Effects of different decompression device in the prevention of pressure sore: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YAO Li ^1,2 , DING Nannan ^1,2 , YANG Liping ³ , Han Chunyan ^1,2 , JIANG Lingjie ^1,2 , JIANG Biantong ^1,2 , WU Yuchen ³ , ZHANG Caiyun ¹ , TIAN Jinhui ⁴ ,  ZHANG Zhigang ³

1. Department of Nursing, The First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;
2. School of Nursing, Lanzhou University, Lanzhou, 730000, P.R.China;
3. Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;
4. Evidence-Based Medicine Center, Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding author：

ZHANG Zhigang, Email: zzg3444@163.com

Keywords：

Intraoperative pressure sore; Decompression device; Dressing; Decompression pad; Network meta-analysis

DOI：

10.7507/1672-2531.201806070

Video：

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Objectives To systematically review the preventive effects of different pressure relief devices. Methods Databases including PubMed, The Cochrane Library, Web of Science, EMbase, CBM, CNKI, VIP and WanFang Data were searched to collect randomized control trials (RCTs) on the preventive effects of pressure relief devices for the surgical pressure sore from inception to December 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Network meta-analysis was then performed using gemtc package of R 3.5.0 software, Stata 13.0 and JAGS 3.4.0 software. Results A total of 20 RCTs involving 4 183 patients were included. The network meta-analysis showed that micropulse dynamic pad was superior to standard pad. The gel pad was superior to sponge pad. The standard pad and cotton gauze pad. The foam dressing was superior to gel pad. All of the differences were statistically significant. The results of the ranking probability plot suggested foam dressing as an optimal resolution for preventing surgical pressure sore. Conclusions According to the network meta-analysis and rankings, foam dressing is superior to other decompression devices in preventing surgical pressure sores.

Citation： YAO Li, DING Nannan, YANG Liping, Han Chunyan, JIANG Lingjie, JIANG Biantong, WU Yuchen, ZHANG Caiyun, TIAN Jinhui, ZHANG Zhigang. Effects of different decompression device in the prevention of pressure sore: a network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(10): 1086-1092. doi: 10.7507/1672-2531.201806070 Copy

