SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
SingVaSC, Singapore Vascular Surgical Collaborative, Singapore.
Eur J Vasc Endovasc Surg. 2019 Sep;58(3):446-454. doi: 10.1016/j.ejvs.2018.12.021. Epub 2019 Aug 1.
Closed incision negative pressure wound therapy (CiNPT) may be a valuable treatment option for surgical site infections. This systematic review and meta-analysis sought to compare CiNPT against conventional wound care after vascular procedures.
This study conformed to the PRISMA guidelines. An electronic search was performed on Medline/Pubmed, EMBASE, and the Cochrane Library. The date of last search was July 11 2018. Relative risks and mean differences for primary and secondary outcomes were calculated. A random effects model was used for substantial heterogeneity (I > 30%). The Cochrane Risk of Bias tool was employed to rate the methodological quality of the included studies, whilst the GRADE approach was use to grade the level of evidence for the observed effects.
Of 47 studies, five randomised controlled trials (RCTs) were included, comprising 662 patients, of which 47.9% underwent CiNPT and 52.1% received conventional care. The overall risk of infection (RR = 0.31, 95% CI 0.21-0.47) (high quality), Szilagyi Grades I (RR = 0.35, 95% CI 0.20-0.60) (high quality), and III (RR = 0.17, 95% CI 0.04-0.68) (high quality) infections, need for antibiotics (RR = 0.36, 95% CI 0.20-.64) (high quality), and surgical re-intervention (RR = 0.27, 95% CI 0.27-0.98) (high quality) were lower in the CiNPT group. However, there were no significant differences in the risk of Grade II (RR = 0.59, 95% CI 0.10-3.66) (moderate quality), as well as length of hospital stay (mean difference, MD = -0.59, 95% CI -2.48 to 1.31) (moderate quality), and 30 day mortality (RR = 3.95, 95% CI 0.17-94.76) (high quality).
While there is evidence demonstrating that CiNPT reduces the risk of Grades I and III infections and re-interventions, there was a noticeable lack of difference in other important post-operative outcomes. Further well designed RCTs are needed to corroborate these findings.
封闭式切口负压伤口治疗（CiNPT）可能是血管手术后治疗手术部位感染的一种有价值的治疗选择。本系统评价和荟萃分析旨在比较 CiNPT 与传统伤口护理在血管手术后的效果。
本研究符合 PRISMA 指南。在 Medline/Pubmed、EMBASE 和 Cochrane 图书馆进行了电子检索。最后一次检索日期为 2018 年 7 月 11 日。计算了主要和次要结局的相对风险和均值差异。对于具有显著异质性（I > 30%）的结果，采用随机效应模型。使用 Cochrane 偏倚风险工具评估纳入研究的方法学质量，同时使用 GRADE 方法评估观察到的效果的证据水平。
在 47 项研究中，有 5 项随机对照试验（RCT）纳入研究，共纳入 662 名患者，其中 47.9%接受 CiNPT，52.1%接受传统护理。感染总风险（RR = 0.31，95%CI 0.21-0.47）（高质量）、Szilagyi Ⅰ级（RR = 0.35，95%CI 0.20-0.60）（高质量）和 Ⅲ级（RR = 0.17，95%CI 0.04-0.68）（高质量）感染、抗生素使用（RR = 0.36，95%CI 0.20-0.64）（高质量）和手术再干预（RR = 0.27，95%CI 0.27-0.98）（高质量）的风险较低。然而，CiNPT 组在Ⅱ级（RR = 0.59，95%CI 0.10-3.66）（中等质量）以及住院时间（平均差值，MD =-0.59，95%CI -2.48 至 1.31）（中等质量）和 30 天死亡率（RR = 3.95，95%CI 0.17-94.76）（高质量）方面的风险无显著差异。
虽然有证据表明 CiNPT 降低了Ⅰ级和Ⅲ级感染和再干预的风险，但在其他重要的术后结局方面，差异并不明显。需要进一步设计良好的 RCT 来证实这些发现。
