负压伤口疗法在肥胖产妇中应用效果的meta分析

摘要
图/表
参考文献(27)
相关文章 (15)

全文: PDF (1292 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨负压伤口疗法（NPWT）在肥胖产妇中的应用效果，为临床实践提供可靠证据。方法系统检索PubMed、EMBase、the Cochrane Central Register of Controlled Trials、ClnicalTrials.gov及中国知网、万方数据库从建库至2020年12月发表的所有符合标准的临床随机对照研究。由两名研究人员独立阅读、提取入选研究中的数据。运用Review Manager 5.3对收集的数据进行分析，TSA 0.9对研究结果的可靠性进行评估。结果共纳入9篇文献。meta分析结果显示，两组手术切口感染率比较，差异无统计学意义（RR = 0.85，95%CI：0.66~1.08，P = 0.18）；NPWT组切口感染在内的切口并发症发生率低于常规敷料组（RR = 0.81，95%CI：0.68~0.97，P = 0.02）；NPWT组除切口感染外的切口并发症发生率低于常规敷料组（RR = 0.75，95%CI：0.66~0.86，P < 0.0001）；两组再入院率比较，差异无统计学意义（RR = 1.19，95%CI：0.62~2.27，P = 0.60）。结论 NPWT能够有效降低肥胖产妇术后切口的并发症发生率，但并不能降低该类患者的切口感染率和再入院率。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	何慧琳1 何芳1 黄华平2▲

关键词 ：剖宫产, 超重, 负压伤口疗法, meta分析

Abstract：Objective To investigate the effect of negative pressure wound therapy (NPWT) in maternal obesity, and providing the best evidence to clinical practice. Methods PubMed, EMBase, the Cochrane Central Register of Controlled Trials, ClinicalTrial.gov, CNKI, and WanFang data were systematically searched from create database to December, 2020 to identify relevant randomized controlled trials. Two authors independently read and extracted data from the selected studies. Review Manager 5.3 was applied to analyze the collected data; TSA 0.9 was used to evaluate the reliability of the study results. Results A total of nine articles were included. Meta analysis results showed that, there was no significant difference in surgical site infection rate between two groups (RR = 0.85, 95%CI: 0.66-1.08, P = 0.18); the incidence of site complications including site infection in NPWT group was lower than that in conventional dressing group (RR = 0.81, 95%CI: 0.68-0.97, P = 0.02); the incidence of site complications except site infection in NPWT group was lower than that in conventional dressing group (RR = 0.75, 95%CI: 0.66-0.86, P < 0.0001); there was no statistically significant difference in the readmission rate between two groups (RR = 1.19, 95%CI: 0.62-2.27, P = 0.60). Conclusion NPWT can effectively reduce postoperative site complication rate in maternal obesity, but it cannot reduce surgical site infection rate and readmission rate.

Key words： Cesarean section Obese Negative pressure wound therapy Meta-analysis

基金资助:四川省卫生和计划生育委员会科研课题（18PJ2 86）。

通讯作者: ▲通讯作者

引用本文:

何慧琳1 何芳1 黄华平2▲. 负压伤口疗法在肥胖产妇中应用效果的meta分析[J]. 中国医药导报, 2021, 18(36): 85-90.
HE Huilin1 HE Fang1 HUANG Huaping2▲. Meta analysis of negative pressure wound therapy in maternal obesity#br#. 中国医药导报, 2021, 18(36): 85-90.

链接本文:

https://www.yiyaodaobao.com.cn/CN/ 或 https://www.yiyaodaobao.com.cn/CN/Y2021/V18/I36/85

