院前外用止血敷料的系统性评价

Systematic evaluation of prehospital external hemostatic dressings

目的 针对院前外用止血敷料临床证据有限的现况,对不同种类院前外用止血敷料的有效性、安全性和可操作性进行系统性评价,为后续建立综合指标体系提供合理支撑和借鉴。方法 运用系统综述方法,梳理、总结沸石、高岭土和壳聚糖3类止血敷料的评价指标。结果 纳入15项研究,仅一项随机对照试验(RCT)研究,其余均为描述性研究,研究对象包括军人和平民。纳入研究的3类止血敷料均产生良好的止血效果,但数据量有限,无法比较不同种类间的止血效果;除沸石类因放热灼伤伤口,其余种类不良反应少,可操作性不明。结论 结合理想型止血剂和我国专家共识的标准要求,建议纳入后续研究的指标包括有效性、安全性、可操作性、稳定性和经济性,选取的文献中并无稳定性和经济性的数据,后续将纳入临床前动物研究,用以补充相关指标。

Objective To evaluate the effectiveness,safety and operability of different types of pre⁃hospital topical hemostatic dressings given the limited clinical evidence of pre⁃hospital topical hemostatic dressings so as to provide reference for the subsequent establishment of a comprehensive index system.Methods A systematic review method was used to sift through and summarize the evaluation indexes of zeolite,kaolin and chitosan.Results Fifteen studies were included,only one of which was randomized controlled trial(RCT)study,and the rest were descriptive studies,involving military and civilian subjects.All the three types of hemostatic dressings in the included studies had good haemostatic effects,but the amount of data was too limited to compare the haemostatic effects between different types.Except for zeolite wounds that were likely to be burned by exothermic heat,the other types caused few adverse reactions but with unclear operability.There was no data on stability and economy in the selected literature.Conclusion Considering the ideal hemostatic agent and the standard requirements of Chinese expert consensus,it is recommended that the indicators in follow⁃up studies include efficacy,safety,operability,stability and economy,and that preclinical animal studies be included to supplement related indicators.