Ran Hao, Mao Luo, Yanting Xiao, Jing Li, Xinyue Lv, Yumei Peng, Yuxuan Wu, Yan Shen, Wei Jiang
{"title":"负压伤口疗法联合富血小板血浆治疗慢性难治性伤口的有效性和安全性：随机对照试验的系统回顾与元分析","authors":"Ran Hao, Mao Luo, Yanting Xiao, Jing Li, Xinyue Lv, Yumei Peng, Yuxuan Wu, Yan Shen, Wei Jiang","doi":"10.1002/hsr2.70205","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background and Aims</h3>\n \n <p>Chronic refractory wound is a disease that seriously impairs the quality of life of patients. Negative pressure wound therapy and platelet-rich plasma are commonly used to treat various types of wounds. Further research is necessary to explore the efficacy and safety of the combination of negative pressure wound therapy and platelet-rich plasma in treating chronic refractory wounds.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>PubMed, Web of Science, EMBASE, Cochrane, CINAHL, CNKI, Sino Med, and Wanfang Med Online up until March 2024 were searched(PROSPERO No. CRD42024507963). Two investigators screened literature according to inclusion and exclusion criteria, evaluated bias and certainty of evidence using RoB 2.0 and GRADE. Stata 12.0 was used to analyze the data.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 35 randomized controlled trials involving 2495 participants were included. 34 studies were assessed as having some concerns, and 1 study as having high risk in the risk of bias assessment. The results of meta-analysis showed that effective rate (RR1.23, 95% CI [1.17, 1.30], <i>p</i> < 0.001; I<sup>2</sup> = 44.7%, <i>p</i> = 0.013), healing time (WMD-9.32, 95% CI [−10.60, −8.03], <i>p</i> < 0.001; I² = 91.00%, <i>p</i> < 0.001), healing rate (RR1.76, 95% CI [1.50, 2.07], <i>p</i> < 0.001; I<sup>2</sup> = 62.6%, <i>p</i> < 0.001), positive rate of bacterial(RR0.25, 95% CI [0.15, 0.40], <i>p</i> < 0.001; I² = 0%, <i>p</i> = 0.841), pain score (WMD-1.43, 95% CI [−2.14, −0.72], <i>p</i> < 0.001; I² = 96.5%, <i>p</i> < 0.001), incidence of complications (RR0.45, 95% CI [0.30, 0.68], <i>p</i> < 0.001; I² = 46.3%, <i>p</i> = 0.098), length of hospital stay (WMD-9.88, 95% CI [−13.42, 6.34], <i>p</i> < 0.001; I<sup>2</sup> = 98.9%, <i>p</i> < 0.001), number of dressing changes (WMD-2.56, 95% CI [−4.28, −0.83], <i>p</i> = 0.004; I² = 98.9%, <i>p</i> < 0.001), white blood cell level (WMD-1.71, 95% CI [−2.00, −1.41], <i>p</i> < 0.001; I² = 33.9%, <i>p</i> = 0.195), c-reactive protein level (WMD-0.68, 95% CI [−1.04, −0.33], <i>p</i> < 0.001; I² = 88.8%, <i>p</i> < 0.001), erythrocyte sedimentation rate (WMD-6.09, 95% CI [−8.05, −4.13], <i>p</i> < 0.001; I² = 13%, <i>p</i> = 0.32), score of vancouver scar scale (WMD-1.78, 95% CI [−1.89, −1.66], <i>p</i> < 0.001; I² = 38.3%, <i>p</i> = 0.166) and preparation time of secondary repair (WMD-4.95, 95% CI [−7.03, −2.87], <i>p</i> < 0.001; I² = 84.7%, <i>p</i> < 0.001) had statistically significant effects. However, hospitalization costs (WMD1423.56, 95% CI [−4588.93, 7436.06], <i>p</i> = 0.643; I<sup>2</sup> = 100%, <i>p</i> < 0.001) had no significant difference.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>This study demonstrates that the combination of negative-pressure wound therapy and platelet-rich plasma can improve the efficacy and safety on chronic refractory wounds. Optimal parameter combinations, elucidation of pathogenesis and treatment mechanisms can be explored in the future.</p>\n </section>\n </div>","PeriodicalId":36518,"journal":{"name":"Health Science Reports","volume":"7 11","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hsr2.70205","citationCount":"0","resultStr":"{\"title\":\"The Efficacy and Safety of Negative-Pressure Wound Therapy Combined With Platelet-Rich Plasma in Chronic Refractory Wounds: A Systematic Review and Meta-Analysis of Randomized Controlled Trials\",\"authors\":\"Ran Hao, Mao Luo, Yanting Xiao, Jing Li, Xinyue Lv, Yumei Peng, Yuxuan Wu, Yan Shen, Wei Jiang\",\"doi\":\"10.1002/hsr2.70205\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background and Aims</h3>\\n \\n <p>Chronic refractory wound is a disease that seriously impairs the quality of life of patients. Negative pressure wound therapy and platelet-rich plasma are commonly used to treat various types of wounds. Further research is necessary to explore the efficacy and safety of the combination of negative pressure wound therapy and platelet-rich plasma in treating chronic refractory wounds.