University of Nottingham, School of Veterinary Medicine and Science, Loughborough, Leicestershire, UK.
Oakham Veterinary Hospital, Oakham, Rutland, UK.
Equine Vet J. 2021 Jan;53(1):18-29. doi: 10.1111/evj.13289. Epub 2020 Jul 17.
There are currently no evidence summaries on wounds in the horse.
To develop evidence-based guidelines on wound management in the horse.
Evidence review using the GRADE framework.
Research questions were proposed by a panel of veterinarians, and developed into PICO format. Evidence in the veterinary literature was evaluated using the GRADE evidence-to-decision framework. Searches for human evidence summaries were conducted in the NICE, Cochrane and JBI databases. Final recommendations were based on both veterinary and human evidence.
The research questions were categorised into three areas: A. Wound lavage and topical treatments; B. Wound debridement and closure; C. Therapeutics for wound healing. Three hundred and six veterinary publications were identified across thirteen different topics. Fourteen papers were assessed using the GRADE criteria. Twenty-five human evidence summaries were reviewed. The results were developed into recommendations: Wound lavage and topical treatments: (i) Tap water should be considered instead of saline for lavage; (ii) Povidone iodine lavage should be considered for contaminated wounds; (iii) Topical silver sulfadiazine may not be suitable for acute wounds; (iv) Optimal lavage pressures are around 13 psi. Wound debridement and closure: (i) Debridement pads should be considered for wound preparation; (ii) Larvae debridement should be considered in selected cases; (iii) Hydrosurgery should be considered in acute contaminated wounds. Therapeutics for wound healing: (i) Honey may reduce duration of some phases of wound healing. There was insufficient evidence to draw conclusions on the use of chemical debridement, therapeutic ultrasound, laser therapy, wound closure with staples compared to sutures, or identify optimal concentrations of antiseptic lavage solutions.
Low quality evidence in veterinary literature; majority of recommendations were based on human evidence.
These findings should be used to inform decision-making in equine primary care practice.
目前尚无关于马的伤口的证据总结。
制定马的伤口处理循证指南。
使用 GRADE 框架进行证据回顾。
由一组兽医提出研究问题，并将其制定为 PICO 格式。使用 GRADE 证据决策框架评估兽医文献中的证据。在 NICE、Cochrane 和 JBI 数据库中搜索人类证据总结。最终建议基于兽医和人类证据。
研究问题分为三个领域：A. 伤口冲洗和局部治疗；B. 伤口清创和闭合；C. 伤口愈合治疗。在十三个不同的主题中，确定了 306 篇兽医出版物。使用 GRADE 标准评估了 14 篇论文。审查了 25 份人类证据总结。结果被制定成建议：伤口冲洗和局部治疗：(i) 应考虑使用自来水代替生理盐水冲洗；(ii) 应考虑使用聚维酮碘冲洗污染伤口；(iii) 银磺胺嘧啶可能不适合急性伤口；(iv) 最佳冲洗压力约为 13 psi。伤口清创和闭合：(i) 清创垫应考虑用于伤口准备；(ii) 幼虫清创术应在某些情况下考虑；(iii) 水刀应考虑用于急性污染伤口。伤口愈合治疗：(i) 蜂蜜可能会缩短某些阶段的伤口愈合时间。关于化学清创术、治疗性超声波、激光治疗、与缝合相比用钉书钉闭合伤口、或确定最佳浓度的抗菌冲洗溶液，没有足够的证据得出结论。
兽医文献中证据质量低；大多数建议都是基于人类的证据。
这些发现应用于指导马的初级保健实践中的决策。
