本文選題：負(fù)壓創(chuàng)面療法　切入點(diǎn)：壓力性損傷　出處：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:應(yīng)用系統(tǒng)評價(jià)的方法對負(fù)壓創(chuàng)面療法治療壓力性損傷的有效性、經(jīng)濟(jì)性和安全性進(jìn)行分析。方法:根據(jù)研究目的制定文獻(xiàn)檢索策略,通過對Pub Med、EMBASE、Cochrane Library、Web of Science、Google Scholar、CINAHL、CNKI、萬方數(shù)據(jù)庫、VIP、JBI等數(shù)據(jù)庫進(jìn)行檢索,檢索時(shí)間截止至2016年12月。同時(shí)對會議論文、已注冊的在研研究和相關(guān)學(xué)術(shù)網(wǎng)站等進(jìn)行檢索,獲取所有負(fù)壓創(chuàng)面療法治療壓力性損傷的隨機(jī)對照試驗(yàn)研究的文獻(xiàn),按照預(yù)先制定的納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)篩選符合條件的文獻(xiàn),提取數(shù)據(jù)并對納入的文獻(xiàn)進(jìn)行質(zhì)量評價(jià),并應(yīng)用Revman軟件對結(jié)局指標(biāo)進(jìn)行統(tǒng)計(jì)分析。結(jié)果:(1)本研究共檢索到負(fù)壓創(chuàng)面療法治療壓力性損傷的相關(guān)文獻(xiàn)1720篇,根據(jù)制定的納入和排除標(biāo)準(zhǔn),最終納入29篇負(fù)壓創(chuàng)面療法治療壓力性損傷的研究,其中英文文獻(xiàn)6篇、中文文獻(xiàn)23篇,研究對象共1336名患者。根據(jù)JADAD量表對納入文獻(xiàn)進(jìn)行偏倚風(fēng)險(xiǎn)評估,結(jié)果顯示高質(zhì)量文獻(xiàn)13篇,低質(zhì)量文獻(xiàn)16篇。(2)共有11篇文獻(xiàn)對負(fù)壓創(chuàng)面療法組與對照組治療壓力性損傷的治愈率進(jìn)行對比,7篇文獻(xiàn)對有效率進(jìn)行對比,11篇文獻(xiàn)對愈合時(shí)間進(jìn)行對比,2篇文獻(xiàn)對肉芽組織生成時(shí)間進(jìn)行對比,6篇文獻(xiàn)對住院時(shí)間進(jìn)行對比,4篇文獻(xiàn)對換藥時(shí)間進(jìn)行對比,2篇文獻(xiàn)對抗生素使用時(shí)間進(jìn)行對比,2篇文獻(xiàn)對創(chuàng)面清潔時(shí)間進(jìn)行對比,2篇文獻(xiàn)對疼痛評分進(jìn)行對比,2篇文獻(xiàn)對創(chuàng)面植皮時(shí)間進(jìn)行對比,3篇文獻(xiàn)對不良反應(yīng)進(jìn)行對比,4篇文獻(xiàn)對醫(yī)療費(fèi)用進(jìn)行對比。(3)對主要結(jié)局指標(biāo)進(jìn)行Meta分析的結(jié)果顯示,負(fù)壓創(chuàng)面療法治療壓力性損傷的治愈率[OR=3.26,95%CI(2.19,4.84),P0.001]、有效率[OR=5.33,95%CI(2.63,10.80),P0.00001]、愈合時(shí)間[SMD=-3.63,95%CI(-4.92,-2.35),P0.001]、肉芽組織生成所需時(shí)間[SMD=-0.48,95%CI(-0.86,-0.09),P0.05]與對照組相比具有統(tǒng)計(jì)學(xué)意義。對次要結(jié)局指標(biāo)進(jìn)行Meta分析的結(jié)果顯示,負(fù)壓創(chuàng)面療法治療壓力性損傷的住院時(shí)間[SMD=-2.59,95%CI(-3.64,-1.54),P0.001]、換藥次數(shù)[SMD=-4.54,95%CI(-5.48,-3.60),P0.001]、應(yīng)用抗生素時(shí)間[SMD=-4.68,95%CI(-7.23,-2.14),P0.001]、創(chuàng)面清潔時(shí)間[SMD=-2.81,95%CI(-3.60,-2.02),P0.001]、疼痛評分[SMD=-2.77,95%CI(-3.37,-2.17),P0.001]、創(chuàng)面植皮時(shí)間[SMD=-6.27,95%CI(-12.21,-0.32),P0.05]、醫(yī)療費(fèi)用[SMD=-1.34,95%CI(-2.18,-0.49),P0.01]與對照組相比具有統(tǒng)計(jì)學(xué)意義。而負(fù)壓創(chuàng)面療法治療壓力性損傷的不良反應(yīng)與對照組相比沒有統(tǒng)計(jì)學(xué)意義[OR=0.83,95%CI(0.19,3.56),P0.05]。結(jié)論:負(fù)壓創(chuàng)面療法可提高壓力性損傷患者創(chuàng)面的治愈率、有效率;可減少壓力性損傷患者創(chuàng)面的愈合時(shí)間、肉芽組織生成所需時(shí)間、換藥次數(shù)、創(chuàng)面清潔時(shí)間、創(chuàng)面植皮時(shí)間,并可縮短患者的住院時(shí)間、應(yīng)用抗生素時(shí)間、降低疼痛評分、醫(yī)療費(fèi)用;不會增加壓力性損傷患者的不良反應(yīng),是一種有效、經(jīng)濟(jì)且安全的創(chuàng)面療法。
[Abstract]:Objective: to analyze the efficacy, economy and safety of negative pressure wound therapy in the treatment of pressure-induced injury by means of systematic evaluation. Through the retrieval of Pub Medus EMBASE Pub of Science Library, Pub Scholarn CINAHLN CNKI, Wanfang database VIPN JBI and so on, the retrieval time is up to December 2016. At the same time, the papers of the conference, the registered research sites in research and related academic websites, etc., have been searched, and so on. To obtain all the literatures of the randomized controlled trial on the treatment of stress injury by negative pressure wound therapy, and to screen the eligible documents according to the pre-established inclusion criteria and exclusion criteria, and to extract the data and evaluate the quality of the included literature. Revman software was used to analyze the outcome