Abstract:

Objective To identify some nursing care initiatives and their effects when taking care of tumor patients with malignant fungating wound（s） and then provide evidences for nursing practice. Methods We performed a systematic research in Cochrane Library,PubMed,Elsevier ScienceDirect,Web of Science,CNKI,Wanfang Data and VIP to collect studies about the effects of nursing care on malignant fungating wounds published from inception to March 2019. Data was analyzed by RevMan 5.3 after literature screening,data extraction,and quality appraisal according to criteria in Cochrane Reviewer’s Handbook by two reviewers independently. Results 11 studies were recruited,including 703 cases. Meta analysis showed that compared to the control group,alginate dressing including silver ions,cat litter based on silica gel and vacuum suction might be more useful to reduce moderate odor of malignant fungating wounds[RR=0.58,95%CI（0.38,0.90）,P=0.010];however,metronidazole and green tea were not better choices to reduced odor of malignant fungating wounds[RR=0.63,95%CI（0.30,0.96）,P<0.001];alginate dressing including silver ions and green tea were more likely to reduce exudation of malignant fungating wounds,no matter it was moderate or severe[RR=0.66,95%CI（0.45,0.95）,P=0.030;RR=0.38,95%CI（0.17,0.88）,P=0.020];besides,applying vacuum suction or cat litter based on silica gel might not be more helpful to alleviate pain mildly [RR=1.46,95%CI（1.06,2.00）,P=0.020] when comparing to the control group,and alginate dressing including silver ions and continuous nursing might also not be better methods to improve quality of life of tumor patients with malignant fungating wound（s） in a degree[RR=6.05,95%CI（3.74,8.36）,P<0.001]. Conclusion alginate dressing including silver ions,cat litter based on silica gelor vacuum suction can be effective measures to decrease the odor of malignant fungating wounds,unfortunately,whether they are capable of pain and improving life quality of cancer patient with such wounds still needs more reliable evidences. Recently,alginate dressing including silver ionsandgreen tea may play a more important role in diminishing moderate or severeexudation of malignant fungating wounds. Since evidences to deal with malignant fungating wounds in nursing care are still unsufficient recently,and sample size varies in each study,more high-quality studies are needed for future research.

Key words: Carcinoma, Malignant Fungating Wounds, Nursing Care, Meta-analysis

摘要：

目的 探讨癌性伤口护理的方法及效果,为临床癌性伤口护理提供循证依据。方法 计算机检索Cochrane Library、PubMed、Elsevier ScienceDirect、Web of Science、中国知网、万方数据库及维普数据库中关于癌性伤口护理的随机对照试验,并筛检纳入文献的参考文献,检索时限为建库至2019年3月。由2名评价人员按照Cochrane Reviewer’s Handbook质量评价标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析。结果 纳入11篇文献,共计703例患者。Meta分析显示,银离子藻酸盐敷料、硅胶猫砂以及负压吸引可减轻癌性伤口中度臭味[RR=0.58,95%CI（0.38,0.90）,P=0.010];甲硝唑和绿茶包对改善癌性伤口臭味的效果不如对照组[RR=0.63,95%CI（0.30,0.96）,P<0.001];银离子藻酸盐敷料和绿茶包可减轻癌性伤口中等及大量渗液[RR=0.66,95%CI（0.45,0.95）,P=0.030;RR=0.38,95%CI（0.17,0.88）,P=0.020]。负压吸引以及硅胶猫砂对减轻癌性伤口轻度疼痛的效果不如对照组[RR=1.46,95%CI（1.06,2.00）,P=0.020];银离子藻酸盐敷料以及家庭延续性护理措施对改善癌性伤口患者生活质量的效果亦不如对照组[RR=6.05,95%CI（3.74,8.36）,P<0.001]。结论 银离子藻酸盐敷料、硅胶猫砂或负压吸引对减轻癌性伤口的臭味有促进作用,对改善癌性伤口的疼痛及生活质量的效果尚需一定试验支撑;银离子藻酸盐敷料和绿茶包对改善癌性伤口中等及大量渗液效果更佳。目前关于癌性伤口的护理研究证据尚不充足,且各研究样本量差异较大,后期尚需更多高质量研究进行验证。

关键词: 癌, 癌性伤口, 护理, Meta分析