慢性伤口临床治疗的循证研究.ppt
慢性伤口临床治疗的循证研究Evidence-base Clinical Study of Chronic WoundCWs群体发病率在群体发病率在1-2%左右左右 DM发病专率发病专率5.6 15%DM出现出现DFU 10-14.5%DFU截肢截肢 截肢后月内死亡截肢后月内死亡10%CEs最低费用达到6000美元;全球费用负担每年130-150亿美元 临床上比较常见的慢性伤口类型临床上比较常见的慢性伤口类型 静脉瘀滞性溃疡静脉瘀滞性溃疡; ;动脉溃疡动脉溃疡; ;糖尿病足部溃疡糖尿病足部溃疡; ;压力性溃疡（压疮）压力性溃疡（压疮）; ;烧伤后溃疡；烧伤后溃疡；脉管炎脉管炎; ;坏疽性脓皮症坏疽性脓皮症; ;放射性皮损放射性皮损临床治疗慢性伤口的原则临床治疗慢性伤口的原则 创面局部保持湿润和伤口尽早封闭；创面局部保持湿润和伤口尽早封闭；防止细菌滋生和局部感染；防止细菌滋生和局部感染；清创（伤口床准备）；清创（伤口床准备）；辅助治疗辅助治疗辅助治疗辅助治疗加压加压局部负压装置局部负压装置生长因子生长因子皮肤替代品皮肤替代品高压氧治疗高压氧治疗干细胞干细胞中药中药维维A A酸酸己酮可可碱己酮可可碱生长因子生长因子细胞细胞生长生长抑制抑制因子因子上上皮皮细细胞胞生生长长因因子子成成纤纤维维细细胞胞生生长长因因子子血血小小板板衍衍生生生生长长因因子子转转化化生生长长因因子子胰胰岛岛素素样样生生长长因因子子白白介介素素临床常用的包扎敷料 p纱布敷料（纱布敷料（GauzesGauzes）；）；p薄膜敷料（薄膜敷料（FilmsFilms）；）；p水凝胶敷料（水凝胶敷料（HydrogelsHydrogels）；）；p水胶体敷料（水胶体敷料（HydrocolloidsHydrocolloids）；）；p藻酸盐敷料（藻酸盐敷料（AlginatesAlginates）；）；p泡沫敷料（泡沫敷料（FoamsFoams）；）；p胶原蛋白敷料（胶原蛋白敷料（CollagensCollagens）；）；p杀菌剂（杀菌剂（AntimicrobialsAntimicrobials） 第一部分组织工程皮肤治疗糖尿病足溃疡的Meta分析 目的：分析TES治疗DFU的随机对照试验，效果与效益。 方法：计算机检索Cochrane图书馆、Pubmed、EMbase、CBMWeb、CNKI、VIP，手工检索有关引用文献，收集以TES为干预措施治疗DFU的RCT，评价纳入研究的方法学质量并提取有效数据进行Meta分析。 纳入7个，共880名患者，多中心研究6个。 No. No. AuthorAuthorRandomizationRandomizationBlindingBlindingConcealmentConcealmentWithdrawalWithdrawalITTITTQuality levelQuality level1 1Gray DG 1996Gray DG 1996 1010AdequateAdequateSi- BlindSi- BlindAdequateAdequateDescribedDescribedYesYesA A2 2Richard AP Richard AP 19971997 11 11UnclearUnclearSi- BlindSi- BlindAdequateAdequateDescribedDescribedYesYesA A3 3Aristidis V 2001Aristidis V 2001 1212AdequateAdequateNot useNot useUnclearUnclearDescribedDescribedYesYesB B4 4Jason RH 2002Jason RH 2002 1313AdequateAdequateSi- BlindSi- BlindAdequateAdequateNot- descriNot- descriYesYesA A5 5Hunter HSHunter HS 20022002 1414AdequateAdequateNot useNot useAdequateAdequateDescribedDescribedYesYesA A6 6Carlo C 2003Carlo C 2003 15 15AdequateAdequateSi- BlindSi- BlindUnclearUnclearDescribedDescribedYesYesA A7 7William AM 2003William AM 2003 1616AdequateAdequateSi- BlindSi- BlindAdequateAdequateDescribedDescribedYesYesA ATES与CT治疗DFU的疗效分析 Study or SubgroupCaravaggi C 2003 21Gentzkow GD 1996 10Jason R 2002 22Marston WA 2003 24Richard AP 1997 23Sams HH 2002 25Veves AF 2001 12Total (95% CI)Total eventsHeterogeneity: Chi = 5.32, df = 6 (P = 0.50); I = 0%Test for overall effect: Z = 4.28 (P 0.0001)Events2611153940563199Total4337241301099112464Events15162140436123Total361322115126896416Weight9.5%1.5%3.5%23.0%34.7%2.8%25.0%100.0%M-H, Fixed, 95% CI2.14 0.87, 5.275.08 0.59, 43.954.44 1.27, 15.521.92 1.05, 3.511.25 0.73, 