Dissemond Joachim, Böttrich Johannes Georg, Braunwarth Horst, Hilt Jörg, Wilken Patricia, Münter Karl-Christian
Department of Dermatology, Venereology, and Allergology, University Hospital Essen, Essen, Germany.
B. Braun Melsungen AG, Melsungen, Germany.
J Dtsch Dermatol Ges. 2017 May;15(5):524-535. doi: 10.1111/ddg.13233.
Given that the scientific evidence for silver in wound care is generally considered insufficient, there is uncertainty among users regarding its clinical use.
A group of experts evaluated the clinical studies on silver in wound management published from 2000-2015.
Overall, 851 articles were identified, 173 of which were included and categorized. There were 31 randomized controlled trials (RCTs) and eight cohort studies. Twenty-eight of these studies showed statistically significant outcome parameters in support of silver. While nine of these studies investigated burn injuries, 20 addressed other indications (venous leg ulcers: 9; pressure ulcers: 3; chronic wounds: 2; diabetic foot ulcer: 1; other types of wounds: 5). In 16 studies, the primary parameter was wound healing, whereas quality of life including pain was assessed in twelve studies; cost-effectiveness, in eight studies; reduction of bacterial load, in three studies. Based on these results, a treatment algorithm for the clinical use of silver in wound care has been developed.
The present meta-analysis shows that the evidence base for silver in wound management is significantly better than perceived in the current scientific debate. Thus, if used selectively and for a limited period of time, silver not only has antimicrobial effects but is also characterized by an improvement in quality of life and good cost-effectiveness.
鉴于伤口护理中使用银的科学证据通常被认为不足，使用者对其临床应用存在不确定性。
一组专家评估了2000年至2015年发表的关于银在伤口管理中的临床研究。
总体而言，共识别出851篇文章，其中173篇被纳入并分类。有31项随机对照试验（RCT）和8项队列研究。其中28项研究显示支持使用银的结果参数具有统计学意义。这些研究中，9项调查了烧伤，20项涉及其他适应症（下肢静脉溃疡：9项；压疮：3项；慢性伤口：2项；糖尿病足溃疡：1项；其他类型伤口：5项）。在16项研究中，主要参数是伤口愈合，而在12项研究中评估了包括疼痛在内的生活质量；8项研究评估了成本效益；3项研究评估了细菌负荷的降低。基于这些结果，制定了伤口护理中银临床应用的治疗算法。
目前的荟萃分析表明，伤口管理中使用银的证据基础明显优于当前科学辩论中的认知。因此，如果有选择地并在有限时间内使用，银不仅具有抗菌作用，而且还具有改善生活质量和良好成本效益的特点。
