摘要
目的应用荟萃分析方法系统评价微粒皮和Meek微型皮片移植修复大面积深度烧伤创面的临床效果。方法以"Meek micrografting、burn"为检索词检索《PubMed》《Cochrane Library》数据库,以"微粒皮、Meek植皮、烧伤"为检索词检索《中国期刊全文数据库》《中国生物医学文献数据库》《维普数据库》《万方数据库》,检索各数据库自建库起至2019年3月20日公开发表的有关微粒皮和Meek微型皮片移植修复大面积深度烧伤创面的随机对照试验。结局指标为首次手术后的植皮成活率、一期愈合率、手术耗时、手术治疗费用以及创面愈合时间、住院时间。采用RevMan 5.3及Stata 14.0统计软件对符合标准的研究进行荟萃分析。结果共纳入15篇文献821例大面积深度烧伤患者,包括接受微粒皮移植治疗的微粒皮组患者410例和接受Meek微型皮片移植治疗的Meek微型皮片组患者411例。纳入的15项研究偏倚风险均不确定。与微粒皮组比较,Meek微型皮片组患者植皮成活率和一期愈合率均明显升高,相对危险度=0.76、0.66(95%置信区间=0.66~0.88、0.50~0.88,P<0.01);手术治疗费用明显降低,标准化均数差=3.19(95%置信区间=1.36~5.01,P<0.01);手术耗时、创面愈合时间和住院时间均明显缩短,标准化均数差=6.05、2.39、2.35(95%置信区间=3.66~8.44、1.43~3.35、2.03~2.68,P<0.01)。亚组分析显示,微粒皮联合异体皮移植可能是手术耗时异质性的来源。敏感性分析结果显示,手术耗时、手术治疗费用、创面愈合时间合并效应量结果稳定性好。一期愈合率和手术治疗费用存在发表偏倚(P<0.01),植皮成活率、手术耗时、创面愈合时间和住院时间不存在发表偏倚(P>0.05)。结论在大面积深度烧伤创面的临床治疗中,Meek微型皮片移植与微粒皮移植相比可提高植皮成活率和一期愈合率,缩短手术耗时、创面愈合时间和住院时间,降低治疗费用。
Objective To systematically evaluate the clinical effects of microskin grafting and Meek microskin grafting in repairing extensively deep burn wounds using meta-analysis.Methods Foreign language databases including PubMed and Cochrane Library were searched with the terms of"Meek micrografting,burn",and Chinese databases including Chinese Journal Full-Text Database,Chinese Biomedical Database,VIP database,and Wanfang Data were searched with the terms in Chinese version of"微粒皮,Meek植皮,烧伤"to retrieve the publicly published randomized controlled trials on the microskin grafting and Meek microskin grafting in repairing extensively deep burn wounds from the establishment of each database to March 20,2019.The outcome indexes included the survival rate of skin graft,primary healing rate,operation time,and surgical treatment cost after the first operation,as well as the wound healing time and length of hospital stay.RevMan 5.3 and Stata 14.0 statistical software were used to conduct a meta-analysis of eligible studies.Results A total of 821 patients with extensively deep burns were included in 15 studies,including 410 patients in microskin group who received microskin grafting and 411 patients in Meek microskin group who received Meek microskin grafting.The bias risks of the 15 studies included were uncertain.Compared with those of microskin group,the survival rate of skin graft and primary healing rate of patients in Meek microskin group were significantly increased,with relative risks of 0.76 and 0.66(95%confidence interval=0.66-0.88,0.50-0.88,P<0.01),the surgical treatment cost was significantly reduced,with a standardized mean difference of 3.19(95%confidence interval=1.36-5.01,P<0.01),and the operation time,wound healing time,and length of hospital stay were significantly shortened,with standardized mean differences of 6.05,2.39,and 2.35(95%confidence interval=3.66-8.44,1.43-3.35,2.03-2.68,P<0.01).Subgroup analysis showed that microskin grafting combined with allogenic skin graft might be a heterogeneous source of operation time.Sensitivity analysis showed that the combined effect size was stable in the operation time,surgical treatment cost,and wound healing time.There was no publication bias in the survival rate of skin graft,operation time,wound healing time,and length of hospital stay(P>0.05),while the primary healing rate and surgical treatment cost had publication bias(P<0.01).Conclusions Compared with microskin grafting,Meek microskin grafting improves the rates of skin graft survival and primary healing,shortens operation time,wound healing time,and length of hospital stay,and reduces the treatment cost in treating extensively deep burn wounds.
作者
张高飞
刘文军
王迪
段建兴
李晓庆
Zhang Gaofei;Liu Wenjun;Wang Di;Duan Jianxing;Li Xiaoqing(Department of Burns,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China)
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2020年第7期560-567,共8页
Chinese Journal of Burns
基金
国家自然科学基金(81660319)。
