■糖尿病足溃疡(DFU)具有毁灭性的并发症,终生发生率为15%-34%。DFU清创术被认为是加速溃疡愈合的干预措施,并可能减少包括截肢在内的并发症。感染,和生活质量差(QoL),具有严重的公共卫生和临床意义。有必要对SRs和随机对照试验(RCT)进行系统评价(SR),并进行荟萃分析(MA),以综合所有人类实验证据。
■在这些结果中,DFU的清创方法是否优于其他形式和标准纱布敷料(对照条件)?
■所有SRs/MAs/RCT将DFU的清创方法与其他清创方法和对照方法进行比较。
■Cochrane创伤组专业注册,Cochrane中央对照试验登记册(Cochrane图书馆),OvidMEDLINE,PubMed,EMBASE,EBSCO,CINAHL,和WebofScience。
■与其他清创方法或对照相比,使用DFU和任何清创方法的1/2型糖尿病成年人。
■截肢率,伤口感染,QoL,溃疡愈合的比例,完成愈合的时间,溃疡复发,和治疗费用。
■由两个独立的审阅者使用具有敏感性分析的随机效应模型汇集的数据提取/合成。
■检索并定性报告了10个SR。六个SR包括MA。这项SR包括30项研究,有2654名参与者,使用19种清创组合。将清创方法与汇总到MA中的发现进行比较。Meta回归(MR)没有确定结果的重要预测因子/调节因子。
■这些研究可能动力不足。纳入/排除标准各不相同,偏倚风险增加导致证据质量低下。
■缺乏证据表明,清创方法优于DFU中其他形式的清创或控制。
■研究人员应遵循标准化报告指南(报告试验的综合标准)。临床医生/研究人员可以使用该SR/MA/MR的发现来指导患者的个性化决策和设计未来的RCT。
UNASSIGNED: Diabetic foot ulceration (DFU) has devastating complications and a lifetime occurrence of 15%-34%. Debridement of DFU is regarded as an intervention that accelerates ulcer healing and may reduce complications including amputations, infections, and poor quality of life (QoL), which have serious public health and clinical implications. A systematic
review (SR) of SRs and of randomized controlled trials (RCTs) with meta-analyses (MAs) on debridement of DFU that synthesizes all human experimental evidence is warranted.
UNASSIGNED: Are debridement methods in DFU beneficial over other forms and standard gauze dressings (control condition) in these outcomes?
UNASSIGNED: All SRs/MAs/RCTs comparing debridement methods for DFU with alternative methods of debridement and with control.
UNASSIGNED: Cochrane Wounds Group Specialized Register, Cochrane Central Register of Controlled Trials (Cochrane Library), Ovid MEDLINE, PubMed, EMBASE, EBSCO, CINAHL, and Web of Science.
UNASSIGNED: Adults with type 1/2 diabetes with DFU and any debridement method compared with alternative debridement methods or control.
UNASSIGNED: Amputation rates, wound infections, QoL, proportion of ulcers healed, time to complete healing, ulcer recurrence, and treatment cost.
UNASSIGNED: Data extraction/synthesis by two independent reviewers pooled using a random-effects model with sensitivity analysis.
UNASSIGNED: 10 SRs were retrieved and reported qualitatively. Six SRs included MAs. This SR included 30 studies, with 2654 participants, using 19 debridement combinations. The debridement methods were compared with findings pooled into MAs. Meta-regression (MR) did not identify significant predictors/moderators of outcomes.
UNASSIGNED: The studies may have been under-powered. The inclusion/exclusion criteria varied and the increased risk of bias contributed to low-quality evidence.
UNASSIGNED: Weak evidence exists that debridement methods are superior to other forms of debridement or control in DFU.
UNASSIGNED: Researchers should follow standardized reporting guidelines (Consolidated Standards of Reporting Trials). Clinicians/investigators could use the findings from this SR/MA/MR in guiding patient-individualized decision making and designing future RCTs.