糖尿病足潰瘍使用局部氧氣治療對傷口癒合之成效The effect of topical oxygen therapy on the healing of diabetic foot ulcer

740 0 187

2023-10-17 已刊登
綜　整 預防/治療/介入類型

作　　者

鄭婉如 劉君薇 李玲玲*

文章類別

A 類:實證健康照護綜整

問題類型

治療/預防性問題

健康狀況

內分泌與糖尿病 (Endocrinology and Diabetes)  

治療/介入措施

其他(Others) - 局部氧療

專長類別

消化、內分泌

中文關鍵詞

#糖尿病足潰瘍傷口 #局部氧氣治療 #傷口癒合

英文關鍵詞

#Diabetic foot ulcer # Topical oxygen therapy # Wound healing

機構名稱

台灣基督長老教會馬偕醫療財團法人台東馬偕紀念醫院

申請單位

內科加護病房

中文摘要
形成臨床提問：
糖尿病足部潰瘍是全球失能的十大原因之一，其發生後五年內的死亡率為31%。台灣臨床照護仍多以一般傳統照護進行糖尿病足潰瘍之傷口照護。臨床觀察使用局部氧氣治療的個案可產生更快的傷口癒合，故引發作者運用實證知識綜整方法瞭解糖尿病足潰瘍使用局部氧氣治療在提升傷口癒合之成效。
文獻搜尋的方法與分析：
依據主題建立中英文關鍵字、同義字及醫學主題詞(Medical Subject Heading, MeSH term)，以布林邏輯OR及AND搜尋Cochrane Library、PubMed、EMBASE、CINAHL及華藝線上圖書館等五個資料庫；研究類型以系統文獻回顧(Systematic review, SR)及隨機對照試驗(Randomized controlled trial, RCT)為主；搜尋限制近五年內發表之文獻、語言不限制，搜尋至2022年12月之文獻。共搜尋1236篇相關文獻，依納入條件刪除非SR、MA及RCT之文獻1091篇，檢視標題及摘要刪除119篇，進一步檢視全文內容後刪除4篇已納入SR之RCT及不符合之文獻6篇，最後納入三篇系統性文獻回顧進行文獻綜整。
文獻的品質評讀：
本文納入之文獻以Critical Appraisal Skills Programme (CASP)之2018年系統評論研究檢核表(Systematic Review Checklist)進行文獻偏差風險、結果重要性與實務應用之評讀。
結果、結論與建議：
綜整三篇文獻之結果均發現局部氧氣治療較標準治療能有效提升糖尿病足傷口癒合率。使用局部氧氣3至15 ml/hr，每天90分鐘，每週約3至7天，持續4至12週，對提升傷口癒合、減少傷口面積有明顯效果。

英文摘要
Ask an answerable question (PICO)：
Diabetic foot ulcer is one of the top ten causes of disability globally, with a mortality rate of 31% within five years of its onset. In Taiwan, clinical care of diabetic foot ulcer is mostly on the basis of traditional wound care. We observed that topical oxygen therapy might resulted in better would healing in clinical settings and led us to use the process of evidence-based knowledge synthesis to generate a better understanding of the effectiveness of topical oxygen therapy on enhancing the healing of diabetic foot ulcer.
The Method and Analysis of Literature Review：
According to the subject of this synthesis, Chinese and English keywords, synonyms, and Medical Subject Heading (MeSH term) were established. Several databased including Cochrane Library, PubMed, EMBASE, CINAHL, and Airiti Library were searched using Boolean algebra, i.e. OR and AND. The study design is mainly systematic review (SR) and randomised controlled trial (RCT); The search is restricted to documents published within five years, and the language is not restricted. A total of 1,236 relevant articles were searched, 1,091 articles that were not SR, MA, and RCT were deleted according to the inclusion criteria, 119 articles were deleted after reviewing the title and abstract, and 4 RCTs that had been included in SR and 6 articles that did not meet the requirements were deleted after further inspection of the full text.
Critical Appraisal：
The three literatures included were critically appraised using 2018 Systematic Review Checklist of Critical Appraisal Skills Program (CASP) for the appraisal of risk of bias, the importance of study results, and the practicability of each study.
Results, Conclusions and Recommendations：
The synthesised of the three included studies found that the topical oxygen therapy could enhance would healing of diabetic foot ulcer. The use of topical oxygen 3 to 15 ml/hr, 90 minutes/day, around three to seven day/week, for around 4 to 12 weeks, has a significant effect on improving would healing and decreasing would area.