水动力清创治疗烧伤的效果：随机对照试验的系统评价

doi:10.3969/j.issn.1674-8115.2025.05.010

摘要/Abstract

摘要：

目的·利用系统评价比较治疗烧伤的清创过程中，水动力清创和常规清创在创面愈合时间、每1%总体表面积（total body surface area，TBSA）创面的清创时间、住院时间、术后7 d植皮存活率、二次清创率、术后3 d创面分泌物细菌培养阳性率以及术后感染发生率方面的差异，以期选择出针对需要清创的烧伤创面更加有效的清创方式。方法·检索PubMed、Embase、Web of Science、Cochrane Library、中国知网（CNKI）、中国生物医学文献服务系统（SinoMed）、维普中文期刊数据库及万方数据库，纳入水动力清创对比常规清创治疗烧伤的文献，检索语种为中文和英文，检索时限为建库至2024年10月1日，研究类型为随机对照试验（randomized controlled trial，RCT）。检索和筛选文献后，对纳入文献进行质量评价，并提取相关数据。定性资料和定量资料分别通过相对危险度（risk ratio，RR）和均数差（mean difference，MD）描述。使用RevMan5.4软件采用固定或随机效应模型制作森林图，使用Stata 14.0软件制作漏斗图以及进行Egger′s检验。结果·纳入15篇高质量RCT研究，包含需要清创的烧伤患者1 261例。分析结果显示：与常规清创组相比，水动力清创组术后的创面愈合时间（MD=-3.29，95%CI -3.88~-2.70，P<0.001）、每1% TBSA创面清创时间（MD=-0.63，95%CI -0.76~-0.50，P<0.001）、住院时间（MD=-4.22，95%CI -6.17~-2.28），P<0.001）明显缩短，术后7 d植皮存活率（MD=8.62，95%CI 7.21~10.04，P<0.001）明显升高，二次清创率（RR=0.21，95%CI 0.12~0.37，P<0.001）和术后3 d创面分泌物细菌培养阳性率（RR=0.30，95%CI 0.17~0.53，P<0.001）明显降低；2组术后感染发生率的差异无统计学意义（RR=1.06，95%CI 0.66~1.69，P=0.820）。结论·在烧伤创面治疗中，水动力清创与传统常规清创方式相比表现出更好的效果，具有清创和住院时间减少、二次清创需求降低、创面分泌物细菌培养阳性率降低以及植皮存活率提高的优势。

关键词: 水动力清创, 常规清创, 烧伤, 随机对照试验, 系统评价, meta分析

Abstract:

Objective ·To compare the effectiveness of hydrodynamic debridement versus conventional debridement in the treatment of burn wounds through a systematic review, focusing on differences in time to complete healing after graft, time to debride a 1% total body surface area (TBSA) wound, hospitalization duration, skin graft survival rate at 7 d post-surgery, secondary debridement rate, and positive rate of bacterial culture of wound exudate at 3 d post-surgery, aiming to select a more effective debridement method for burn wounds requiring debridement. Methods ·A systematic literature search was conducted in PubMed, Embase, Web of Science, Cochrane Library, CNKI, SinoMed, China Science and Technology Journal Database,and Wanfang Database, for studies comparing hydrodynamic debridement and conventional debridement in the treatment of burns. The search included articles published in Chinese and English, and the search period was from the inception of the databases to October 1, 2024. The study type was randomized controlled trials (RCTs). After literature search and screening, the included studies was evaluated for quality, and relevant data were extracted. Qualitative variables were presented as relative risk (RR), and quantitative variables as mean difference (MD). Forest plots were created by using RevMan 5.4 software with fixed- or random- effects models. Funnel plots were generated and Egger's test was performed by using Stata 14.0 software. Results ·Fifteen high-quality RCTs were included in this study, involving 1 261 patients with burn injuries requiring debridement. The analysis results showed that compared to the conventional debridement group, the hydrodynamic debridement group had significantly shorter time to complete healing after graft (MD=-3.29,95%CI -3.88‒-2.70, P<0.001), shorter time required to debride a 1% TBSA wound (MD=-0.63, 95%CI -0.76‒-0.50, P<0.001), and reduced hospitalization duration (MD=-4.22, 95%CI -6.17‒-2.28, P<0.001). The skin graft survival rate at 7 d post-surgery in the hydrodynamic debridement group (MD=8.62, 95%CI 7.21‒10.04, P<0.001) was significantly higher, while the secondary debridement rate (RR=0.21, 95%CI 0.12‒0.37, P<0.001) and the positive rate of bacterial culture of wound exudate at 3 d post-surgery (RR=0.30, 95%CI 0.17‒0.53, P<0.001) were significantly lower compared with the conventional debridement group. There was no statistically significant difference in the postoperative infections rates between the two groups (RR=1.06, 95%CI 0.66‒1.69, P=0.820). Conclusion ·In the treatment of burn wounds, hydrodynamic debridement outperforms traditional debridement. In the management of burn wounds, hydrodynamic debridement outperforms conventional debridement by shortening debridement and hospitalization durations, reducing the need for secondary debridement, decreasing early bacterial colonization, and improving skin graft survival. In terms of postoperative infection risk, no significant difference was observed between the two methods, indicating comparable safety profiles.

