很少有证据表明抗生素有助于开放手术伤口愈合

很少有证据表明抗生素有助于开放手术伤口愈合

2016-10-13 来源：Medscape 我要投稿



There are no high-quality trials assessing whether using antibiotics or antiseptics on open surgical wounds speeds healing by slowing the growth of dangerous microorganisms,according to a new Cochrane review.


一项最新循证医学综述表示，没有高质量的试验评估在开放性手术伤口上使用抗生素或抗菌药（通过减慢有危害的微生物的生长）能否加速愈合。


While most surgical incisions are closed with stitches or staples,some cannot be closed if skin edges do not align or there is a high risk of infection,the authors explain.These incisions are left open to heal,which can take longer and be more painful and require regular dressing changes.


大部分手术切口使用缝线或缝钉进行伤口闭合，如果皮肤边沿不能对齐或有极高的感染风险时，一部分伤口不能闭合，作者们解释道。这些切口保持开放等待治疗，将花费更长的时间、承受更多的疼痛，并需要定期更换绷带。


Open surgical wounds are said to heal by secondary intention rather than primary intention like a closed wound.


据悉，开放手术伤口像一个闭合的伤口一样，通过继发性愈合而非原发性愈合。


"Currently,there is very little information available on how many people have wounds healing in this way,or what proportion of surgeries result in a wound healing by secondary intention,"said lead author Gill Norman of the University of Manchester in the U.K.


“现如今，关于多少人用这种方式治疗伤口可获取的信息寥寥无几，或有多少手术致使伤口通过继发性愈合，”来自英国曼彻斯特大学的第一作者Gill Norman说。


One recent U.K.study estimated that four out of every 10,000 adults were currently living with a wound of this type,and that for two of these individuals this was the planned course of treatment,Norman told Reuters Health by email.


英国最近的一项研究显示：在每10000个成年人中有四个带有这种类型的伤口，其中两位已计划采用上述疗法。


The reviewers examined 11 randomized trials of topical or systemic antibiotic or antiseptic use on secondary intention surgical wounds conducted between 1998 and 2013.They included a total of more than 800 patients,with three trials in children.


研究者们检查了在1998到2013年之间的11项关于在继发性外科伤口处理中使用局部或全身性抗生素或抗菌素的随机临床试验。他们共纳入了超过800位的患者，其中三个实验在儿童中进行。


Three trials were conducted in the U.S.,two in Italy,and the rest in other European countries,Asia or Africa.Four compared antiseptic treatment to other treatment with no antimicrobials,four studied alternative antimicrobial options and three compared management with versus without antimicrobial agents.


三项试验在美国实施，两项在意大利实施，其余的在其他欧洲国家、亚洲或非洲进行；四项对比了防腐处理和其他未用抗菌药物的疗法；四项研究了抗菌药物的选择替代物；三项将使用和不使用抗感染药物健康管理情况作比较。


There was moderate evidence that a topical antibiotic cream may increase the chance of healing three weeks after hemorrhoid surgery compared with a nonantibiotic cream,but low-quality evidence that other antibiotic or antiseptic wound management would decrease time to healing,increase number of wounds healed,decrease adverse events or infection,as reported in the September 28 JAMA Dermatology summary of the Cochrane review.


有中级证据显示，相比无抗生素软膏，局部外用抗生素软膏提升痔疮手术后三周内的治愈几率，但是低质量的证据显示，其他抗生素或杀菌剂伤口治疗减少愈合所需时间，提升伤口愈合数量，减少不良事件或感染的发生，研究在9月28日的JAMA Dermatology摘要的Cochrane综述中报道。


But the reviewed studies were small and often poorly reported,and the interventions they examined may not accurately reflect current clinical practice,the authors note.


作者们注意到，回顾性研究都而且经常很少被发表，他们检查过的干预措施可能没有精确的反应目前的临床实践。


"Research has been conducted talking to people with these open wounds and this highlights the shock and anguish that these wounds can cause people,as well as the feeling of frustration and powerlessness felt when living with them,"Norman said.


“已实施关于开放性伤口愈合的研究，而且这一点加深了伤口给患者带来的震惊和苦闷，当必须忍受他们时，会带来挫折感和无力感，”Norman说。


Since there is no reliable evidence that antibiotic or antiseptics are helpful,decision makers will draw on national and local guidelines,by the cost and availability of some treatments,the safety data they have available to them and/or personal or patient preference,she said.


因为无可靠的证据显示抗生素或杀菌剂有帮助，所以决策者们将借鉴全国性和地区性指南，根据一些疗法的花销和可用性、现有的关于决策者和/或个人的安全数据或者患者喜好，来做出决定。她说。


There is also uncertainty surrounding other treatments for open wounds,like negative pressure wound therapy and different types of dressings,she said.Negative pressure therapy involves the application of a wound dressing through which a vacuum is applied,with any wound and tissue fluid that is drawn away from the area being collected in a canister.


对开放性伤口的其他疗法还存在一些不确定性，像负压伤口疗法和不同类型的包扎，她说。负压疗法涉及到一个伤口敷料的应用，通过应用真空，将任何伤口和组织液，从流出的区域收集到罐中。


"It is important to note that,whilst further randomized controlled trials in the field are required,they should be of high quality using methodology that minimizes bias,"Norman said.


“重要的是要注意，需要进行更多的随机对照试验的时候，应该做到高质量、使用方法论并将偏倚降至最低。”Norman说。