| ObjectiveMeta-analysis of randomized controlled studies on the use of dressing drugs to prevent radiation dermatitis,to find the best dressing for prevention of radiation dermatitis among dressing drugs;the clinical randomized controlled trial was conducted to evaluate the efficacy of the best evidence-based Hydrofilm polyurethane film for the prevention of radiation dermatitis,so as to provide clinical practice basis for prophylactics of radiation dermatitis.MethodsBy searching Pub Med,Cochrane Library,EMbase,Web of Science,China Biology Medicine(CBM)database,Viper database,Wanfang database and China National Knowledge Infrastructure(CNKI)and other databases,Meta-analysis of randomized controlled studies on the use of dressing drugs to prevent radiation dermatitis was conducted to find the best dressing for the prevention of radiation dermatitis.The 84 tumor patients who received radiotherapy for the first time were randomly divided into a control group(42 cases)and an intervention group(42 cases).The control group was treated with Oak spray line protector which is commonly used in clinic,and the intervention group used the best evidence-based dressing Hydrofilm polyurethane film.During the whole course of radiotherapy,the skin of the irradiated field was evaluated according to the Radiation Therapy Oncology Group,and the clinical effect of the Hydrofilm polyurethane film in preventing radiation dermatitis was evaluated.Results(1)This study retrieved 2393 related documents,and finally included41 studies(16 pieces of Sanyrene,17 pieces of Mepilex dressing,4 pieces of Hydrofilm polyurethane film,2 pieces of 3M Cavilon Barrier Film,1piece of Collagen Dressing,1 piece of Chitosan Fiber Medical Dressing)that met the standard,with a total of 3432 patients.Among the included studies,58.5% of the studies described the method of random order generation;29.3% of the studies described the allocation hiding of the random scheme;No studies indicated that the study subjects and intervention implementers were blinded;12.2% of the studies indicated the outcome measurers were blinded;97.6% of the study outcome indicators were described completely.All studies did not show selective reporting of study results,and there were no other sources of bias.The overall quality of the included literature is moderate.(2)Because 3M Cavilon Barrier Film,Collagen Dressing and Chitosan Fiber Medical Dressing have few documents and are of average quality,this study only conducted a meta-analysis of the studies on the application of three dressings including Sanyrene,Mepilex dressing and Hydrofilm polyurethane film to prevent radiation dermatitis.The results show that:(1)In terms of preventing radiation dermatitis and reducing the overall incidence of radiation dermatitis,the preventive effect of Sanyrene[OR=0.20,95%CI(0.13,0.29),P<0.05],Mepilex dressing[OR=0.17,95%CI(0.05,0.61),P<0.05] and Hydrofilm polyurethane film[OR=0.15,95%CI(0.10,0.24),P<0.05] is better than other preventive drugs or nursing measures.The difference was statistically significant.(2)In terms of preventing the occurrence of grade I radiation dermatitis,the incidence of grade I radiation dermatitis in those who use Sanyrene[OR=2.16,95%CI(1.18,3.98)P<0.05] and Mepilex dressing[OR=4.55,95%CI(2.33,8.90),P<0.05] is higher than that of those who use other preventive drugs or nursing measures.The incidence of grade I radiation dermatitis in those who use Hydrofilm polyurethane film[OR=0.41,95%CI(0.18,0.94),P<0.05] is lower than those who use other preventive drugs or nursing measures,the difference is statistically significant.(3)In terms of preventing radiation dermatitis of grade II and above,and reducing the incidence of radiation dermatitis of grade II and above,the preventive effect of Sanyrene[OR=0.21,95%CI(0.16,0.27),P<0.05],Mepilex dressing[OR=0.12,95%CI(0.08,0.20),P<0.05] and Hydrofilm polyurethane film[OR=0.22,95%CI(0.13,0.38),P<0.05] is significantly better than other preventive drugs or nursing measures.The difference was statistically significant.(4)Sanyrene,Mepilex dressing and Hydrofilm polyurethane film have better preventive effects than other preventive drugs and nursing measures in preventing radiation dermatitis and reducing the incidence of radiation dermatitis.(3)The results of the Meta analysis of the three dressings showed that:the incidence of radiation dermatitis in patients who used Sanyrene,Mepilex dressing and Hydrofilm polyurethane film to prevent radiation dermatitis was 63.20%,51.09% and 41.32%,respectively;the incidence of grade I radiation dermatitis was 42.73%,49.27%,and 33.47%,respectively;and the incidence of grade II and above radiation dermatitis was 33.16%,24.05%,and 7.85%,respectively.Of the three dressings,patients with Hydrofilm polyurethane film had the lowest overall incidence of radiation dermatitis,the incidence of radiation dermatitis of grade I,and the incidence of radiation dermatitis of grade II and above.It can be concluded that the Hydrofilm polyurethane film is the best dressing for preventing radiation dermatitis among the three dressings.(4)A total of 55 patients(65.48%)in the control group and intervention group developed radiation dermatitis,of which 18 cases(42.86%)in the intervention group and 37 cases(88.10%)in the control group;the number of cases of grade I radiation dermatitis were 13 cases(30.95%)in the intervention group and 25 cases(59.52%)in the control group;the number of cases of radiation dermatitis of grade II and above were 5 cases(11.90%)in the intervention group and 12 cases(28.57%)in the control group;the differences were statistically significant(P<0.05).(5)In the first three weeks after the start of radiotherapy,the incidence of radiation dermatitis in the intervention group was not statistically different from that in the control group(P>0.05);in the fourth week,the number of new cases of radiation dermatitis in the intervention group was significantly less than in the control group,and the difference was statistically significant(P<0.05);the peak of radiation dermatitis in the control group was in the 4th week,and radiation dermatitis basically occurred by the 4th week;patients in the intervention group gradually developed radiation dermatitis in the 4-5th week.After the fourth week,the number of new cases of radiation dermatitis in the intervention group was more than that in the control group,and the difference was statistically significant(P<0.05).(6)Before and after the intervention,there was no significant difference in the local skin allergic reaction,blood routine,electrolytes,liver and kidney function indexes between the two groups of patients(P>0.05).Conclusion(1)Sanyrene,Mepilex dressing and Hydrofilm polyurethane film can better prevent the occurrence of radiation dermatitis,prevent the deterioration of radiation skin damage,and reduce the severity of radiation dermatitis than other preventive drugs and nursing measures.(2)Hydrofilm polyurethane film is better than Sanyrene and Mepilex dressing in preventing radiation dermatitis,and it is the best dressing in preventing radiation dermatitis among the three dressings.(3)Hydrofilm polyurethane films are more effective in preventing the occurrence of radiation dermatitis,reducing the damage degree of radiation dermatitis,and delaying the occurrence time of radiation dermatitis than Oak spray.It can be popularized and applied in clinical practice. |
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