Key words: hydrodynamic debridement, conventional debridement, burn, randomized controlled trial, systematic review, meta-analysis

中图分类号:

R644

赵建磊, 赵婧琦, 刘唱, 黄靖竣, 金升元. 水动力清创治疗烧伤的效果：随机对照试验的系统评价[J]. 上海交通大学学报（医学版）, 2025, 45(5): 614-623.

ZHAO Jianlei, ZHAO Jingqi, LIU Chang, HUANG Jingjun, JIN Shengyuan. Efficacy of hydrodynamic debridement in the treatment of burns: a systematic review of randomized controlled trials[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(5): 614-623.

图/表 14

参考文献 36

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Study	Study design	Hydrosurgery debridement group			Conventional debridement group			Outcome
Study	Study design	n	Age/year	TBSA/%	n	Age/year	TBSA/%	Outcome
NAWAR et al, 2022^[29]	RCT	20	21.20±11.10	23.30±8.30	20	19.00±9.20	24.50±9.60	②
LEGEMAT et al, 2022^[13]	RCT	137	42.89±25.47	8.41±7.49	137	42.89±25.47	8.41±7.49	⑦
HYLAND et al, 2015^[14]	RCT	30	‒	‒	31	‒	‒	⑦
GRAVANTE et al, 2007^[16]	RCT	42	46.00±26.90	25.00±14.00	45	50.00±28.40	23.00±16.00	①
GUO et al, 2022^[15]	RCT	30	‒	‒	30	‒	‒	①
CHANG, 2022^[24]	RCT	41	40.32±10.66	‒	42	40.56±10.72	‒	①②③④⑤
JI et al, 2019^[28]	RCT	40	44.23±6.23	19.38±5.68	40	44.28±6.24	18.75±6.05	①②③④⑤⑥
LIU et al, 2016^[7]	RCT	34	41.00±12.00	73.00±11.00	42	40.00±12.00	74.00±12.00	①②③④⑤
LIU et al, 2024^[23]	RCT	41	41.15±6.82	23.06±2.12	41	41.93±6.50	22.78±2.35	①②④⑥
LIU et al, 2023^[27]	RCT	60	‒	‒	60	‒	‒	①⑥
QIU et al, 2022^[6]	RCT	37	42.93±1.91	52.37±5.79	36	42.91±1.94	52.33±5.81	①②④
WANG, 2021^[26]	RCT	20	45.67±2.11	65.21±0.51	20	45.25±2.46	65.25±0.56	①⑦
XIAO et al, 2016^[22]	RCT	32	27.10±6.80	‒	32	28.00±7.40	‒	④
XU et al, 2016^[11]	RCT	37	44.00±27.00	37.00±14.00	41	50.00±19.00	34.00±16.00	⑥
ZHANG, 2024^[25]	RCT	21	44.57±7.70	66.86±9.64	22	43.59±9.89	67.18±8.61	①②③④⑤