index. Results: a total of 1720 articles about the treatment of pressure injury with negative pressure wound therapy were found in this study, according to the criteria of inclusion and exclusion. Finally, 29 studies on the treatment of stress injury with negative pressure wound therapy were included, of which 6 were in Chinese and 6 in Chinese, and a total of 1336 patients were included in the study. The risk of bias was assessed according to the JADAD scale. The results showed that 13 articles were of high quality. A total of 11 articles compared the cure rate of the negative pressure wound therapy group with that of the control group in the treatment of stress injury. 7 articles compared the effective rate. 11 articles compared the healing time and 2 articles. The time of granulation tissue formation was compared. 6 articles were compared with the time of hospitalization. 4 articles compared the time of dressing change. 2 articles compared the time of antibiotic use and 2 articles compared the cleaning time of wound surface. 2 articles were compared with pain score and 2 articles were used to compare the time of skin grafting on the wound. 3 articles were compared on adverse reactions. 4 articles were compared with the medical expenses. 3) the results of Meta analysis on the main outcome indexes were found. The cure rate of negative pressure wound therapy for pressure-induced injury [OR3.2695CI2.194.84 / P0.001], the effective rate [OR5.3395CI2.63310.80], the healing time [SMD-3.6395CI-4.92-2.35P0.001], the time of granulation tissue formation [SMD-0.4895CI-0.868-0.09] were statistically significant compared with those of the control group. The length of stay in hospital [SMD-2.5995CI-3.64CI-1.54 P0.001], the times of dressing change [SMD-4.545CI-5.48-3.60P0.001], the time of application of antibiotics [SMD-4.6895CI-7.23-2.14C0.001], the time of wound cleaning [SMD-2.81CI-3.60-2.02P0.001], the pain score [SMD-2.795CI-3.377CI-2.17P0.001], the time of skin grafting [SMD-6.2795CI-12.21- 0.320.320.32] [SMD-2.81CI-3.60-2.02P0.001], the pain score [SMD-2.795 CI-3.377-CI-2.17p0.001], the time of skin grafting [SMD-6.2795CI-12.21- 0.320.32] [SMD-2.895 CI-3.60-2.02P0.001] and the pain score [SMD-2.795 CI-3.377-2.17P0.001], [SMD-2.895 CI-3.60-2.02P0.001], [SMD-2.795 CI-3.375-2.17], [SMD-6.2795CI-12.21-0.320.32], [SMD-2.895 CI-3.60-2.02P0.001]; However, there was no significant difference between negative pressure wound therapy and control group in the treatment of stress injury. Conclusion: negative pressure wound therapy can improve the healing rate of the patients with pressure injury, but there is no significant difference between the treatment group and the control group [ORO 0.8395] .Conclusion: negative pressure wound therapy can improve the healing rate of the patients with pressure injury. The effective rate can reduce wound healing time, granulation tissue formation time, times of dressing change, wound cleaning time, wound skin grafting time, hospital stay time and antibiotic application time. Reducing pain scores, medical costs, and not increasing adverse reactions in patients with stress injuries is an effective, economical and safe wound therapy.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R641

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