Chinese Journal of Tissue Engineering Research ›› 2023, Vol. 27 ›› Issue (7): 1141-1148.doi: 10.12307/2023.007
Effects of different dressings in the treatment of burn wounds: a network meta-analysis
Li Wenjie1, You Aijia1, Zhou Junli1, Fang Sujuan2, Li Chun1
- 1School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China; 2Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
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Received:2021-11-10Accepted:2021-12-21Online:2023-03-08Published:2022-07-20 -
Contact:Li Chun, Associate professor, School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China -
About author:Li Wenjie, Master candidate, School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China -
Supported by:University Characteristic Innovation Project of Guangdong Provincial Department of Education, No. 2020KTSCX025 (to LC)
CLC Number:
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Li Wenjie, You Aijia, Zhou Junli, Fang Sujuan, Li Chun. Effects of different dressings in the treatment of burn wounds: a network meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(7): 1141-1148.
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2.1 文献检索及筛选流程 初步检索共获得相关文献2 123篇，经过逐层筛选最终纳入文献32篇[7，16-46]，其中英文文献22篇[7，16-17，19-20，22，24-25，27-29，32-36，38-40，42，45-46]，中文文献10篇[18，21，23，26，30-31，37，41，43-44]。文献筛选流程图见图2。"
2.2 纳入研究基本特征 共纳入32项随机对照试验，涉及3 795例烧伤患者。其中31项为双臂研究，1项为三臂研究[43]。纳入研究共涉及11种敷料，分别为银离子敷料、磺胺嘧啶银、传统敷料、重组人粒细胞巨噬细胞集落刺激因子、重组人表皮生长因子、成纤维细胞生长因子、富血小板血浆、芦荟敷料、蜂蜜敷料、羊膜敷料及异种猪皮敷料。纳入研究基本特征见表1。"
2.3 纳入研究质量评价结果 共纳入32篇文献，均为随机对照试验，所有研究均提及随机分组，其中19项研究报告了随机序列产生的具体方法[16-24，26-29，32，36-38，42，45]，主要采用随机数字表法[17-19，21-22，26，28，36-37，42，45]、随机序列法[16，27，42]，2项研究按就诊日期或就诊顺序随机[23，38]；5项研究报告了分配隐藏的具体方法[16，22，36，40，45]；15项研究报告了盲法的使用情况[17，20，22，25，30-31，33-36，40-42，44-45]，其中9项研究采用双盲法[25，30-31，33，35-36，40-41，44]，纳入研究中有3项研究提出因敷料特殊性或其他原因而无法设置盲法[16，24，29]；12项研究报告了试验组和对照组病例具体脱落情况[16，20，22，28-29，35-37，39-40，42，45]，对研究结果影响较小，其他研究未提及病例脱落、退出，数据完整。其结果运用RevMan 5.4软件绘制如图3，4。"
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2.4 各研究烧伤创面愈合时间的网状Meta分析结果 2.4.1 结局指标证据网络 共31项研究报告了烧伤创面愈合时间[7，16-45]，涉及11种敷料，分别为银离子敷料、磺胺嘧啶银、传统敷料、重组人粒细胞巨噬细胞集落刺激因子、重组人表皮生长因子、成纤维细胞生长因子、富血小板血浆、芦荟敷料、蜂蜜敷料、羊膜敷料及异种猪皮敷料，图5为烧伤创面愈合时间的网状关系图，图中点的大小代表该干预措施的数量，线的粗细代表涉及该两种干预措施对比的研究数量。"
