分層皮膚移植供皮區傷口照護成效分析：系統性回顧與統合分析

Efficacy Analysis of Split Thickness Skin Graft Donor Site Wound Care: A Systematic Review and Meta-analysis

林怡君

分層皮膚移植 ； 供皮區傷口照護 ； 敷料 ； 統合分析 ； split thickness skin graft ； donor site wound care ； dressings ； meta-analyses

義守大學醫務管理學系學位論文

2017年

碩士

呂筑韻

繁體中文

研究背景：分層皮膚移植長年以來運用在傷口重建，明顯縮短傷口癒合時間及減少瘢痕攣縮。但供皮區為手術需要所造成的傷口，照顧上卻無標準流程，導致傷口疼痛、癒合延遲、疤痕增生，甚至出現感染等不良問題。 目的：本研究希望藉由文獻回顧及統合分析，瞭解吸水保濕型敷料使用於分層皮膚移植供皮區傷口照護的成效。 研究方法：本研究利用電子資料庫及人工檢索搜尋自2009至2016年6月止，所有出版及未出版的中、英文研究資料。參考的電子資料庫包括PubMED、MEDLINE、CINAHL、台灣期刊論文以及中文期刊服務（CEPS）等資料庫。符合納入條件將收入分析，納入條件有：1) 臨床試驗研究設計；2) 接受分層皮膚移植（STSG）的成年病人；3) 研究的結果為疼痛、癒合成效或合併症，並有足夠資料可以計算成效值(Effect size)。運用Comprehensive Meta-Analysis軟體3.0版計算三項研究成果的成效值。 結果：初步搜尋得相關文獻454篇，根據納入條件與排除條件，得5篇文獻。將敷料分為“吸水保濕型敷料”及“非吸水保濕型敷料”兩種類型。同一文獻出現多種敷料介入措施比較，將敷料依分類相互配對，依嚴謹度將統計上顯著性訂立為P值<0.05。傷口疼痛結果分析，參與分析有5篇，共8組資料，“吸水保濕型敷料”與“非吸水保濕型敷料”相比的統合成效值為-0.002 (95%信賴區間，-0.348，0.344)，未達顯著值。傷口癒合結果分析，參與分析有5篇，共7組資料，“吸水保濕型敷料”與“非吸水保濕型敷料”相比的統合成效值為 -0.408 (95%信賴區間，-0.816，0.000)，有達顯著值。傷口感染參與分析有5篇，共6組資料，“吸水保濕型敷料”與“非吸水保濕型敷料”相比的統合成效值為0.610 (95%信賴區間，0.139，2.672)，未達統計上的顯著。 結論：在移植供皮區傷口照護上，吸水保濕型敷料對傷口癒合具有明顯成效。建議在臨床照護上應推廣吸水保濕型敷料傷口照護的敷料，並訂定吸水保濕型敷料的傷口照護流程。

Background: Split-thickness skin grafts (STSG) have been widely used in wound reconstruction, because it could decrease the duration of wound healing and minimize scar contracture. Skin grafting, however, can result in extra wounds, i.e., donor sites. Because standard care guideline for donor site is inconclusive, poor implications, such as increased wound pain, delay of wound healing, hypertrophic scar, and even infection may occur. Purpose: This study is aimed to analyze efficacy of dressing types for skin grafting donor site care, using a literature review and meta-analysis design. Methods: A comprehensive literature search was conducted to identify research publications between Jan 2009 and June 2016 that were addressed on outcomes of dressing types for split-thickness skin graft donor sites in the PubMED, MEDLINE, CINAHL, and Chinese databases (including CEPS). Research inclusion criteria were: 1) a clinical trial design; 2) adults receiving STSG; 3) study outcomes on pain, healing time, or complication. Comprehensive Meta-Analysis 3.0 software was applied to examine the effect size of the three outcome variables. Results: A rough search was resulted in 454 relevant studies; of them, five publications were met the study inclusion and exclusion criteria. For the purpose of the study, types of dressing were divided into two categories: absorb vs. non-absorb. As if there are more than two types of wound care dressing used in the publication study, multiple data entries would be occurred. A significant level 0.05 is applied in the current study. There are five publications and 8 data entries included in pain outcome analysis. The overall effect of pain between absorb and non-absorb groups is -0.002 (95% confidence interval (CI), -0.348, 0.344), which is insignificant. There are five publications and 7 data entries included in healing time outcome analysis. The overall effect of healing time between absorb and non-absorb groups is -0.408 (95% CI, -0.816, 0.000), which is insignificant. There are five publications and 6 data entries included in complication outcome analysis. The overall effect of complication between absorb and non-absorb groups is 0.610 (95% CI, 0.139, 2.672), which is insignificant. Conclusion: The study result supports absorb wound care dressing is benefit for wound healing. It is important to implement such dressing type as standard wound care.

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