Cai Ji-Yu, Zha Man-Li, Chen Hong-Lin
Nantong University, Nantong City, Jiangsu Province, PR China.
Wound Manag Prev. 2019 Feb;65(2):30-38.
Use of a hydrocolloid dressing (HCD) is generally recommended to help prevent pressure ulcers (PUs) in high-risk patients, including ulcers caused by noninvasive ventilation (NIV).
The study was conducted to compare the effect of preventive use of HCD to other methods in the rate of facial PUs caused by NIV.
PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang Data were searched from date of index inception to August 2018 without language restrictions to identify randomized controlled trials (RCTs) that compared HCD use to other NIV-related PU prevention measures. Publications were systematically reviewed, data were extracted, and study quality was assessed using the Jadad scale. Odds ratio (OR) with 95% confidence intervals (CIs) for PU incidence in patients using HCD versus patients managed with gauze or standard skin care procedures (control) were calculated using a fixed-effects model.
The search yielded 80 publications; 40 met the study criteria for full-text and 22 met the meta-analysis inclusion criteria (total study participants = 2519). Patients who used a HCD (n = 1260) had a significantly decreased incidence of PU (OR = 0.15; 95% CI: 0.11-0.20) compared with control group patients (n = 1259). Subgroup analysis by age showed a lower incidence in children (OR = 0.09; 95% CI: 0.01-0.81) and adults (OR = 0.16; 95% CI: 0.12-0.22) in the HCD group than in the control group. PU incidence using HCD was lower compared to gauze (OR = 0.17; 95% CI: 0.10-0.28) and regular skin care (OR = 0.13; 95% CI: 0.09-0.19). Funnel plot diagrams suggested a risk of bias. Sensitivity analysis using a random-effects model did not change the result of the main meta-analysis.
Using a HCD significantly decreased the incidence of facial PUs caused by NIV. Additional high-quality, prospective research to confirm the effectiveness of HCD in preventing NIV-related PUs is warranted.
一般建议使用水胶体敷料（HCD）来帮助预防高危患者发生压疮（PU），包括无创通气（NIV）导致的溃疡。
本研究旨在比较预防性使用HCD与其他方法在NIV所致面部PU发生率方面的效果。
检索了从索引起始日期到2018年8月的PubMed、Web of Science、中国知网和万方数据，无语言限制，以识别将使用HCD与其他NIV相关的PU预防措施进行比较的随机对照试验（RCT）。对出版物进行系统评价，提取数据，并使用Jadad量表评估研究质量。使用固定效应模型计算使用HCD的患者与使用纱布或标准皮肤护理程序（对照组）的患者PU发生率的比值比（OR）及其95%置信区间（CI）。
检索共得到80篇出版物；40篇符合全文研究标准，22篇符合荟萃分析纳入标准（研究参与者总数 = 2519）。与对照组患者（n = 1259）相比，使用HCD的患者（n = 1260）PU发生率显著降低（OR = 0.15；95% CI：0.11 - 0.20）。按年龄进行的亚组分析显示，HCD组儿童（OR = 0.09；95% CI：0.01 - 0.81）和成人（OR = 0.16；95% CI：0.12 - 0.22）的发生率均低于对照组。与使用纱布（OR = 0.17；95% CI：0.10 - 0.28）和常规皮肤护理（OR = 0.13；95% CI：0.09 - 0.19）相比，使用HCD时PU发生率更低。漏斗图提示存在偏倚风险。使用随机效应模型的敏感性分析未改变主要荟萃分析的结果。
使用HCD可显著降低NIV所致面部PU的发生率。有必要进行更多高质量的前瞻性研究以证实HCD在预防NIV相关PU方面的有效性。