2.141.25 0.19, 8.442.14 1.23, 3.741.88 1.41, 2.51TESCTOdds RatioOdds RatioM-H, Fixed, 95% CI0.010.1110100Favours experimentalFavours control不同种类组织工程皮肤疗效亚组分析 Study or Subgroup1.1.1 Dermagraft VS. CTGentzkow GD 1996 10Jason R 2002 22Marston WA 2003 24Richard AP 1997 23Subtotal (95% CI)Total eventsHeterogeneity: Chi = 5.11, df = 3 (P = 0.16); I = 41%Test for overall effect: Z = 3.09 (P = 0.002)1.1.2 Graftskin VS. CTSams HH 2002 25Veves AF 2001 12Subtotal (95% CI)Total eventsHeterogeneity: Chi = 0.27, df = 1 (P = 0.60); I = 0%Test for overall effect: Z = 2.71 (P = 0.007)1.1.3 Hyalograft 3D VS. CTCaravaggi C 2003 21Subtotal (95% CI)Total eventsHeterogeneity: Not applicableTest for overall effect: Z = 1.69 (P = 0.09)Total (95% CI)Total eventsHeterogeneity: Chi = 6.08, df = 6 (P = 0.41); I = 1%Test for overall effect: Z = 4.41 (P 0.0001)Test for subgroup differences: Not applicableEvents11153940105563682626199Total372413010930091121214343464Events16214068436401515123Total13221151262768961043636416Weight4.5%5.3%28.2%27.0%65.0%2.0%23.9%25.9%9.1%9.1%100.0%M-H, Fixed, 95% CI0.22 0.01, 0.430.35 0.08, 0.620.12 0.01, 0.220.05 -0.07, 0.170.12 0.04, 0.190.06 -0.42, 0.530.19 0.05, 0.320.18 0.05, 0.310.19 -0.03, 0.410.19 -0.03, 0.410.14 0.08, 0.20TESCTRisk DifferenceRisk DifferenceM-H, Fixed, 95% CI-0.5-0.2500.250.5Favours experimentalFavours controlStudy or Subgroup1.2.1 Wound InfectionCaravaggi C 2003Gentzkow G.D 1996Jason R 2002Marston W.A 2003Richard A. P 1997Veves A 2001Subtotal (95% CI)Total eventsHeterogeneity: Chi = 1.42, df = 5 (P = 0.92); I = 0%Test for overall effect: Z = 2.06 (P = 0.04)1.2.2 OsteomyelitisJason R 2002Marston W.A 2003Veves A 2001Subtotal (95% CI)Total eventsHeterogeneity: Chi = 3.93, df = 2 (P = 0.14); I = 49%Test for overall effect: Z = 1.74 (P = 0.08)1.2.3 CellulitisJason R 2002Marston W.A 2003Sams H.H 2002Veves A 2001Subtotal (95% CI)Total eventsHeterogeneity: Chi = 5.62, df = 3 (P = 0.13); I = 47%Test for overall effect: Z = 0.69 (P = 0.49)Total (95% CI)Total eventsHeterogeneity: Chi = 12.34, df = 12 (P = 0.42); I = 3%Test for overall effect: Z = 2.67 (P = 0.008)Test for subgroup differences: Not applicableEvents3911723126511431811221025108Total433724163109112488241631122992416391123081095Events6322730138141310275140827135Total36132215112696444221519626922151896277990Weight3.8%1.9%2.2%15.2%11.3%10.0%44.4%2.2%15.2%10.0%27.4%2.2%15.2%0.8%10.0%28.2%100.0%M-H, Fixed, 95% CI-0.10 -0.24, 0.050.01 -0.26, 0.28-0.05 -0.19, 0.10-0.07 -0.15, 0.00-0.03 -0.13, 0.0