[1] Li HT，Luo S，Trasand L，et al. Geographic variations and temporal trends in cesarean delivery rates in China，2008-2014 [J]. JAMA，2017，317（1）：69-76.
[2] Ayres-de-Campos D. Obesity and the challenges of caesarean delivery：prevention and management of wound complications [J]. Best Pract Res Clin Obstet Gynaecol，2015，29（3）：406-414.
[3] Alanis MC，Villers MS，Law TL，et al. Complications of cesarean delivery in the massively obese parturient [J]. Am J Obstet Gynecol，2010，203（3）：271e1-7.
[4] Olsen MA，Butler AM，Willers DM，et al. Comparison of costs of surgical site infection and endometritis after cesarean delivery using claims and medical record data [J]. Infect Control Hosp Epidemiol，2010，31（8）：872-875.
[5] Orgill DP，Bayer LR. Negative pressure wound therapy：past，present and future [J]. Int Wound J，2013，10（Suppl1）：15-19.
[6] Sahebally SM，Mckevitt K，Stephens I，et al. Negativepressure wound therapy for closed laparotomy incisions in general and colorectal surgery：a systematicreview and meta-analysis [J]. JAMA Surg，2018，153（11）：e183467.
[7] Cooper HJ，Roc GC，Bas MA，et al. Closed incisionnegative pressure therapy decreases complicationsafter periprosthetic fracture surgery around the hipand knee [J]. Injury，2018，49（2）：386-391.
[8] Smid MC，Dotters-katz SK，Grace M，et al. Prophylacticnegative pressure wound therapy for obese womenafter cesarean delivery：a systematic review and meta-analysis [J]. Obstet Gynecol，2017，130（5）：969-978.
[9] Yu L，Kronen RJ，Simon LE，et al. Prophylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection：asystematic review and meta-analysis [J]. Am J Obstet Gynecol，2018，218（2）：200-210.e1
[10] Tuuli MG，Liu J，Tita ATN，et al. Effect of Prophylactic Negative Pressure Wound Therapy vs Standard Wound Dressing on Surgical-Site Infection in Obese Women After Cesarean Delivery：A Randomized Clinical Trial [J]. JAMA，2020，324（12）：1180-1189.
[11] Higgins JP，Altman DG，G?覬tzsche PC，et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials [J]. BMJ，2011，343：d5928.
[12] Higgins JP，Thompson SG，Deeks JJ，et al. Measuring inconsistency in meta-analyses [J]. BMJ，2003，327（7414）：557-560.
[13] 翁鸿，郭成城，吕军，等.试验序贯分析之信息量的计算[J].中国循证医学杂志，2017，17（1）：113-116.
[14] Chaboyer W，Anderson V，Webster J，et al. Negative pressure wound therapy on surgical site infections in women undergoing elective cesarean sections：a pilot RCT [J]. Healthcare（Basel），2014，2（4）：417-428.
[15] Gunatilake RP，Swamy GK，Brancazio LR，et al. Closed incision negative-pressure therapy in obese patients undergoing cesarean delivery：a randomized controlled trial [J]. AJP Rep，2017，7（3）：e151-e157.
[16] Tuuli MG. Prophylactic incisional care in obese women at cesarean （PICO-C）. 2017 [DB/OL]. [2020-12-31]. https：//clinicaltrials.gov/ct2/show/NCT02578745?term=NCT025 78745&draw=2&rank=1.
[17] Ruhstaller K，Downes KL，Chandrasekaran S，et al. Prophylactic Wound vacuum therapy after cesarean section to prevent wound complications in the obese population：a randomized controlled trial（the ProVac Study）[J]. AJP Rep，2017，34（11）：1125-1130.
[18] Wihbey KA，Joyce EM，Spalding ZT，et al. Prophylactic negative pressure wound therapy and wound complication after cesarean delivery in women with class Ⅱ or Ⅲ obesity：a randomized controlled trial [J]. Obstet Gynecol，2018，132（2）：377-384.
[19] Hyldig N，Vinter CA，Kruse M，et al. Prophylactic incisional negative pressure wound therapy reduces the risk of surgical site infection after caesarean section in obese women：a pragmatic randomised clinical trial [J]. BJOG，2019，126（5）：628-635.
[20] Hussamy DJ，Wortman AC，Mcintire DD，et al. Closed Incision Negative Pressure Therapy in Morbidly Obese Women Undergoing Cesarean Delivery：A Randomized Controlled Trial [J]. Obstet Gynecol，2019，134（4）：781-789.
[21] House M. Do Single Use Negative Pressure Dressings Reduce Wound Complications in Obese Women After Cesarean Delivery. 2019 [DB/OL]. [2021-01-31]. Available from：https：//clinicaltrials.gov/ct2/show/NCT02799667?term=NCT02799667&draw=2&rank=1.
[22] 冯缘，文方，赵文君，等.氯己定与聚维酮碘在剖宫产中皮肤消毒效果的系统评价[J].护理管理杂志，2020，20（6）：399-403.
[23] Li HZ，Xu XH，Wang DW，et al. Negative Pressure Wound Therapy for Surgical Site Infections：A Systematic Review and Meta-Analysis of Randomized Controlled Trials [J]. Clin Microbiol Infect，2019，25（11）：1328-1338.
[24] Carbonnel M，Brot D，Benedrtti C，et al. Risks factors for wound complications after cesarean section [J]. J Gynecol Obstet Hum Reprod，2020，50（7）：101987.
[25] 张剑宇，杨亚莉，张雅丽，等.切口负压治疗预防肥胖产妇剖宫产术后并发症的临床观察[J].中国计划生育和妇产科，2019，11（1）：70-72.
[26] Echebiri NC，Mcdoom MM，Aalto MM，et al. Prophylactic use of negative pressure wound therapy after cesarean delivery [J]. Obstet Gynecol，2015，125（2）：299-307.
[27] Mattox EA. Reducing risks associated with negativepressure wound therapy：strategies for clinical practice [J]. Crit Care Nurse，2017，37（5）：67-77.