負壓傷口治療對糖尿病潰瘍傷口之成效：系統性文獻回顧及統合分析

Negative Pressure Wound Therapy Effect on Diabetic Foot Ulcers：A Systematic Review and Meta-Analysis

林筱青(Hsiao-Ching Lin) ； 陳威臣(Wei-Chen Chen) ； 楊正三(Sam Yang) ； 張簡志炫(Chin-Hsuan Chang Chien) ； 許晉豪(Chin-Hao Hsu) ； 方前量(Chien-Liang Fang)

《南臺灣醫學雜誌》 14卷1期 (2018/06) Pp. 1-12

https://doi.org/10.6726/MJST.201806_14(1).0001

摘要

目的：糖尿病潰瘍傷口嚴重時需進行截肢手術，而負壓傷口治療用於慢性傷口已有不錯成效，但用於糖尿病潰瘍傷口之成效如何，國內目前沒有對此議題做相關論述及整理，本研究收集高品質之隨機控制試驗文獻，運用系統性回顧及統合分析，探討負壓傷口治療對糖尿病潰瘍傷口之成效。方法：依關鍵字搜尋：華藝線上圖書館、Cochrane Library、PubMed及Medline，搜尋設定年限為2000年1月至2017年10月，將納入準則之文獻使用Modified Jadad Score及Oxford Centre for Evidence-based Medicine評讀研究品質，並以Review Manager 5統計軟體進行統合分析。結果：納入12篇隨機臨床試驗研究進入統合分析，共1185位個案，研究結果：傷口癒合時間-19.78天(95%CI：-40.05,0.48)、傷口減少面積比例27.72(95%CI：5.65,49.79)、傷口減少面積10.05平方公分(95%CI：4.34,15.77)、傷口減少深度比例39.18(95%CI：28.96,49.39)、傷口完全癒合比例3.01(95%CI：1.64,5.53)、截肢率0.28(95%CI：0.14,0.57)和不良事件1.10(95%CI：0.67,1.78)。結論：實證研究發現負壓傷口治療可顯著減少糖尿病潰瘍傷口的面積及深度、增加傷口完全閉合和降低截肢，這可供醫療人員參考，以提升照護品質。

關鍵字

負壓傷口治療 ； 糖尿病潰瘍傷口 ； 常規傷口護理

並列摘要

Objective: Severe diabetic ulcer wounds require amputation surgery. The negative pressure wound treatment on chronic wounds has good success recently. However, there are no effective data for the diabetic ulcer wounds in Taiwan. We performed systematic review and meta-analysis to study the negative pressure wound treatment effectiveness on diabetic ulcer wounds. Methods: The retrieved articles were Searched from Huayi Online Library, Cochrane Library, PubMed and Medline databases from January 2000 to October 2017 and evaluated using Modified Jadad Score, Evidence-based Medicine (CEBM) and Review Manager 5. Results: Twelve randomized clinical trials including 1185 patients were analyzed: wound healing time -19.78 (95% CI: -40.05, 0.48)、wound area reduction ratio 27.72 (95% CI：5.65, 49.79 )、wound area reduction 10.05 (95%CI: 4.34, 15.77)、wound depth reduction 39.18(95%CI: 28.96,49.39)、wound complete healing ratio 3.01(95%CI: 1.64, 5.53)、amputation rate 0.28(95%CI：0.14, 0.57)、and the adverse events 1.10(95% CI:0.67, 1.78). Conclusions: Evidence-based medicine showed that negative pressure wound treatment can significantly reduce the area and depth of diabetic ulcer wounds, promote the wound healing and lessen the amputation. These can help medical personnel to enhance the quality of care.

並列關鍵字

negative pressure wound therapy ； diabetic ulcers ； wound care