1.	王彩凤, 巫向前. 压疮形成机制研究进展. 护理学杂志, 2007, 22(1): 74-77.
2.	旷婉, 赵体玉, 余云红. 术中获得性压疮预防相关研究进展. 中国护理管理, 2017, 17(6): 851-855.
3.	Schoonhoven L, Defloor T, Grypdonck MH. Incidence of pressure ulcers due to surgery. J Clin Nurs, 2002, 11(4): 479-487.
4.	蒋琪霞, 瞿小龙, 郭秀君, 等. 手术患者压疮发生率及发生时间和影响因素研究. 中国护理管理, 2013, 13(9): 25-28.
5.	Schuurman JP, Schoonhoven L, Keller BP, et al. Do pressure ulcers influence length of hospital stay in surgical cardiothoracic patients? A prospective evaluation. J Clin Nurs, 2009, 18(17): 2456-2463.
6.	Pham B, Teague L, Mahoney J, et al. Support surfaces for intraoperative prevention of pressure ulcers in patients undergoing surgery: a cost-effectiveness analysis. Surgery, 2011, 150(1): 122-132.
7.	刘国伟, 于莉莉, 贾洪霞, 等. 系统评价中的间接比较与网状 Meta 分析方法研究进展. 中国循证医学杂志, 2014, 14(10): 1276-1280.
8.	周玉洁, 杨美玲, 张洪君, 等. 压疮分期及其护理进展. 中国护理管理, 2014, 14(7): 683-686.
9.	Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions (Version 5. 1. 0). Available at: http://handbook. cochrane.org.
10.	张超, 董圣杰, 曾宪涛. R 软件 gemtc 程序包在网状 Meta 分析中的应用. 中国循证医学杂志, 2013, 13(10): 1258-1264.
11.	张超, 孙凤, 曾宪涛. R 软件调用 JAGS 软件实现网状 Meta 分析. 中国循证医学杂志, 2014, 14(2): 241-248.
12.	张超, 鄢金柱, 孙凤, 等. 网状 Meta 分析一致性的鉴别与处理方法. 中国循证医学杂志, 2014, 14(7): 884-888.
13.	Nixon J, McElvenny D, Mason S, et al. A sequential randomised controlled trial comparing a dry visco-elastic polymer pad and standard operating table mattress in the prevention of postoperative pressure sores. Int J Nurs Stud, 1998, 35(4): 193-203.
14.	Aronovitch SA, Wilber M, Slezak S, et al. A comparative study of an alternating air mattress for the prevention of pressure ulcers in surgical patients. Ostomy Wound Manage, 1999, 45(3): 34-40.
15.	Schultz A, Bien M, Dumond K, et al. Etiology and incidence of pressure ulcers in surgical patients. AORN J, 1999, 70(3): 434-437.
16.	Russell JA, Lichtenstein SL. Randomized controlled trial to determine the safety and efficacy of a multi-cell pulsating dynamic mattress system in the prevention of pressure ulcers in patients undergoing cardiovascular surgery. Ostomy Wound Manage, 2000, 46(2): 46-51.
17.	Feuchtinger J. Preventing decubitus ulcer in heart surgery interventions: visco-elastic foam layer on the operating room table-a study. Pflege Z, 2006, 59(8): 498-501.
18.	陈蕾, 任从才, 刘晓红. 两种不同体位垫在俯卧位脊柱手术中的应用观察. 现代临床护理, 2010, 9(3): 44-45.
19.	汪继斌, 朱绣峰. 液体敷料和聚氨酯凝胶垫在手术患者压疮预防中的应用. 海南医学院学报, 2010, 16(10): 1366-1368.
20.	汪琳. 美皮康贴膜用于妇科腹腔镜截石位手术中压疮的预防. 护理学杂志, 2011, 26(16): 59-60.
21.	王汝娜. 水胶体减压贴预防俯卧位手术患者面部压疮效果观察. 护理学杂志, 2011, 26(16): 56-57.
22.	王莉, 陈翠玲, 吴景明, 等. 凝胶减压垫在俯卧位手术患者预防压疮中的应用. 现代临床护理, 2011, 10(6): 47-48.
23.	李锦英, 冯润科, 莫丽梅. 凝胶体位垫在骨科侧卧位手术中的作用与护理. 护理实践与研究, 2012, 9(11): 141-142.
24.	王新凤, 程月娥. 凝胶果冻垫预防术中患者压疮的效果观察. 解放军护理杂志, 2012, 29(1): 73-74.
25.	陆建平, 阎倩, 袁洁萍, 等. 硅胶凝胶垫预防老年患者手术中压疮的效果. 上海护理, 2012, 12(2): 5-7.
26.	李静如. 软聚硅酮泡沫敷料在预防术中骶尾部压疮的效果观察. 护士进修杂志, 2012, 27(22): 2080-2081.
27.	张云凤, 宋思贤, 梁亮芳. 医用高分子凝胶体位垫在侧卧位手术中预防急性压疮的效果评价. 中国实用护理杂志, 2014, 30(20): 49-50.
28.	梁馨之, 丁晨. 液体敷料在俯卧位后颅窝手术中的应用效果. 中国医科大学学报, 2015, 44(1): 91-93.
29.	陈小花, 陶勇, 彭玉兰, 等. 三种俯卧位垫在俯卧位手术中的应用研究. 中国实用护理杂志, 2015, 31(14): 1057-1059.
30.	杨永辉, 曹勍, 白晓霞. 泡沫敷料预防长时间术中平卧位患者骶尾部压疮的效果观察. 实用医院临床杂志, 2016, 13(5): 206-208.
31.	缪蓉, 余华, 苏月焦, 等. 美皮康敷贴对行侧卧位颅脑手术患者压疮的预防效果. 现代临床护理, 2017, 16(2): 60-62.
32.	易凤琼, 曾彦超, 郭宇, 等. 软聚硅酮异型泡沫敷料对脊柱手术下颏部压疮预防的效果观察. 中国实用护理杂志, 2017, 33(21): 1606-1608.
33.	郭月, 余云红, 赵体玉. 手术室患者压疮临床特点的回顾性分析. 护理学杂志, 2014, 29(24): 36-39.
34.	马红利, 袁晓华, 张文敏, 等. 术中压疮影响因素 Meta 分析. 重庆医学, 2016, 45(31): 4389-4392.
35.	Kirkland-Walsh H, Teleten O, Wilson M, et al. Pressure mapping comparison of four or surfaces. AORN J, 2015, 102(1): 1-9.
36.	Shahin ES, Dassen T, Halfens RJ. Pressure ulcer prevalence and incidence in intensive care patients: a literature review. Nurs Crit Care, 2008, 13(2): 71-79.
37.	Defloor T, De Schuijmer JD. Preventing pressure ulcers: an evaluation of four operating-table mattresses. Appl Nurs Res, 2000, 13(3): 134-141.
38.	Brindle CT, Wegelin JA. Prophylactic dressing application to reduce pressure ulcer formation in cardiac surgery patients. J Wound Ostomy Continence Nurs, 2012, 39(2): 133-142.
39.	Black J, Clark M, Dealey C, et al. Dressings as an adjunct to pressure ulcer prevention: consensus panel recommendations. Int Wound J, 2015, 12(4): 484-488.

