以质量求发展,以服务铸品牌

护理学报 ›› 2019, Vol. 26 ›› Issue (22): 27-32.doi: 10.16460/j.issn1008-9969.2019.22.027

• 循证护理 • 上一篇    下一篇

低水平激光治疗慢性伤口有效性与安全性的Meta分析

邓波1, 李飞1, 吴秀丽2, 李显蓉2   

  1. 1.西南医科大学 护理学院,四川 泸州646000;
    2.西南医科大学附属医院,四川 泸州 646000
  • 收稿日期:2019-07-22 发布日期:2020-07-27
  • 通讯作者: 李显蓉(1968-),女,四川泸州人,本科学历,硕士研究生导师,主任护师。E-mail:1204987356@qq.com
  • 作者简介:邓 波(1994-),男,四川巴中人,本科学历,硕士研究生在读。
  • 基金资助:
    泸州市科技计划项目[2017-S-40(1/18)]

Efficacy and Safety of Low-level Laser Therapy for Chronic Wounds: A Meta-analysis

DENG Bo1, LI Fei1, WU Xiu-li2, LI Xian-rong2   

  1. 1. School of Nursing, Southwest Medical University, Luzhou 646000, China;
    2. Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
  • Received:2019-07-22 Published:2020-07-27

摘要: 目的 评价低水平激光治疗慢性伤口的有效性和安全性。方法 检索PubMed、Medline、EMbase、Cochrane Library、Web of Science、BMJ Best Practice、CBM、中国知网、万方、维普数据库,并检索伤口治疗相关专业网站,搜集关于低水平激光治疗慢性伤口的随机对照试验,检索时间均从建库至2018年12月,使用Cochrane Review Handbook 5.1.0进行质量评价,采用RevMan 5.3进行Meta分析。结果 共纳入16个随机对照研究,509例患者。结果 显示:低水平激光组未愈合伤口面积[MD=-0.63,95%CI(-0.97,-0.29),P<0.01]、伤口面积平均减少率[MD=22.17,95%CI(19.34, 25.00),P<0.01]、伤口治愈人数[OR=2.04,95%CI(1.33,3.12),P<0.01]、伤口疼痛值[MD=-4.34,95%CI(-4.92,-3.75,P<0.01]与对照组比较差异均有统计学意义,而不良事件发生率[OR=0.66,95%CI(0.24,1.81),P=0.42]与对照组比较差异无统计学意义。结论 低水平激光能加速伤口愈合,有效减轻伤口治疗期间患者疼痛,并且是安全的。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

关键词: 低水平激光, 下肢静脉溃疡, 糖尿病足, 压力性溃疡, Meta分析

Abstract: Objective To evaluate the efficacy and safety of low-level laser therapy for chronic wounds. Methods Randomized controlled trials (RCTs) of low-level laser therapy for chronic wounds were collected from PubMed, Medline, EMbase, Cochrane Library, Web of Science, BMJ Best Practice, CBM, China Knowledge Network, Wanfang data and VIP data by computer from the inception to December of 2018. The quality of the included studies was evaluated using Cochrane Review Handbook 5.1.0 and performed using RevMan 5.3 software. Results Sixteen RCTs and 509 patients were included in the study. Meta-analysis showed that the area of non-healing wounds in the low-level laser group [MD=-0.63, 95%CI (-0.97, -0.29), P<0.01], mean reduction in wound area [MD=22.17, 95%CI(19.34, 25.00), P<0.01 ], the number of wounds cured [OR=2.04, 95%CI (1.33, 3.12), P=0.01] and the value of wound pain [MD=-4.34, 95%CI (-4.92, -3.75), P<0.01] in the observation group were significantly different from those of the control group, but the incidence of adverse events [OR=0.66,95%CI(0.24, 1.81), P=0.42] was not statistically significant. Conclusion Low-level laser can accelerate wound healing, effectively alleviate pain during wound treatment, and it is safe. Subject to the limitations of the number and quality of studies included, the above conclusions are yet to be verified by more high-quality studies.