Study	Study design	Hydrosurgery debridement group			Conventional debridement group			Outcome
Study	Study design	n	Age/year	TBSA/%	n	Age/year	TBSA/%	Outcome
NAWAR et al, 2022^[29]	RCT	20	21.20±11.10	23.30±8.30	20	19.00±9.20	24.50±9.60	②
LEGEMAT et al, 2022^[13]	RCT	137	42.89±25.47	8.41±7.49	137	42.89±25.47	8.41±7.49	⑦
HYLAND et al, 2015^[14]	RCT	30	‒	‒	31	‒	‒	⑦
GRAVANTE et al, 2007^[16]	RCT	42	46.00±26.90	25.00±14.00	45	50.00±28.40	23.00±16.00	①
GUO et al, 2022^[15]	RCT	30	‒	‒	30	‒	‒	①
CHANG, 2022^[24]	RCT	41	40.32±10.66	‒	42	40.56±10.72	‒	①②③④⑤
JI et al, 2019^[28]	RCT	40	44.23±6.23	19.38±5.68	40	44.28±6.24	18.75±6.05	①②③④⑤⑥
LIU et al, 2016^[7]	RCT	34	41.00±12.00	73.00±11.00	42	40.00±12.00	74.00±12.00	①②③④⑤
LIU et al, 2024^[23]	RCT	41	41.15±6.82	23.06±2.12	41	41.93±6.50	22.78±2.35	①②④⑥
LIU et al, 2023^[27]	RCT	60	‒	‒	60	‒	‒	①⑥
QIU et al, 2022^[6]	RCT	37	42.93±1.91	52.37±5.79	36	42.91±1.94	52.33±5.81	①②④
WANG, 2021^[26]	RCT	20	45.67±2.11	65.21±0.51	20	45.25±2.46	65.25±0.56	①⑦
XIAO et al, 2016^[22]	RCT	32	27.10±6.80	‒	32	28.00±7.40	‒	④
XU et al, 2016^[11]	RCT	37	44.00±27.00	37.00±14.00	41	50.00±19.00	34.00±16.00	⑥
ZHANG, 2024^[25]	RCT	21	44.57±7.70	66.86±9.64	22	43.59±9.89	67.18±8.61	①②③④⑤

Outcome	Heterogeneity test		Effect Model	Meta-analysis
Outcome	P value	I²/%	Effect Model	MD/RR (95%CI)	P value
Time to complete healing after graft	<0.001	68	Random	-3.29 (-3.88, -2.70)	<0.001
Time to debride 1% TBSA wound	0.003	69	Random	-0.63 (-0.76, -0.50)	<0.001
Percentage of skin graft survival	0.690	0	Fixed	8.62 (7.21, 10.04)	<0.001
Secondary debridement rate	0.980	0	Fixed	0.21 (0.12, 0.37)	<0.001
Positive rate of bacterial culture of wound exudate at 3 d post-surgery	0.990	0	Random	0.30 (0.17, 0.53)	<0.001
Hospitalization duration	<0.001	92	Random	-4.22 (-6.17, -2.28)	<0.001
Postoperative infection rate	0.810	0	Random	1.06 (0.66, 1.69)	0.820

Outcome	Heterogeneity test		Effect Model	Meta-analysis
Outcome	P value	I²/%	Effect Model	MD/RR (95%CI)	P value
Time to complete healing after graft	<0.001	68	Random	-3.29 (-3.88, -2.70)	<0.001
Time to debride 1% TBSA wound	0.003	69	Random	-0.63 (-0.76, -0.50)	<0.001
Percentage of skin graft survival	0.690	0	Fixed	8.62 (7.21, 10.04)	<0.001
Secondary debridement rate	0.980	0	Fixed	0.21 (0.12, 0.37)	<0.001
Positive rate of bacterial culture of wound exudate at 3 d post-surgery	0.990	0	Random	0.30 (0.17, 0.53)	<0.001
Hospitalization duration	<0.001	92	Random	-4.22 (-6.17, -2.28)	<0.001
Postoperative infection rate	0.810	0	Random	1.06 (0.66, 1.69)	0.820

Outcome	Number of studies/n	Fixed-effects model		Random-effects model
Outcome	Number of studies/n	MD/RR (95%CI)	P value	MD/RR (95%CI)	P value
Time to complete healing after graft	10	-3.11 (-3.43, -2.80)	<0.001	-3.29 (-3.88, -2.70)	<0.001
Time to debride 1% TBSA wound	7	-0.65 (-0.71, -0.58)	<0.001	-0.63 (-0.76, -0.50)	<0.001
Percentage of skin graft survival	4	8.62 (7.21, 10.04)	<0.001	8.62 (7.21, 10.04)	<0.001
Secondary debridement rate	7	0.21 (0.12, 0.37)	<0.001	0.22 (0.12, 0.39)	<0.001
Positive rate of bacterial culture of wound exudate at 3 d post-surgery	3	0.30 (0.17, 0.53)	<0.001	0.30 (0.17, 0.53)	<0.001
Hospitalization duration	4	-3.86 (-4.38, -3.33)	<0.001	-4.22 (-6.17, -2.28)	<0.001
Postoperative infection rate	3	1.05 (0.65, 1.68)	0.850	1.06 (0.66, 1.69)	0.820