1. 王彩凤, 巫向前. 压疮形成机制研究进展. 护理学杂志, 2007, 22(1): 74-77.
2. 旷婉, 赵体玉, 余云红. 术中获得性压疮预防相关研究进展. 中国护理管理, 2017, 17(6): 851-855.
3. Schoonhoven L, Defloor T, Grypdonck MH. Incidence of pressure ulcers due to surgery. J Clin Nurs, 2002, 11(4): 479-487.
4. 蒋琪霞, 瞿小龙, 郭秀君, 等. 手术患者压疮发生率及发生时间和影响因素研究. 中国护理管理, 2013, 13(9): 25-28.
5. Schuurman JP, Schoonhoven L, Keller BP, et al. Do pressure ulcers influence length of hospital stay in surgical cardiothoracic patients? A prospective evaluation. J Clin Nurs, 2009, 18(17): 2456-2463.
6. Pham B, Teague L, Mahoney J, et al. Support surfaces for intraoperative prevention of pressure ulcers in patients undergoing surgery: a cost-effectiveness analysis. Surgery, 2011, 150(1): 122-132.
7. 刘国伟, 于莉莉, 贾洪霞, 等. 系统评价中的间接比较与网状 Meta 分析方法研究进展. 中国循证医学杂志, 2014, 14(10): 1276-1280.
8. 周玉洁, 杨美玲, 张洪君, 等. 压疮分期及其护理进展. 中国护理管理, 2014, 14(7): 683-686.
9. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions (Version 5. 1. 0). Available at: http://handbook. cochrane.org.
10. 张超, 董圣杰, 曾宪涛. R 软件 gemtc 程序包在网状 Meta 分析中的应用. 中国循证医学杂志, 2013, 13(10): 1258-1264.
11. 张超, 孙凤, 曾宪涛. R 软件调用 JAGS 软件实现网状 Meta 分析. 中国循证医学杂志, 2014, 14(2): 241-248.
12. 张超, 鄢金柱, 孙凤, 等. 网状 Meta 分析一致性的鉴别与处理方法. 中国循证医学杂志, 2014, 14(7): 884-888.
13. Nixon J, McElvenny D, Mason S, et al. A sequential randomised controlled trial comparing a dry visco-elastic polymer pad and standard operating table mattress in the prevention of postoperative pressure sores. Int J Nurs Stud, 1998, 35(4): 193-203.
14. Aronovitch SA, Wilber M, Slezak S, et al. A comparative study of an alternating air mattress for the prevention of pressure ulcers in surgical patients. Ostomy Wound Manage, 1999, 45(3): 34-40.
15. Schultz A, Bien M, Dumond K, et al. Etiology and incidence of pressure ulcers in surgical patients. AORN J, 1999, 70(3): 434-437.
16. Russell JA, Lichtenstein SL. Randomized controlled trial to determine the safety and efficacy of a multi-cell pulsating dynamic mattress system in the prevention of pressure ulcers in patients undergoing cardiovascular surgery. Ostomy Wound Manage, 2000, 46(2): 46-51.
17. Feuchtinger J. Preventing decubitus ulcer in heart surgery interventions: visco-elastic foam layer on the operating room table-a study. Pflege Z, 2006, 59(8): 498-501.