Key words: low-level laser, varicose ulcer, diabetic foot, pressure ulcer, Meta-analysis

中图分类号: 

  • R473.5
[1] 中华医学会创伤学分会组织修复专业委员会.慢性伤口诊疗指导意见[M].北京:人民卫生出版社,2011.
[2] De Moraes J M, Eterno D O, Moura V B, et al. Anti-inflammatory Effect of Low-intensity Laser on the Healing of Third-degree Burn Wounds in Rats[J].Lasers Med Sci, 2013,28(4):1169-1176. DOI:10.1007/s10103-012-1213-1.
[3] Machado R S, Viana S, Sbruzzi G.Low-Level Laser Therapy in the Treatment of Pressure Ulcers: Systematic Review[J]. Lasers Med Sci,2017, 32(4):937-944.DOI:10.1007/s10103-017-2150-9.
[4] Schubert V.Effects of Phototherapy on Pressure Ulcer Healing in Elderly Patients after a Falling Trauma. A Prospective, Randomized, Controlled Study[J]. Photodermatol Photoimmunol Photomed,2001,17(1):32-38.DOI:10.1034/j.1600-0781.2001.017001032.
[5] Lagan K M, McKenna T A, Witherow, et al. Low-Intensity Laser Therapy/Combined Phototherapy in the Management of Chronic Venous Ulceration: A Placebo-controlled Study[J]. J Clin Laser Med Surg, 2002, 20(3):109-116. DOI:10.1089/104454702760090173.
[6] Lucas C, Van M J, Gemert R J.Efficacy of Low-level Laser Therapy in the Management of Stage III Decubitus Ulcers: A Prospective, Observer-blinded Multicentre Randomised Clinical Trial[J]. Lasers Med Sci,2003, 18(2):72-77. DOI:10.1007/s10103-003-0259-5.
[7] Kopera D, Kokol R, Berger C, et al.Does the Use of Low-level Laser Influence Wound Healing in Chronic Venous Leg Ulcers?[J]. J Wound Care,2005,14(8):391-394. DOI: 10.12968/jowc.2005.14.8.26825.
[8] Caetano K S, Frade M A, Minatel D G, et al.Phototherapy Improves Healing of Chronic Venous Ulcers[J]. Photomed Laser Surg,2009,27(1):111-118.DOI:10.1089/pho.2008.2398.
[9] Barreto J G, Salgado C G.Clinic-Epidemiological Evaluation of Ulcers in Patients with Leprosy Sequelae and the Effect of Low-level Laser Therapy on Wound Healing: A Randomized Clinical Trial[J]. BMC Infect Dis,2010,10(1):237. DOI:10.1186/1471-2334-10-237.DOI10.1186/1471-2334-10-237.
[10] Leclère F M, Puechguiral I R, Rotteleur G, et al.A Prospective Randomized Study of 980 Nm Diode Laser-assisted Venous Ulcer Healing on 34 Patients[J]. Wound Repair Regen,2010, 18(6):580-585.DOI:10.1111/j.1524-475X.2010.00637.
[11] Kaviani A, Djavid G E, Ataie F L, et al.A Randomized Clinical Trial on the Effect of Low-level Laser Therapy on Chronic Diabetic Foot Wound Healing: A Preliminary Report[J]. Photomed Laser Surg,2011,29(2):109-114. DOI: 10.1089/pho.2009.2680.
[12] Erchonia Corporation. Efficacy Study of the Application of Low-level Laser Light to Treat Venous Stasis Ulcers[EB/OL].(2011-06-20)[2019-05-22].http://clinicaltrials.gov/ct2/show/nct01376050.
[13] Sandoval O, Herrera V E, Camargo L, et al.Effects of Low-level Laser Therapy and High Voltage Stimulation on Diabetic Wound Healing[J]. Revista Salud UIS, 2014,46(2):107-117.
[14] Feitosa M, Carvalho A, Feitosa V C, et al.Effects of The Low-Level Laser Therapy (LLLT) in the Process of Healing Diabetic Foot Ulcers[J]. Acta Cirurgica Brasileira,2015,30(12):852-857. DOI:10.1590/S0102-865020150120000010.
[15] Carvalho A F, Feitosa M C, Coelho N P, et al.Low-level Laser Therapy and Calendula Officinalis in Repairing Diabetic Foot Ulcers[J]. Rev Esc Enferm USP, 2016, 50(4):628-634. DOI:10.1590/S0080-623420160000500013.
