).
We searched the Cochrane Library, MEDLINE, EMBASE, Ovid, and Chinese Biological Medicine databases up to June 30, 2016. We also manually searched the articles from reference lists of the retrieved articles, which used the NPWT system in studies of vacuum-assisted closure therapy. Studies were identified and selected, and two independent reviewers extracted data from the studies.
A total of eleven randomized controlled trials, which included a total of 1,044 patients, were selected from 691 identified studies. Compared with standard dressing changes, NPWT had a higher rate of complete healing of ulcers (relative risk, 1.48; 95% confidence interval [CI]: 1.24-1.76; <0.001), shorter healing time (mean difference, -8.07; 95% CI: -13.70- -2.45; =0.005), greater reduction in ulcer area (mean difference, 12.18; 95% CI: 8.50-15.86; <0.00001), greater reduction in ulcer depth (mean difference, 40.82; 95% CI: 35.97-45.67; <0.00001), fewer amputations (relative risk, 0.31; 95% CI: 0.15-0.62; =0.001), and no effect on the incidence of treatment-related adverse effects (relative risk, 1.12; 95% CI: 0.66-1.89; =0.68). Meanwhile, many analyses showed that the NPWT was more cost-effective than standard dressing changes.
These results indicate that NPWT is efficacious, safe, and cost-effective in treating DFUs.
本研究旨在进行一项更新的系统评价和荟萃分析，以评估负压伤口治疗（NPWT）在治疗糖尿病足溃疡（DFU）中的临床疗效、安全性和成本效益。
我们检索了截至2016年6月30日的Cochrane图书馆、MEDLINE、EMBASE、Ovid和中国生物医学数据库。我们还手动检索了检索到的文章参考文献列表中的文章，这些文章在真空辅助闭合治疗研究中使用了NPWT系统。对研究进行识别和筛选，两名独立的审阅者从研究中提取数据。
从691项已识别的研究中总共选择了11项随机对照试验，共纳入1044例患者。与标准换药相比，NPWT的溃疡完全愈合率更高（相对危险度，1.48；95%置信区间[CI]：1.24 - 1.76；P<0.001），愈合时间更短（平均差值，-8.07；95%CI：-13.70 - -2.45；P = 0.005），溃疡面积缩小更明显（平均差值，12.18；95%CI：8.50 - 15.86；P<0.00001），溃疡深度缩小更明显（平均差值，40.82；95%CI：35.97 - 45.67；P<0.00001），截肢更少（相对危险度，0.31；95%CI：0.15 - 0.62；P = 0.001），且对治疗相关不良反应的发生率无影响（相对危险度，1.12；95%CI：0.66 - 1.89；P = 0.68）。同时，许多分析表明NPWT比标准换药更具成本效益。
这些结果表明NPWT在治疗DFU方面有效、安全且具有成本效益。
