From the Department of Plastic Surgery, Loma Linda University Medical Center; 3M; Elson S. Floyd College of Medicine Washington State University; and University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2021 Jan 1;147(1S-1):68S-76S. doi: 10.1097/PRS.0000000000007614.
Large randomized controlled trials that evaluate the effects of negative-pressure wound therapy with instillation of a topical solution and dwell time (NPWTi-d) are lacking. There is a need to synthesize existing data across multiple studies to provide a more precise estimate of the clinical effects of NPWTi-d.
A systematic literature review and a meta-analysis of comparative studies were performed to determine the effects of NPWTi-d versus control therapy in the adjunctive management of complex wounds. Weighted standardized mean difference or odds ratios and 95% confidence intervals were calculated to pool study and control group results in each publication for analysis.
Thirteen studies comprising 720 patients were included in the analysis. Significantly fewer surgical debridements were performed in NPWTi-d patients versus control patients (P = 0.01). Wounds in the NPWTi-d group were ready for closure faster than control wounds (P = 0.03). The odds of reducing bacterial count from baseline in the NPWTi-d group was 4.4 times greater than control group wounds (P = 0.003), and percent reduction of bacterial count in NPWTi-d wounds was evident in all studies that captured that endpoint. There was a significantly shorter length of therapy in NPWTi-d patients versus control patients (P = 0.03). Wounds in NPWTi-d group were 2.39 times more likely to close than control group wounds (P = 0.01). Length of hospital stay was not significantly reduced for NPWTi-d patients compared with that for control patients (P = 0.06).
Results of this meta-analysis show a positive effect with use of NPWTi-d in various wound types.
缺乏评估负压伤口治疗联合局部溶液灌输和保持时间（NPWTi-d）效果的大型随机对照试验。需要综合多项研究的现有数据，以更准确地估计 NPWTi-d 的临床效果。
对比较研究进行了系统的文献回顾和荟萃分析，以确定 NPWTi-d 与对照治疗在辅助治疗复杂伤口方面的效果。计算加权标准化均数差或比值比及其 95%置信区间，以汇总每个出版物中研究组和对照组的结果进行分析。
纳入的分析包括 13 项研究，共 720 例患者。NPWTi-d 组患者的手术清创次数明显少于对照组患者（P=0.01）。NPWTi-d 组的伤口比对照组更快准备好闭合（P=0.03）。NPWTi-d 组减少基线细菌计数的几率是对照组的 4.4 倍（P=0.003），并且所有记录该终点的研究都显示 NPWTi-d 伤口的细菌计数减少。NPWTi-d 组的治疗时间明显短于对照组（P=0.03）。NPWTi-d 组的伤口闭合的可能性是对照组的 2.39 倍（P=0.01）。NPWTi-d 组患者的住院时间与对照组相比没有明显减少（P=0.06）。
这项荟萃分析的结果显示，在各种伤口类型中使用 NPWTi-d 具有积极的效果。
