不同种类敷料治疗烧伤疗效的网状Meta分析

Effects of different dressings in the treatment of burn wounds:a network meta-analysis

目的:目前烧伤敷料种类多样,但何种敷料效果最佳却仍缺乏相应的循证医学证据。文章采用网状Meta分析方法系统评价11种敷料治疗烧伤的疗效。方法:计算机检索中国知网、万方数据知识服务平台、维普数据库、中国生物医学文献数据库、PubMed、Embase、Web of Science及Cochrane Library数据库,检索时间为各数据库建库至2021年8月,纳入关于不同敷料治疗烧伤创面的临床随机对照试验。对文献进行筛选和资料提取,采用RevMan 5.4和Stata 14.2软件进行文献质量评价和数据分析。结果:纳入32项随机对照试验,共3795例烧伤患者,涉及11种敷料。网状Meta分析结果显示:①在缩短烧伤创面愈合时间方面,网状Meta分析排序结果从优到劣依次为:重组人粒细胞巨噬细胞集落刺激因子>富血小板血浆>芦荟敷料>成纤维细胞生长因子>银离子敷料>羊膜>重组人表皮生长因子>蜂蜜敷料>传统敷料>磺胺嘧啶银>异种猪皮敷料;②在控制烧伤创面感染率方面,网状Meta分析排序结果从优到劣依次为:蜂蜜敷料>异种猪皮敷料>银离子敷料>芦荟敷料>磺胺嘧啶银>富血小板血浆>传统敷料。结论:重组人粒细胞巨噬细胞集落刺激因子在缩短烧伤创面愈合时间方面总体效果最佳,蜂蜜敷料在控制创面感染率方面总体效果最好,但未来仍需更多高质量随机对照试验来进一步证实。

OBJECTIVE:There are a variety of external dressings for treating burn,but which one is better than others has not been confirmed by evidence-based research.This article evaluated the efficacy of eleven dressings in treating burn wounds by network meta-analysis.METHODS:Computer search was conducted on CNKI,Wanfang Data Knowledge Service Platform,VIP Database,CBM,PubMed,Embase,Web of Science,and Cochrane Library.The search time was from the database establishment to August 2021.The randomized controlled clinical trials of different dressings for treating burn wounds were included.The literature was screened and extracted,and the software RevMan 5.4 and Stata 14.2 were used to evaluate the literature quality and analyze the data.RESULTS:A total of 32 clinical randomized controlled trials involving 3795 burn patients and 11 kinds of dressings were included.The results of the network meta-analysis showed that(1)in terms of shortening burn wound healing time,which ranked as follows from good to bad:recombinant human granulocytemacrophage colony-stimulating factor>platelet-rich plasma>aloe vera gel>fibroblast growth factor>silver ion dressing>amnion>recombinant human epidermal growth factor>honey dressing>traditional dressings>silver sulfadiazine cream>porcine xenograft dressings.(2)In terms of controlling the burn wound infection rate,which ranked as follows from good to bad:honey dressing>porcine xenograft dressings>silver ion dressing>aloe vera gel>silver sulfadiazine cream>platelet-rich plasma>traditional dressings.CONCLUSION:The recombinant human granulocyte-macrophage colony-stimulating factor had the best overall effect on shortening the healing time of burn wound,and the honey dressing had the best overall effect on controlling the infection rate of burn wound.However,more high-quality randomized controlled trials are needed to further confirm this point in the future.