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部分厚度烧伤的治疗:在门诊环境中比较四种常规使用的烧伤敷料的前瞻性、随机对照试验。

Treatment of Partial Thickness Burns: A Prospective, Randomized Controlled Trial Comparing Four Routinely Used Burns Dressings in an Ambulatory Care Setting.

机构信息

Burns Unit, Concord Repatriation General Hospital, Concord, New South Wales, Australia.

University of Sydney, Camperdown, New South Wales, Australia.

出版信息

J Burn Care Res. 2021 Sep 30;42(5):934-943. doi: 10.1093/jbcr/iraa158.

Abstract

This prospective, randomized controlled trial study compared the effects of four dressings for adult partial thickness burns, focusing on re-epithelialization time and cost effectiveness. Adults with partial thickness burns meeting inclusion criteria were randomized to either Biobrane™, Acticoat™, Mepilex® Ag, or Aquacel® Ag. Primary endpoint for analysis was >95% re-epithelialization. Incremental cost-effectiveness ratios were calculated based on dressing costs. Dominance probabilities between treatment arms were calculated from bootstrap resampling trial data. One hunderd thirty-one partial thickness burn wounds in 119 patients were randomized. Adjusting for sex, age, smoking status, burn mechanism, TBSA, and first aid adequacy, Mepilex® Ag had a reduced time to re-epithelialization compared to Biobrane™ (IRR: 1.26; 95% CI: 1.07-1.48, P < .01). Economic analysis showed that there was a 99%, 71%, and 53% probability that Mepilex® Ag dominated (cheaper and more effective) Biobrane™, Acticoat™, and Aquacel® Ag, respectively. Mepilex® Ag achieved faster re-epithelialization and better cost effectiveness. Patient satisfaction and comfort seems better with Biobrane™ although not reflected within the end outcome of the healed wound. It is the patients' (after extensive education) and clinicians' choice, level of experience, and availability of products in praxis that will guide the decision as to which the product is used individually on which patient.

摘要

这项前瞻性、随机对照试验研究比较了四种敷料治疗成人部分厚度烧伤的效果,重点关注再上皮化时间和成本效益。符合纳入标准的成人部分厚度烧伤患者被随机分为 Biobrane™、Acticoat™、Mepilex®Ag 和 Aquacel®Ag 组。分析的主要终点是 >95%的再上皮化。基于敷料成本计算增量成本效益比。从 bootstrap 重采样试验数据计算治疗臂之间的优势概率。119 名患者的 131 个部分厚度烧伤创面被随机分组。调整性别、年龄、吸烟状况、烧伤机制、TBSA 和急救充分性后,Mepilex®Ag 与 Biobrane™相比,再上皮化时间缩短(IRR:1.26;95%CI:1.07-1.48,P<.01)。经济分析表明,Mepilex®Ag 分别以 99%、71%和 53%的概率(更便宜且更有效)优于 Biobrane™、Acticoat™和 Aquacel®Ag。Mepilex®Ag 实现更快的再上皮化和更好的成本效益。虽然 Biobrane™在愈合伤口的最终结果中没有体现,但患者的满意度和舒适度似乎更好。是患者(经过广泛教育)和临床医生的选择、经验水平以及在实践中产品的可用性,将指导他们决定在哪个患者身上使用哪种产品。

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