负压伤口治疗对慢性伤口愈合的有效性：一项系统评价与荟萃分析。
Effectiveness of negative pressure wound therapy on chronic wound healing: A systematic review and meta-analysis.
作者信息
Burhan Asmat, Khusein Nizam Bin Ali, Sebayang Septian Mixrova
机构信息
School of Nursing, Health Faculty, Universitas Harapan Bangsa, Indonesia.
Wound Surgical Department, Sarawak Kuching Hospital, Malaysia.
出版信息
Belitung Nurs J. 2022 Dec 27;8(6):470-480. doi: 10.33546/bnj.2220. eCollection 2022.
BACKGROUND
Negative Pressure Wound Therapy (NPWT) is considered an effective treatment in facilitating the healing of chronic wounds. However, its effect remains inconsistent, which allows for further investigation.
OBJECTIVE
This study aimed to assess the effectiveness of the NPWT program in improving the management of chronic wound healing.
DESIGN
Systematic review and meta-analysis was used.
DATA SOURCES
The search strategy ranged from 2016 to 2021 in PubMed, CINAHL, ProQuest, and ScienceDirect.
REVIEW METHODS
Risk of bias was done based on the Risk of Bias 2.0 guideline using RevMan 5.4.1, and meta-analysis was done using Jeffreys's Amazing Statistics Program JASP) software version 0.16.3. Critical appraisal of the included articles was done according to Joanna Briggs Institute's (JBI) appraisal checklist.
RESULTS
A total of 15 articles were included, with 3,599 patients with chronic wounds. There was no publication bias in this study seen from the results of the Egger's test value of 0.447 ( >0.05), symmetrical funnel plot, and fail-safe of 137. However, heterogeneity among studies was present, with value of 66.7%, = 41.663 ( <0.001); thus, Random Effect (RE) model was used. The RE model showed a significant positive effect of the NPWT on chronic wound healing, with = 3.014, = 0.003, 95% CI 0.085 to 0.400. The observed effects include decreased rate of surgical site infection, controlled inflammation, edema, and exudate, as well as increased tissue with varying forest plot size, as demonstrated by the small effect size (ES = 0.24, 95% CI -0.26 to 0.79, <0.05).
CONCLUSION
The analysis results show that the standard low pressure of 80-125 mmHg could improve microcirculation and accelerate the healing process of chronic wounds. Therefore, applying the NPWT program could be an alternative to nursing interventions. However, it should be carried out by competent wound nurses who carry out procedure steps, implement general patient care, and give tips on overcoming device problems and evaluation.
PROSPERO REGISTRATION NUMBER
CRD42022348457.
背景
负压伤口治疗（NPWT）被认为是促进慢性伤口愈合的一种有效治疗方法。然而，其效果仍不一致，这有待进一步研究。
目的
本研究旨在评估NPWT方案在改善慢性伤口愈合管理方面的有效性。
设计
采用系统评价和荟萃分析。
数据来源
检索策略涵盖2016年至2021年期间的PubMed、CINAHL、ProQuest和ScienceDirect数据库。
综述方法
使用RevMan 5.4.1软件，根据偏倚风险2.0指南评估偏倚风险，并使用Jeffreys's Amazing Statistics Program（JASP）软件版本0.16.3进行荟萃分析。根据乔安娜·布里格斯研究所（JBI）的评估清单对纳入的文章进行批判性评价。
结果
共纳入15篇文章，涉及3599例慢性伤口患者。从Egger检验值为0.447（>0.05）、对称漏斗图和失安全数为137的结果来看，本研究不存在发表偏倚。然而，研究之间存在异质性，I²值为66.7%，Q = 41.663（P <0.001）；因此，使用随机效应（RE）模型。RE模型显示NPWT对慢性伤口愈合有显著的积极影响，OR = 3.014，P = 0.003，95%CI为0.085至0.400。观察到的效果包括手术部位感染率降低、炎症、水肿和渗出得到控制，以及不同森林图大小的组织增加，效应量较小（ES = 0.24，95%CI -0.26至0.79，P <0.05）表明了这一点。
结论
分析结果表明，80 - 125 mmHg的标准低压可改善微循环并加速慢性伤口的愈合过程。因此，应用NPWT方案可能是护理干预的一种替代方法。然而，应由胜任的伤口护士来实施，他们要执行操作步骤、提供一般的患者护理，并就解决设备问题和评估提供建议。
PROSPERO注册号：CRD42022348457。
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