纳米银敷料、银离子敷料、磺胺嘧啶银治疗Ⅱ度烧伤的网状Meta分析

Mesh Meta analysis of nano silver dressing,silver ion dressing and silver silver dressing in treatment of second degree burn

目的银制剂用于烧伤创面外用药已有数十年历史,主要有磺胺嘧啶银、纳米银敷料、银离子敷料,目前并没有同时比较三者在Ⅱ度烧伤的效果研究,因此本研究拟采用网状Meta分析的方法,纳入随机对照试验,分析纳米银敷料、银离子敷料、磺胺嘧啶银治疗Ⅱ度烧伤的疗效,进而选择最佳的含银制剂。方法全面检索中英文数据库,纳入比较纳米银敷料、银离子敷料、磺胺嘧啶银治疗Ⅱ度烧伤的随机对照试验,两个作者独立筛选研究、提取资料和评价纳入研究质量,数据分析采取Stata软件进行分析,二分类变量数据采用比值比(odds ratio,OR)及其95%可信区间(95%confidence interval,95%CI)为疗效分析统计量,连续性变量采用均数差(mean difference,MD)及其95%CI为疗效分析统计量。结果纳入14个研究(1 211例患者)。纳米银敷料(MD:-4.13,95%CI:-5.74^-2.52)、银离子敷料(MD:-3.25,95%CI:-5.00^-1.49)较磺胺嘧啶银具有较快的伤口愈合时间,但是纳米银敷料和银离子敷料在伤口愈合时间上没有统计学差异(MD:0.89,95%CI:-1.49~3.27)。在伤口愈合时间上,纳米银敷料成为最佳治疗的可能性为77.2%,其次为银离子敷料(可能性为22.8%),最后为磺胺嘧啶银(可能性为0%)。纳米银敷料的细菌感染发生率显著低于磺胺嘧啶银(OR:0.36,95%CI:0.15~0.87),银离子敷料的细菌感染发生率与磺胺嘧啶银(OR:0.52,95%CI:0.18~1.51)、纳米银敷料(OR:1.43,95%CI:0.36~5.66)无统计学差异。在细菌感染发生率上,纳米银敷料成为最佳治疗的可能性为70.3%,其次为银离子敷料(可能性为29.7%),最后为磺胺嘧啶银(可能性为0%)。结论纳米银敷料可能是目前相对于银离子敷料和磺胺嘧啶银的最佳敷料,但是需要未来研究进行证实。

ABSTRACT：Objective Silver formulations have been used for burns for several decades ,including silver sulfadi‐azine ,nano‐silver dressings ,and silver ions dressing ,but there were no comparative studies on these three agents .This study compared the three agents for partial thickness burns using network meta analysis to select the best agent . Methods A systematic search was conducted to include randomized controlled trials which compared silver sulfadi‐azine ,nano‐silver dressings ,silver ions dressing for partial thickness burns .Two authors independently screened the studies ,extracted data and evaluated the quality of included studies .Data analysis was conducted by Stata software . Dichotomous data were expressed by odds ratio （OR） and 95% confidence intervals （95% CI） ,and continuous varia‐bles were expressed by mean difference （MD） and 95% CI .Results Altogether 14 studies involving 1 211 patients were included .Nano‐silver dressings （MD：-4 .13 ,95% CI ：-5 .74‐-2 .52） and silver ions dressing （MD：-3.25 , 95% CI ：-5 .00‐-1 .49） had shorter healing time than silver sulfadiazine ,but there was no statistically significant difference between silver ions dressing and nano‐silver dressings （MD：0 .89 ,95% CI ：-1 .49‐3 .27） in wound healing time .The best treatment in wound healing time was nano‐silver dressings （possibility 77.2% ） ,followed by silver ions dressing （probability 22 .8% ） ,and silver sulfadiazine （probability 0% ） .Nano‐silver dressings had the lowest bacterial infection rate than silver sulfadiazine （ OR ：0 .36 ,95% CI ：0 .15‐0 .87 ） ,and there were no statistical differences a‐mong silver ions dressing and silver sulfadiazine （ OR ：0 .52 ,95% CI ：0 .18‐1 .51 ） ,and nano‐silver dressings （ OR ：1.43 ,95% CI ：0 .36‐5 .66） .The best treatment for bacterial infections was nano‐silver dressings （possibility 70 .3% ） , followed by silver ions dressing （probability 29.7% ） ,and silver sulfadiazine （probability 0% ） .Conclusion Nano‐silver dressings may be the optimal dressing as compared to silver ions and silver sulfadiazine dressings ,but future re‐searches are still needed to confirm this result .