| Objective To analyze the effectiveness of different types of dressings for the prevention of pressure injuries(PIs),and the dressing types with good cost performance were selected by Network Meta-analysis,and corresponding clinical trials were conducted to investigate the differences in the preventive performance of different dressings in practice and to provide reference for clinical nursing staff in selecting dressings for the prevention of PIs.Methods(1)Network Meta-analysis of the effectiveness of different dressing prophylaxis PIs: Randomized Controlled Trials(RCTs)of different types of dressing prophylaxis PIs published up to 1 January 2022 were obtained by searching Chinese and English databases,screened according to inclusion and exclusion criteria,and evaluated the quality of the included RCTs by using the Cochrane Risk of Bias Assessment tool,and the different types of dressings were analyzed and ranked using R studio software and Stata 16.0 software.The main outcome included: total incidence of PIs,incidence of stage I PIs,incidence of both stage I and II PIs,and pain.The top three dressings with better effects were selected for clinical trials;(2)Clinical trials and direct cost evaluation of three different types of dressings for the prevention of PIs: 330 patients hospitalized after general surgery at the Second Hospital of Lanzhou University from February 2022 to January 2023 were selected and divided into three groups according to the patients preference: 110 patients in test group A(liquid dressing group),127 patients in test group B(foam dressing group)127,and 113 patients in test group C(hydrocolloid dressing group).The incidence of PIs,time of PIs occurrence,pain and cost were recorded and assessed in a 7-day observation period when the three dressings were used in the clinic.Results(1)Network Meta-analysis of the effectiveness of different dressings for PIs prevention: 35 RCTs of different dressings for the prevention of PIs were included.13 dressings were involved: sterile gauze,petrolatum gauze,hydrocolloid dressing,foam dressing,band-aid,gel dressing,transparent dressing,silver ionomer dressing,sponge pad,adhesive tape,oil-based dressing,film dressing and liquid dressing.All RCTs had risk of bias in some aspects.The results for the prevention of total PIs were ranked from best to worst: liquid dressing > foam dressing > oil-based dressing >hydrocolloid dressing > film dressing > transparent dressing > petrolatum gauze material > sponge pad > sterile gauze > adhesive tape;22 RCTs reported the incidence of stage I PIs and the results for the prevention of stage I PIs were ranked from best to worst: foam dressing > hydrocolloid dressing > transparent dressing >sterile gauze > adhesive tape > sponge pad;24 RCTs reported on the incidence of stage I and II PIs,and were ranked from best to worst for the prevention of stage I and II PIs: foam dressing > hydrocolloid dressing > transparent dressing > sterile gauze >petrolatum gauze > sponge pad > adhesive tape;a total of 4 RCTs reported on pain,with dressings producing pain in descending order: sterile gauze > sponge pad >hydrocolloid dressing > foam dressing.(2)Clinical trials and cost effectiveness analyses were performed on liquid dressing,foam dressing,and hydrocolloid dressing.In terms of preventive effect,the liquid dressing was less effective,the foam dress ing and hydrocolloid dressing were similarly effective;in terms of pain,the liquid dressing was the least painful,followed by the hydrocolloid dressing and the foam dressing produced the most significant pain;in terms of cost comparison,foam dressing was the costliest,with liquid and hydrocolloid dressing were similarly costly.Cost-effectiveness analysis showed that hydrocolloid dressings had the smallest C/E values,followed by liquid dressings and foam dressings had the highest C/E values.Conclusions:(1)Network Meta-analysis showed that liquid dressings were the most effective in preventing the total incidence of PIs,foam dressings and hydrocolloid dressings were more effective in preventing stage I and II PIs;foam dressings were less effective than hydrocolloid dressings in terms of pain produced;(2)Clinical trial results showed that liquid dressings were less effective in preventing PIs and foam dressings were basically similar to hydrocolloid dressings;the liquid dressing is the least painful,and the hydrocolloid dressing is significantly better than the foam dressing;(3)Cost-effectiveness analysis showed that hydrocolloid dressings were the most cost-effective and had a recommendation. |
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