不同清洁剂预防骨科外固定术后针道感染的网状Meta分析

Different cleansing agents for prevention of pin site infection after orthopedic external fixation:a network Meta-analysis

目的:运用网状Meta分析方法评价不同清洁剂预防骨科外固定术后针道感染发生的概率。方法:采用循证检索策略,计算机检索PubMed、Web of Science、MedLine、CINAHL、the Cochrane Library、EMbase、中国知网、万方数据库发表的有关清洁剂预防骨科外固定术后发生针道感染的临床随机对照试验(RCT);结局指标为针道感染发生率和针道感染阳性率。检索时限为建库至2023年4月30日。所使用Cochrane偏倚风险评估工具对纳入研究进行质量评价,提取文献数据后,应用RevMan 5.4、Stata 17.0软件进行数据分析。结果:共纳入8项RCT,涉及骨科外固定术病人439例,4435个针道口;其中1项为低风险研究,5项为中风险研究。网状Meta分析结果显示:在感染发生率方面,生理盐水+1.5%过氧化氢+Xeroform(93.6%)、生理盐水+Xeroform(70.6%)优于生理盐水(62.0%)。在感染阳性率方面,生理盐水+1.5%过氧化氢+Xeroform(91.2%)、生理盐水+0.2%聚亚己基双胍(85.8%)、生理盐水+Xeroform(53.2%)均优于生理盐水(52.7%)。结论:现有证据表明,在诸多清洁剂中生理盐水+1.5%过氧化氢+Xeroform在预防骨科外固定术后针道感染发生率和感染阳性率方面,成为最佳干预措施的可能性最大。

Objective:This study evaluated the probability of different detergents in preventing pin tract infection after orthopedic external fixation by using network Meta-analysis.Methods:Using evidence-based search strategy,PubMed,Web of Science,MedLine,CINAHL,the Cochrane Library,EMbase,CNKI and WanFang Databases were searched by computer for clinical randomized controlled trials of detergent in preventing pin tract infection after orthopedic external fixation published from self-construction to April 30,2023.The outcome measures were the incidence of pin tract infection and the positive rate of pin tract infection.The Cochrane risk of bias assessment tool was used to evaluate the quality of the included literatures.After the literature data were extracted,the RevMan 5.4 and Stata 17.0 software were used for data analysis.Results:Eight randomized controlled trials involving 439 patients with 4435 pin sites were included.Of these,1 was a low risk study and 5 were medium risk studies.The results of network Meta-analysis showed that the infection rate of normal saline+1.5%H_(2)O_(2)+Xeroform(93.6%)and normal saline+Xeroform(70.6%)was higher than that of normal saline(62.0%).The positive rate of infection was higher in normal saline+1.5%H_(2)O_(2)+Xeroform(91.2%),normal saline+0.2%polyhexamethylene biguanide(85.8%)and normal saline+Xeroform(53.2%)than in normal saline(52.7%).Conclusion:Current evidence shows that normal saline+1.5%H 2O 2+Xeroform is the most likely to be the best intervention in preventing the incidence of pin tract infection and infection positive rate after orthopedic external fixation among many detergents.