[16] Mathur R K, Sahu K, Saraf S, et al.Low-level Laser Therapy as an Adjunct to Conventional Therapy in the Treatment of Diabetic Foot Ulcers[J]. Lasers Med Sci,2017,32(2):275-282. DOI:10.1007/s10103-016-2109-2.
[17] Vitse J, Bekara F, Byun S, et al.A Double-blind, Placebo-controlled Randomized Evaluation of the Effect of Low-Level Laser Therapy on Venous Leg Ulcers[J]. Int J Low Extrem Wounds, 2017,16(1):29-35.DOI:10.1177/1534734617690948.
[18] De Alencar Fonseca Santos J, Campelo M B, de Oliveira R A, et al. Effects of Low-power Light Therapy on the Tissue Repair Process of Chronic Wounds in Diabetic Feet[J]. Photomed Laser Surg,2018,36(6):298-304.DOI:10.1089/pho.2018.4455.
[19] Tantawy S A, Abdelbasset W K, Kamel D, et al.A Randomized Controlled Trial Comparing Helium-neon Laser Therapy and Infrared Laser Therapy in Patients with Diabetic Foot Ulcer[J]. Lasers Med Sci, 2018,33(9):1901-1906. DOI:10.1007/s10103-018-2553-2.
[20] 赵敏,冯金法,杨娜娜,等.氦氖激光联合阿托伐他汀钙治疗糖尿病足的疗效观察[J].影像研究与医学应用, 2017,1(11):173-174. DOI:10.3969/j.issn.2096-3807.2017.11.114.
[21] 夏飞飞,王利君,王军辉.半导体激光照射治疗下肢静脉性溃疡临床观察及护理[J].中国激光医学杂志,2016,25(1):47-49. DOI:10.13480/jissn1003-9430.2016.0047.
[22] Houreld N N, Ayuk S M, Abrahamse H.Expression of Genes in Normal Fibroblast Cells (WS1) in Response to Irradiation at 660nm[J]. J Photochem Photobiol B,2014,130:146-152. DOI:10.1016/j.jphotobiol.2013.11.018.
[23] Steven L, Percival, Katja E.A Review of the Scientific Evidence for Biofilms in Wounds[J].Wound Repair Regen.2012.20.647-657. DOI:10.1111/j.1524-475X.2012.00836.
[24] 李彦红,张继刚,徐艳峰,等.发光二极管630 nm红光和460 nm蓝光照射对日本大耳白兔皮肤创面愈合的影响[J].中国医学科学院学报, 2017,39(3):301-306. DOI:10.3881/j.issn.1000-503X.2017.03.001.
[25] 毛和水,姚敏,俞为荣,等.630~650 nm光照射对糖尿病小鼠创面愈合的影响[J].上海交通大学学报, 2013,33(9):1209-1214.
[26] Wu X, Alberico S, Saidu E, et al.Organic Light Emitting Diode Improves Diabetic Cutaneous Wound Healing in Rats[J]. Wound Repair Regen, 2015,23(1):104-114. DOI:10.1111/wrr.12258.
[27] Myakishev R, Stadler M I, Brondon P, et al.A Preliminary Study of the Safety of Red Light Phototherapy of Tissues Harboring Cancer[J].Photomed Laser Surg,2012,30(9):551-558. DOI:10.1089/pho.2011.3186.
[1] 裴露斯, 杨雪梅, 翟田田, 赵亚芸, 冯兰棱, 张迁. 冷冻疗法降低化疗患者口腔黏膜炎发生的Meta分析[J]. 护理学报, 2020, 27(6): 23-28.
[2] 陈雯, 尹朱丹, 王赛男, 厉姝岑, 张雪芳. 接纳与承诺疗法对慢性疼痛干预效果的Meta分析[J]. 护理学报, 2020, 27(5): 22-27.
[3] 徐绍莲, 臧谋红, 唐瑭, 霍丽萍, 朱贞祥. 肿瘤化疗患者植入式静脉输液港与PICC并发症发生情况Meta分析[J]. 护理学报, 2020, 27(3): 37-42.
[4] 惠靖瑞, 熊振芳, 陈涵彬, 雷雨迟, 李敬文. 神阙穴贴敷治疗肿瘤患者化疗相关性便秘疗效的Meta分析[J]. 护理学报, 2020, 27(2): 38-42.
[5] 刘敏, 刘安诺, 吴德全, 高宇, 陈国红, 朱桂月, 张萌, 马雯, 丁翠路. 运动干预对2型糖尿病老年患者步行功能影响的Meta分析[J]. 护理学报, 2020, 27(11): 40-45.
[6] 刘熠, 欧阳艳琼, 黄毅, 聂小菲. 正念减压疗法对乳腺癌患者干预效果的Meta分析[J]. 护理学报, 2019, 26(8): 31-36.
[7] 郑嘉祺, 马恩婷, 魏力. 区域医联体内护士糖尿病足知识认知现状研究[J]. 护理学报, 2019, 26(6): 10-13.
[8] 梁欣, 高祖梅, 张海元, 海容, 邓文芳. 父母陪伴下麻醉诱导对患儿围术期影响的Meta分析[J]. 护理学报, 2019, 26(6): 32-37.
[9] 蒋娅, 罗祥蓉, 谢翠华, 李景香, 曾艳梅. 自设糖尿病足伤口护理记录单的改良与临床应用[J]. 护理学报, 2019, 26(22): 75-78.
[10] 朱亚莉, 杨超, 范湘鸿. 枸橼酸钠对比肝素封管液对血液透析导管维护有效性的Meta分析[J]. 护理学报, 2019, 26(2): 39-44.
[11] 孙烯辉, 杨丽, 黄德斌, 张桂宁, 李琳, 廖婷婷, 邱丽燕, 巫雪花. 机械通气患者胸部物理治疗效果的Meta分析[J]. 护理学报, 2019, 26(17): 31-36.
[12] 邓波, 江波, 陈静文, 李显蓉. 自体富血小板纤维蛋白治疗慢性伤口有效性与安全性的Meta分析[J]. 护理学报, 2019, 26(13): 6-11.
[13] 张红梅, 傅荣, 张宁. 正念疗法对糖尿病患者糖尿病相关心理痛苦影响的Meta分析[J]. 护理学报, 2019, 26(13): 44-49.
[14] 田婷, 黄锐娜, 戚熠, 周亚娟, 韩慧, 刘婉君, 贺海霞, 吴小婉. 肿瘤患者PICC置管相关静脉血栓形成危险因素Meta分析[J]. 护理学报, 2019, 26(11): 49-54.
[15] 王红玉,杨雅,曾满琴,曾洁,史伟. 糖尿病APP在糖尿病足分级风险管理中的应用[J]. 护理学报, 2018, 25(3): 74-76.
Viewed
Full text