2.4.2 研究异质性及一致性检验结果 针对形成的7个闭环进行异质性检验，当95%CI包含0时，说明该闭环同质性较好，结果显示7个闭环的95%CI均包含0，不一致因子(IF)均较小，提示同质性良好，见图6。运用直接Meta分析进行异质性检验，结果显示总体I2=93.7%，P < 0.05，显示异质性较高，经亚组分析，剔除异质性较大的文献后再次进行直接Meta分析，结果与前次相比较为稳定，故采用随机效应模型进行分析，见表2。"
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对纳入的31项研究运用不一致性模型进行检验，结果显示：P=0.634，P > 0.05，说明不一致性模型不显著，可以使用一致性模型进行一致性拟合，结果显示：P=0.634，P > 0.05，说明一致性较好。运用节点分裂法(node-splitting method)进行局部不一致性检验，结果显示：P > 0.05，表明各研究间具有一致性，因此在一致性模型下进行网状Meta分析。 2.4.3 不同敷料烧伤创面愈合时间的网状Meta分析结果 纳入的31个随机对照试验[7，16-45]，网状Meta分析结果显示：重组人粒细胞巨噬细胞集落刺激因子、富血小板血浆、芦荟敷料、羊膜、重组人表皮生长因子、银离子敷料、成纤维细胞生长因子在缩短烧伤创面愈合时间方面均优于传统敷料、磺胺嘧啶银和异种猪皮敷料(P < 0.05)；重组人粒细胞巨噬细胞集落刺激因子在烧伤创面愈合时间上优于成纤维细胞生长因子，差异有显著性意义(P < 0.05)；其他干预措施之间比较差异无显著性意义(P > 0.05)，见表3。 "
网状Meta分析排序结果从优到劣依次为重组人粒细胞巨噬细胞集落刺激因子(92.0%)>富血小板血浆(79.2%)>芦荟敷料(75.4%)>成纤维细胞生长因子(52.1%)>银离子敷料(55.4%)>羊膜(59.5%)>重组人表皮生长因子(58.4%)>蜂蜜敷料(44.3%)>传统敷料(18.6%)>磺胺嘧啶银(13.2%)>异种猪皮敷料(2.0%)，见图7。 "
2.4.4 不同敷料烧伤创面愈合时间的发表偏倚分析 文章通过Stata 14.2软件绘制发表偏倚的比较-校正漏斗图，结果显示纳入研究在漏斗图两侧分布大致对称，且多集中于漏斗图的中上部分，表示文章存在小样本效应或发表偏倚的可能性较小。见图8。"
2.5 各研究烧伤创面感染率的网状Meta分析结果 2.5.1 结局指标证据网络 有9项研究报告了烧伤创面感染率[16，23-24，26，30，33，37，43，46]，涉及7种敷料，分别为传统敷料，磺胺嘧啶银、银离子敷料、芦荟敷料、富血小板血浆、蜂蜜敷料和异种猪皮敷料。烧伤创面感染率的网状关系图见图9，图中点的大小代表该干预措施的数量，线的粗细代表涉及该2种干预措施对比的研究数量。 2.5.2 异质性及一致性检验结果 针对形成的1个闭环进行异质性检验，结果显示95%CI：0.00-3.88包含0，不一致因子(IF)=0.24，提示同质性较好。运用直接Meta分析对各研究间异质性进行分析，结果显示，整体I2=8.9%，P > 0.05，提示各研究间统计学异质性较小，故采用固定效应模型分析，见图10。"
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在进行网状Meta分析时，首先运用不一致性模型进行检验，结果显示P=0.892，I2=0.02，因P > 0.05说明不一致性检验不显著，一致性较好，可以使用一致性模型进行一致性拟合，通过一致性检验显示，P > 0.05，提示一致性较好。运用节点分裂法进行局部不一致性检验，结果显示P > 0.05，表明各研究间具有一致性，因此在一致性模型下进行网状Meta分析。 2.5.3 不同敷料烧伤创面感染率的网状Meta分析结果 纳入的9个随机对照试验，涉及7种敷料。网状Meta分析结果显示：在控制烧伤创面感染率上，蜂蜜敷料、异种猪皮敷料、银离子敷料、芦荟敷料和磺胺嘧啶银均优于传统敷料(P < 0.05)；蜂蜜敷料、异种猪皮敷料及银离子敷料在控制感染率上均优于富血小板血浆(P < 0.05)；相比磺胺嘧啶银，蜂蜜敷料抗感染效果更佳(P < 0.05)，其他干预措施之间比较差异无显著性意义(P > 0.05)，见表4。 "
网状Meta分析排序结果从优到劣依次为蜂蜜敷料(90.2%)>异种猪皮敷料(77.7%)>银离子敷料(68.7%)>芦荟敷料(52.6%)>磺胺嘧啶银(40.5%)>富血小板血浆(14.1%)>传统敷料(6.2%)，见图11。 "
2.5.4 不同敷料烧伤创面感染率的发表偏倚分析 通过Stata 14.2软件绘制发表偏倚的比较-校正漏斗图，结果显示纳入研究在漏斗图分布大致对称，表示文章存在小样本效应或发表偏倚的可能性较小，见图12。"
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