Department of Surgery, Motahari Burn Hospital, Iran University of Medical Sciences, Tehran, Iran.
Department of general surgery, Shahed faculty of medicine, shahed university, Tehran, Iran.
J Burn Care Res. 2020 Nov 30;41(6):1224-1230. doi: 10.1093/jbcr/iraa074.
Burns are a significant public health burden worldwide. In addition to those who die, millions remain with life-threatening deformities and disabilities resulting in stigma and rejection. Surgical excision is currently the standard of care for removing necrotic tissues in burn wounds to prepare the wound bed for grafting or enhancing the healing process. However, there is a growing interest on enzymatic debridement as an adjunct therapy in burn wounds. The aim of this study was to investigate clinical trials using debriding agents for burn wound in humans in a systematic review. This was a systematic review of electronic databases including CINAHL, PubMed, Ovid Medline, Web of Science, Google Scholar, and Embase from January 1969 to February 2019. The study protocol was registered in PROSPERO registry. The following keywords were searched: "burn wounds", "enzymatic debridement", "papain", "papain-urea", "pine apple", "Bromelain", "collagenases", "Nexobrid", "Debrase", "Debridase", "Actinidia deliciosa", "Sutilains", "Debrace", "piruvat acid". Those studies fulfilling the inclusion and exclusion criteria with low score of bias based on Cochrane Bias Tool were reviewed. Sixteen investigations fulfilled our inclusion criteria to be reviewed. Six, seven, and three clinical trials on humans were found regarding collagenase, bromelain, and miscellaneous agents. Collagenase has been reported to be effective in burns below 25% of TBSA, especially in outpatients' clinics. However, Nexobrid has been shown to be effective in deep burns and decreases the percentage of graft without significant adverse effects. There was not enough evidence supporting the clinical values of Papain, Sutilains, Urea, etc. Surgical excision still remains the standard of care for burn wounds debridement. However, enzymatic debridement, especially Bromelain might help to reduce sessions for surgical debridement or area under graft as an adjunct treatment. Despite the fact, more studies with larger sample sizes and with less conflicts of interest are needed to clearly elucidate the exact role of Bromelain.
烧伤是全球范围内一个重大的公共卫生负担。除了那些死亡的人，还有数百万人因危及生命的畸形和残疾而留下疤痕和被人排斥。手术切除是目前治疗烧伤创面坏死组织的标准方法，旨在为植皮做准备或促进愈合过程。然而，酶清创术作为烧伤创面的辅助治疗方法越来越受到关注。本研究旨在通过系统评价调查人类烧伤创面使用清创剂的临床试验。这是一项对电子数据库（包括 CINAHL、PubMed、Ovid Medline、Web of Science、Google Scholar 和 Embase）的系统评价，检索时间从 1969 年 1 月到 2019 年 2 月。研究方案在 PROSPERO 注册。检索了以下关键词：“烧伤创面”、“酶清创术”、“木瓜蛋白酶”、“木瓜蛋白酶-尿素”、“菠萝”、“菠萝蛋白酶”、“胶原酶”、“Nexobrid”、“Debrase”、“Debridase”、“奇异果”、“Sutilains”、“Debrace”、“丙酮酸”。根据 Cochrane 偏倚工具对满足纳入和排除标准且偏倚评分低的研究进行了评价。有 16 项研究符合纳入标准进行了综述。发现了 6 项、7 项和 3 项关于胶原酶、菠萝蛋白酶和其他制剂的人类临床试验。胶原酶已被报道在 TBSA 低于 25%的烧伤中有效，尤其是在门诊诊所。然而，Nexobrid 已被证明在深烧伤中有效，并减少了植皮面积，而没有显著的不良反应。没有足够的证据支持木瓜蛋白酶、奇异果、尿素等的临床价值。手术切除仍然是烧伤创面清创的标准方法。然而，酶清创术，特别是菠萝蛋白酶，可能有助于减少手术清创的次数或作为辅助治疗的植皮面积。尽管如此，仍需要更多具有更大样本量和更少利益冲突的研究来明确阐明菠萝蛋白酶的确切作用。
