高级敷料对剖宫产术后手术部位感染的系统评价及Meta分析

A systematic review and meta-analysis of advanced dressings for surgical site infection after cesarean section

目的 系统评价新型不同溶液浸渍敷料对剖宫产术后手术部位感染的影响。方法 计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国生物医学文献数据库、中国知网、万方期刊数据库及维普数据库不同溶液浸渍敷料对剖宫产术后感染影响的随机对照研究,检索时间截至2022年3月。由2位研究者独立根据纳入排除标准进行文献筛选、资料提取和质量评价后,对纳入研究进行系统评价和Meta分析。结果 共检索符合纳入排除标准的8项研究,5种高级敷料,包括DACC浸泡敷料、银离子敷料、铜离子敷料、葡萄糖酸氯己定敷料和芦荟凝胶敷料。Meta分析结果显示,与普通敷料相比,DACC敷料可显著降低剖宫产术后SSI发生率[OR=0.32,95%CI(0.13,0.76),Z=2.58,P=0.01],银离子敷料差异不存在显著统计学意义[OR=1.21,95%CI(0.76,1.93),Z=0.80,P=0.42]。定性分析结果显示铜离子敷料和芦荟凝胶敷料对降低剖宫产术后感染发生率可能有效,葡萄糖酸氯己定敷料对剖宫产术后感染的影响尚不显著。结论 现有证据证实DACC浸泡敷料可有效降低剖宫产术后感染发生率,银离子敷料对剖宫产手术部位感染无影响,其他高级敷料仍需更多高质量、大样本的RCT进一步验证,定量合并提升证据级别。

Objective A systematic review of the effects of novel different solution-impregnated dressings on surgical site infection after cesarean section. Methods Computer search of PubMed, Web of Science, Cochrane Library, Embase, Chinese Biomedical Literature Database, CNKI, Wanfang Journal Database and Weipu Database for randomized controlled studies of the effects of different solution dipping dressings on post-cesarean section infections. The time is as of March 2022. Two researchers independently conducted literature screening, data extraction and quality evaluation according to the inclusion and exclusion criteria, and then systematically evaluated the included studies. Results A total of 8 studies that met the inclusion and exclusion criteria were searched for 5 novel dressings, including DACC immersion dressing, silver ion dressing, copper ion dressing, chlorhexidine gluconate dressing and aloe vera gel dressing. Meta-analysis results showed that compared with ordinary dressings, DACC dressings can significantly reduce the incidence of SSI after cesarean section [OR=0.32, 95%CI(0.13,0.76), Z=2.58, P=0.01], silver ion dressings the difference was not statistically significant [OR=1.21, 95%CI(0.76, 1.93), Z=0.80,P=0.42]. Qualitative analysis showed that copper ion dressing and aloe vera gel dressing may be effective in reducing the incidence of infection after cesarean section, while chlorhexidine gluconate dressing has no significant effect on infection after cesarean section. Conclusion Existing evidence confirms that DACC immersion dressing can effectively reduce the incidence of infection after cesarean section, and silver ion dressing has no effect on cesarean section infection. Other new dressings still need more high-quality, large-sample RCTs to further validate, and quantitatively combine to improve the level of evidence.