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首页> 外文期刊>Evidence-based nursing >Paraffin ointment or mupirocin ointment did not differ from no ointment under moist occlusive dressings on non-contaminated surgical wounds for wound infections
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Paraffin ointment or mupirocin ointment did not differ from no ointment under moist occlusive dressings on non-contaminated surgical wounds for wound infections

机译:石蜡软膏或莫匹罗星软膏与未受污染的手术伤口上的湿性闭塞敷料下无软膏的伤口感染没有区别

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摘要

Case studies suggest that dressings or topical applications are effective for surgical wounds. Few properly conducted clinical trials have been done, in part, because they are expensive and difficult to do. The high quality trial by Dixon et al had a sufficient sample size to detect clinically significant differences in infection rates if they existed. Based on wound infection rates of 4% and a clinically significant reduction to < 1 %, the authors determined that 1500 wounds would be needed; they, in fact, recruited patients with a total of 1801 wounds. They found no differences in wounds treated in the paraffin, mupirocin, and no ointment groups for any of the outcomes, except for an increased risk of skin necrosis with mupirocin ointment compared with the other 2 groups. The authors acknowledge some limitations. It is unclear if allocation was concealed as balls were drawn from a bag to indicate treatment groups. This introduces the possibility of selection bias. Although study groups appeared to be similar for age and sex, it is possible that they differed for other attributes. As well, the power calculation was done on the basis of wounds, whereas patients were the unit of randomisation; some patients had > 1 wound. However, this is unlikely to be a problem because no patient had > 1 infected wound, and the authors conducted a subanalysis of first wounds in each patient, which showed similar results. A further problem is that it was not entirely possible to blind both patients and clinicians applying the treatments. Although patients and the surgeon assessing wounds were not told which treatment was given, patients might have been aware that they had received ointment. However if a placebo effect did exist, one would expect it in the group that believed they had an active treatment, and no such difference was observed. Finally, the infection rate was lower than anticipated, reducing the power of the trial. Despite these minor limitations, it is clear that in this patient population with low infection rates, applying ointment does not seem to improve outcomes, and applying mupirocin ointment may be associated with increased skin necrosis.
机译:案例研究表明,敷料或局部应用对手术伤口有效。很少进行适当的临床试验,部分是因为它们昂贵且难以完成。 Dixon等人的高质量试验具有足够的样本量,可以检测出感染率的临床显着差异(如果存在)。基于4%的伤口感染率和临床上显着降低至<1%,作者确定需要1500处伤口。实际上,他们招募了总共1801例伤口的患者。他们发现在石蜡,莫匹罗星治疗的伤口中没有任何差异,在任何结局中都没有软膏组,除了与其他两组相比,使用莫匹罗星软膏的皮肤坏死风险增加外。作者承认一些局限性。目前尚不清楚是否隐藏了分配,因为从袋子中抽出一些球来表示治疗组。这引入了选择偏差的可能性。尽管研究小组在年龄和性别上似乎相似,但在其他属性上却可能有所不同。同样,功效是根据伤口进行计算的,而患者是随机分组的单位。一些患者的伤口> 1。但是,这不太可能成为问题,因为没有患者感染的伤口超过1个,并且作者对每位患者的第一个伤口进行了亚分析,结果相似。另一个问题是,不可能完全使采用该疗法的患者和临床医生都不知情。尽管没有告知患者和评估伤口的外科医生接受了哪种治疗,但患者可能已经意识到他们已经接受了药膏的治疗。但是,如果确实存在安慰剂作用,则认为相信他们已经进行了积极治疗的组中会出现这种情况,并且没有观察到这种差异。最后,感染率低于预期,降低了试验的效力。尽管存在这些较小的限制,但很明显,在感染率较低的这一患者人群中,应用软膏似乎并不能改善预后,而应用莫匹罗星软膏可能会增加皮肤坏死。

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