De Freitas Lucas R, Udoma-Udofa Ofonime Chantal, Reginato Pedro Henrique, Mitsui Henrique Costa, Provinciatto Henrique, Torres Fabricio Carvalho
Department of Medicine, Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora, MG 36036-900, Brazil.
Department of Medicine, Faculty of Medicine, Federal University of Paraná, Curitiba, PR 80060-240, Brazil.
J Burn Care Res. 2025 Jan 24;46(1):123-131. doi: 10.1093/jbcr/irae172.
Deep burn injuries necessitate effective debridement to promote healing and reduce complications. Traditional surgical debridement is the standard of care; however, it can lead to significant tissue loss, excessive bleeding and delayed healing. Bromelain-based enzymatic debridement offers a potential less invasive alternative that aims to selectively remove necrotic tissue while preserving viable ones. Therefore, this systematic review and meta-analysis comprehensively compares bromelain debridement versus standard care in the management of partial and full thickness burns. Cochrane Library, Embase, and Medline were searched until May 30, 2024 for studies comparing bromelain debridement versus standard care. R version 4.4.0 was used to pooled risk ratio and mean difference in a random-effects model. We included 7 studies, comprising 484 participants, of whom 238 (49%) were treated with enzymatic debridement. Bromelain significantly reduced time to eschar removal (MD -7.60 days 95% CI [-9.76, -5.44]; I2 = 70%) in comparison with standard care. Additionally, bromelain group presented a significant reduction in the risk of surgical excision (RR 0.17; 95% CI [0.06, 0.47]; I2 = 79%) and need for autografts (RR 0.40; 95% CI [0.18, 0.93]; I2 = 76%) in comparison with standard group. No differences were found in behalf of time to wound closure (MD -7.64 days; 95% CI [-18.46]-[3.18]; I2 = 86%), nor in Modified Vancouver Scar Scale (MD -0.36 points; 95% CI [-0.96]-[0.23]; I2 = 0%). Bromelain-based enzymatic debridement may accelerate eschar removal and reduce the need for surgical excision and autografts, without adversely affecting wound closure time or long-term scar quality.
深度烧伤需要有效的清创术来促进愈合并减少并发症。传统的手术清创术是护理标准；然而，它可能导致大量组织损失、过度出血和愈合延迟。基于菠萝蛋白酶的酶促清创术提供了一种潜在的侵入性较小的替代方法，旨在选择性地去除坏死组织，同时保留存活组织。因此，本系统评价和荟萃分析全面比较了菠萝蛋白酶清创术与标准护理在治疗部分厚度和全厚度烧伤中的效果。检索了Cochrane图书馆、Embase和Medline数据库，截至2024年5月30日，查找比较菠萝蛋白酶清创术与标准护理的研究。使用R版本4.4.0在随机效应模型中汇总风险比和平均差异。我们纳入了7项研究，共484名参与者，其中238名（49%）接受了酶促清创术治疗。与标准护理相比，菠萝蛋白酶显著缩短了焦痂清除时间（MD -7.60天，95%CI [-9.76, -5.44]；I2 = 70%）。此外，与标准组相比，菠萝蛋白酶组手术切除风险（RR 0.17；95%CI [0.06, 0.47]；I2 = 79%）和自体移植需求（RR 0.40；95%CI [0.18, 0.93]；I2 = 76%）显著降低。在伤口闭合时间方面未发现差异（MD -7.64天；95%CI [-18.46]-[3.18]；I2 = 86%），在改良温哥华瘢痕量表方面也未发现差异（MD -0.36分；95%CI [-0.96]-[0.23]；I2 = 0%）。基于菠萝蛋白酶的酶促清创术可能会加速焦痂清除，并减少手术切除和自体移植的需求，而不会对伤口闭合时间或长期瘢痕质量产生不利影响。