18. 陈蕾, 任从才, 刘晓红. 两种不同体位垫在俯卧位脊柱手术中的应用观察. 现代临床护理, 2010, 9(3): 44-45.
19. 汪继斌, 朱绣峰. 液体敷料和聚氨酯凝胶垫在手术患者压疮预防中的应用. 海南医学院学报, 2010, 16(10): 1366-1368.
20. 汪琳. 美皮康贴膜用于妇科腹腔镜截石位手术中压疮的预防. 护理学杂志, 2011, 26(16): 59-60.
21. 王汝娜. 水胶体减压贴预防俯卧位手术患者面部压疮效果观察. 护理学杂志, 2011, 26(16): 56-57.
22. 王莉, 陈翠玲, 吴景明, 等. 凝胶减压垫在俯卧位手术患者预防压疮中的应用. 现代临床护理, 2011, 10(6): 47-48.
23. 李锦英, 冯润科, 莫丽梅. 凝胶体位垫在骨科侧卧位手术中的作用与护理. 护理实践与研究, 2012, 9(11): 141-142.
24. 王新凤, 程月娥. 凝胶果冻垫预防术中患者压疮的效果观察. 解放军护理杂志, 2012, 29(1): 73-74.
25. 陆建平, 阎倩, 袁洁萍, 等. 硅胶凝胶垫预防老年患者手术中压疮的效果. 上海护理, 2012, 12(2): 5-7.
26. 李静如. 软聚硅酮泡沫敷料在预防术中骶尾部压疮的效果观察. 护士进修杂志, 2012, 27(22): 2080-2081.
27. 张云凤, 宋思贤, 梁亮芳. 医用高分子凝胶体位垫在侧卧位手术中预防急性压疮的效果评价. 中国实用护理杂志, 2014, 30(20): 49-50.
28. 梁馨之, 丁晨. 液体敷料在俯卧位后颅窝手术中的应用效果. 中国医科大学学报, 2015, 44(1): 91-93.
29. 陈小花, 陶勇, 彭玉兰, 等. 三种俯卧位垫在俯卧位手术中的应用研究. 中国实用护理杂志, 2015, 31(14): 1057-1059.
30. 杨永辉, 曹勍, 白晓霞. 泡沫敷料预防长时间术中平卧位患者骶尾部压疮的效果观察. 实用医院临床杂志, 2016, 13(5): 206-208.
31. 缪蓉, 余华, 苏月焦, 等. 美皮康敷贴对行侧卧位颅脑手术患者压疮的预防效果. 现代临床护理, 2017, 16(2): 60-62.
32. 易凤琼, 曾彦超, 郭宇, 等. 软聚硅酮异型泡沫敷料对脊柱手术下颏部压疮预防的效果观察. 中国实用护理杂志, 2017, 33(21): 1606-1608.
33. 郭月, 余云红, 赵体玉. 手术室患者压疮临床特点的回顾性分析. 护理学杂志, 2014, 29(24): 36-39.
34. 马红利, 袁晓华, 张文敏, 等. 术中压疮影响因素 Meta 分析. 重庆医学, 2016, 45(31): 4389-4392.
35. Kirkland-Walsh H, Teleten O, Wilson M, et al. Pressure mapping comparison of four or surfaces. AORN J, 2015, 102(1): 1-9.
36. Shahin ES, Dassen T, Halfens RJ. Pressure ulcer prevalence and incidence in intensive care patients: a literature review. Nurs Crit Care, 2008, 13(2): 71-79.
37. Defloor T, De Schuijmer JD. Preventing pressure ulcers: an evaluation of four operating-table mattresses. Appl Nurs Res, 2000, 13(3): 134-141.
38. Brindle CT, Wegelin JA. Prophylactic dressing application to reduce pressure ulcer formation in cardiac surgery patients. J Wound Ostomy Continence Nurs, 2012, 39(2): 133-142.
39. Black J, Clark M, Dealey C, et al. Dressings as an adjunct to pressure ulcer prevention: consensus panel recommendations. Int Wound J, 2015, 12(4): 484-488.

Chinese Journal of Evidence-Based Medicine

Effects of different decompression device in the prevention of pressure sore: a network meta-analysis

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