He Si, Tang Na, Li Sha
Hospital Infection Management Department, Changsha Stomatological Hospital, Stomatological Clinical College of Hunan University of Chinese Medicine, Changsha, China.
PLoS One. 2025 Aug 7;20(8):e0328771. doi: 10.1371/journal.pone.0328771. eCollection 2025.
Negative pressure wound therapy (NPWT) has become a popular treatment option for sternal wound infection (SWI). However, it remains uncertain whether the therapeutic benefits of NPWT are superior to conventional wound care. This study aimed to systematically evaluate the therapeutic effects of NPWT on SWI compared to conventional wound care through meta-analysis.
A comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library databases was conducted from inception to April 29, 2024 for all potential studies. The pooling of dichotomous outcome data was achieved using relative risk (RR), with results presented within a 95% confidence interval (CI). We utilized the standard mean difference (SMD) and 95% CI for continuous outcomes. Heterogeneity test, publication bias assessment, sensitivity analysis, and trial sequential analysis (TSA) were conducted. Publication bias was detected through the Begg's and Egger's tests. Software R 4.3.1, Stata 12.0, and TSA v0.9.5.10 Beta software were utilized for all analyses.
Out of 1832 articles identified, 10 were included in this study. The overall results revealed that NPWT significantly decreased the sternal wound reinfection (SWRI) rate (RR [95% CI] = 0.179 [0.099 to 0.323], 95% prediction interval [PI]: 0.082 to 0.442), in-hospital mortality (RR [95% CI] = 0.242 [0.149 to 0.394], 95% PI: 0.144 to 0.461), and shortened the length of intensive care unit (ICU) stay (SMD [95% CI] = -0.601 [-0.820 to -0.382], 95% PI: -1.317 to 0.128) compared with conventional wound care. There was no significant difference in length of hospital stay (SMD [95% CI] = -0.402 [-0.815 to 0.012], 95% PI: -1.801 to 0.998) and treatment duration (SMD [95% CI] = -0.398 [-1.646 to 0.849], 95% PI: -16.340 to 15.543) between the NPWT group and control group. Further subgroup analysis demonstrated the benefits of NPWT in shortening hospitalization length in the European population (p < 0.05).
The present evidence corroborates that the application of NPWT in the treatment of SWI after cardiac surgery effectively reduces the SWRI incidence and in-hospital mortality while shortening the length of ICU stay.
负压伤口治疗（NPWT）已成为胸骨伤口感染（SWI）的一种常用治疗选择。然而，NPWT的治疗效果是否优于传统伤口护理仍不确定。本研究旨在通过荟萃分析系统评价NPWT与传统伤口护理相比对SWI的治疗效果。
从数据库建立至2024年4月29日，全面检索PubMed、Web of Science、Embase和Cochrane图书馆数据库，查找所有潜在研究。采用相对危险度（RR）汇总二分法结局数据，结果以95%置信区间（CI）表示。对于连续型结局，我们使用标准化均数差（SMD）和95%CI。进行异质性检验、发表偏倚评估、敏感性分析和试验序贯分析（TSA）。通过Begg检验和Egger检验检测发表偏倚。所有分析均使用R 4.3.1软件、Stata 12.0软件和TSA v0.9.5.10 Beta软件。
在检索到的1832篇文章中，本研究纳入了10篇。总体结果显示，与传统伤口护理相比，NPWT显著降低了胸骨伤口再感染（SWRI）率（RR [95%CI] = 0.179 [0.099至0.323]，95%预测区间[PI]：0.082至0.442）、住院死亡率（RR [95%CI] = 0.242 [0.149至0.394]，95%PI：0.144至0.461），并缩短了重症监护病房（ICU）住院时间（SMD [95%CI] = -0.601 [-0.820至-0.382]，95%PI：-1.317至0.128）。NPWT组与对照组在住院时间（SMD [95%CI] = -0.402 [-0.815至0.012]，95%PI：-1.801至0.998）和治疗持续时间（SMD [95%CI] = -0.398 [-1.646至0.849]，95%PI：-16.340至15.543）方面无显著差异。进一步的亚组分析表明，NPWT在缩短欧洲人群住院时间方面有益（p < 0.05）。
现有证据证实，NPWT应用于心脏手术后SWI的治疗可有效降低SWRI发生率和住院死亡率，同时缩短ICU住院时间。