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>PubMed, Web of Science, EMBASE, Cochrane, CINAHL, CNKI, Sino Med, and Wanfang Med Online up until March 2024 were searched(PROSPERO No. CRD42024507963). Two investigators screened literature according to inclusion and exclusion criteria, evaluated bias and certainty of evidence using RoB 2.0 and GRADE. Stata 12.0 was used to analyze the data.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>A total of 35 randomized controlled trials involving 2495 participants were included. 34 studies were assessed as having some concerns, and 1 study as having high risk in the risk of bias assessment. The results of meta-analysis showed that effective rate (RR1.23, 95% CI [1.17, 1.30], <i>p</i> < 0.001; I<sup>2</sup> = 44.7%, <i>p</i> = 0.013), healing time (WMD-9.32, 95% CI [−10.60, −8.03], <i>p</i> < 0.001; I² = 91.00%, <i>p</i> < 0.001), healing rate (RR1.76, 95% CI [1.50, 2.07], <i>p</i> < 0.001; I<sup>2</sup> = 62.6%, <i>p</i> < 0.001), positive rate of bacterial(RR0.25, 95% CI [0.15, 0.40], <i>p</i> < 0.001; I² = 0%, <i>p</i> = 0.841), pain score (WMD-1.43, 95% CI [−2.14, −0.72], <i>p</i> < 0.001; I² = 96.5%, <i>p</i> < 0.001), incidence of complications (RR0.45, 95% CI [0.30, 0.68], <i>p</i> < 0.001; I² = 46.3%, <i>p</i> = 0.098), length of hospital stay (WMD-9.88, 95% CI [−13.42, 6.34], <i>p</i> < 0.001; I<sup>2</sup> = 98.9%, <i>p</i> < 0.001), number of dressing changes (WMD-2.56, 95% CI [−4.28, −0.83], <i>p</i> = 0.004; I² = 98.9%, <i>p</i> < 0.001), white blood cell level (WMD-1.71, 95% CI [−2.00, −1.41], <i>p</i> < 0.001; I² = 33.9%, <i>p</i> = 0.195), c-reactive protein level (WMD-0.68, 95% CI [−1.04, −0.33], <i>p</i> < 0.001; I² = 88.8%, <i>p</i> < 0.001), erythrocyte sedimentation rate (WMD-6.09, 95% CI [−8.05, −4.13], <i>p</i> < 0.001; I² = 13%, <i>p</i> = 0.32), score of vancouver scar scale (WMD-1.78, 95% CI [−1.89, −1.66], <i>p</i> < 0.001; I² = 38.3%, <i>p</i> = 0.166) and preparation time of secondary repair (WMD-4.95, 95% CI [−7.03, −2.87], <i>p</i> < 0.001; I² = 84.7%, <i>p</i> < 0.001) had statistically significant effects. However, hospitalization costs (WMD1423.56, 95% CI [−4588.93, 7436.06], <i>p</i> = 0.643; I<sup>2</sup> = 100%, <i>p</i> < 0.001) had no significant difference.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>This study demonstrates that the combination of negative-pressure wound therapy and platelet-rich plasma can improve the efficacy and safety on chronic refractory wounds. Optimal parameter combinations, elucidation of pathogenesis and treatment mechanisms can be explored in the future.</p>\\n </section>\\n </div>\",\"PeriodicalId\":36518,\"journal\":{\"name\":\"Health Science Reports\",\"volume\":\"7 11\",\"pages\":\"\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-11-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hsr2.70205\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Health Science Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/hsr2.70205\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Science Reports","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/hsr2.70205","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的 慢性难治性伤口是一种严重影响患者生活质量的疾病。负压伤口疗法和富血小板血浆常用于治疗各种类型的伤口。有必要进一步研究负压伤口疗法和富血小板血浆联合治疗慢性难治性伤口的有效性和安全性。 方法 检索截至 2024 年 3 月的 PubMed、Web of Science、EMBASE、Cochrane、CINAHL、CNKI、Sino Med 和万方医学在线（PROSPERO 编号：CRD42024507963）。两名研究者根据纳入和排除标准对文献进行了筛选，并使用 RoB 2.0 和 GRADE 评估了偏倚和证据的确定性。数据分析采用 Stata 12.0。 结果 共纳入 35 项随机对照试验，涉及 2495 名参与者。