Abstract

Cited

  Shared   
[1] 徐慧娜, 桂意华. ICU护士血液净化技术培训应用PBL教学法结合能力进阶模式的效果观察[J]. 护理学报, 2020, 27(12): 1 -5 .
[2] 汤琳, 孟爱凤, 智晓旭, 邾萍, 浦亚楼, 路莉静. 癌症青年患者社会心理干预的研究进展[J]. 护理学报, 2020, 27(12): 10 -13 .
[3] 严晓晶, 陈璐, 陈雁. 社区专科护士培训现状及研究进展[J]. 护理学报, 2020, 27(12): 14 -17 .
[4] 卢舒颖, 刘宁, 魏璐华, 梁冬梅, 李妍. 产后出血预防及管理的最佳证据总结[J]. 护理学报, 2020, 27(12): 18 -22 .
[5] 刘小成, 应文娟, 刘智利, 郑锐华, 许诺, 刘慧. 生命末期患者性与亲密关系评估的最佳证据总结[J]. 护理学报, 2020, 27(12): 23 -27 .
[6] 林慧菁, 倪平. 932名武汉市民对生命维持治疗的态度现状及影响因素分析[J]. 护理学报, 2020, 27(12): 28 -32 .
[7] 朱一凡, 陈芷谦, 郭巧红, 苏娅丽. 196例乳腺癌化疗患者尊严现状及影响因素分析[J]. 护理学报, 2020, 27(12): 33 -37 .
[8] 潘国翠, 李梅. 决策疲劳量表的汉化及其应用于ICU患者家属的信度效度评价[J]. 护理学报, 2020, 27(12): 38 -41 .
[9] 贺芳, 温秀兰, 林艳, 刘会, 郭晓萍, 张喆. 新生儿重症监护病房噪音水平调查与对策[J]. 护理学报, 2020, 27(12): 42 -45 .
[10] 田凡立, 李惠玲, 杜美兰, 蒋芳琴, 张新梅, 殷雪群. 新型冠状病毒肺炎下援鄂男护士情绪体验的质性研究[J]. 护理学报, 2020, 27(12): 46 -49 .