在偏倚风险评估中，34 项研究被评估为存在一些问题，1 项研究被评估为存在高风险。荟萃分析结果显示，有效率（RR1.23，95% CI [1.17，1.30]，p <0.001；I2 = 44.7%，p = 0.013）、愈合时间（WMD-9.32，95% CI [-10.60，-8.03], p < 0.001; I² = 91.00%, p < 0.001）、愈合率（RR1.76, 95% CI [1.50, 2.07], p < 0.001; I2 = 62.6%, p < 0.001）、细菌阳性率（RR0.25, 95% CI [0.15，0.40]，p <；0.001；I² = 0%，p = 0.841）、疼痛评分（WMD-1.43，95% CI [-2.14，-0.72]，p <；0.001；I² = 96.5%，p <；0.001）、并发症发生率（RR0.45，95% CI [0.30，0.68]，p <；0.001；I² = 46.3%，p = 0.098）、住院时间（WMD-9.88，95% CI [-13.42，6.34]，p <；0.001；I2 = 98.9%，p <；0.001）、换药次数（WMD-2.56，95% CI [-4.28，-0.83]，p = 0.004；I² = 98.9%，p <；0.001）、白细胞水平（WMD-1.71，95% CI [-2.00，-1.41]，p <；0.001；I² = 33.9%，P = 0.195）、c 反应蛋白水平（WMD-0.68，95% CI [-1.04，-0.33]，P <；0.001；I² = 88.8%，P <；0.001）、红细胞沉降率（WMD-6.09，95% CI [-8.05，-4.13]，p < 0.001；I² = 13%，p = 0.32）、温哥华瘢痕量表评分（WMD-1.78，95% CI [-1.89，-1.66]，p < 0.001；I² = 38.3%，p = 0.166）和二次修复的准备时间（WMD-4.95，95% CI [-7.03，-2.87]，p <0.001；I² = 84.7%，p <0.001）有显著统计学影响。然而，住院费用（WMD1423.56，95% CI [-4588.93, 7436.06]，p = 0.643；I2 = 100%，p <0.001）没有明显差异。 结论 本研究表明，负压伤口疗法与富血小板血浆相结合可提高慢性难治性伤口的疗效和安全性。未来还将探索最佳参数组合、阐明发病机制和治疗机制。
The Efficacy and Safety of Negative-Pressure Wound Therapy Combined With Platelet-Rich Plasma in Chronic Refractory Wounds: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Background and Aims
Chronic refractory wound is a disease that seriously impairs the quality of life of patients. Negative pressure wound therapy and platelet-rich plasma are commonly used to treat various types of wounds. Further research is necessary to explore the efficacy and safety of the combination of negative pressure wound therapy and platelet-rich plasma in treating chronic refractory wounds.
Methods
PubMed, Web of Science, EMBASE, Cochrane, CINAHL, CNKI, Sino Med, and Wanfang Med Online up until March 2024 were searched(PROSPERO No. CRD42024507963). Two investigators screened literature according to inclusion and exclusion criteria, evaluated bias and certainty of evidence using RoB 2.0 and GRADE. Stata 12.0 was used to analyze the data.
Results
A total of 35 randomized controlled trials involving 2495 participants were included. 34 studies were assessed as having some concerns, and 1 study as having high risk in the risk of bias assessment. The results of meta-analysis showed that effective rate (RR1.23, 95% CI [1.17, 1.30], p < 0.001; I2 = 44.7%, p = 0.013), healing time (WMD-9.32, 95% CI [−10.60, −8.03], p < 0.001; I² = 91.00%, p < 0.001), healing rate (RR1.76, 95% CI [1.50, 2.07], p < 0.001; I2 = 62.6%, p < 0.001), positive rate of bacterial(RR0.25, 95% CI [0.15, 0.40], p < 0.001; I² = 0%, p = 0.841), pain score (WMD-1.43, 95% CI [−2.14, −0.72], p < 0.001; I² = 96.5%, p < 0.001), incidence of complications (RR0.45, 95% CI [0.30, 0.68], p < 0.001; I² = 46.3%, p = 0.098), length of hospital stay (WMD-9.88, 95% CI [−13.42, 6.34], p < 0.001; I2 = 98.9%, p < 0.001), number of dressing changes (WMD-2.56, 95% CI [−4.28, −0.83], p = 0.004; I² = 98.9%, p < 0.001), white blood cell level (WMD-1.71, 95% CI [−2.00, −1.41], p < 0.001; I² = 33.9%, p = 0.195), c-reactive protein level (WMD-0.68, 95% CI [−1.04, −0.33], p < 0.001; I² = 88.8%, p < 0.001), erythrocyte sedimentation rate (WMD-6.09, 95% CI [−8.05, −4.13], p < 0.001; I² = 13%, p = 0.32), score of vancouver scar scale (WMD-1.78, 95% CI [−1.89, −1.66], p < 0.001; I² = 38.3%, p = 0.166) and preparation time of secondary repair (WMD-4.95, 95% CI [−7.03, −2.87], p < 0.001; I² = 84.7%, p < 0.001) had statistically significant effects. However, hospitalization costs (WMD1423.56, 95% CI [−4588.93, 7436.06], p = 0.643; I2 = 100%, p < 0.001) had no significant difference.
Conclusions
This study demonstrates that the combination of negative-pressure wound therapy and platelet-rich plasma can improve the efficacy and safety on chronic refractory wounds. Optimal parameter combinations, elucidation of pathogenesis and treatment mechanisms can be explored in the future.
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