提示: 手机请竖屏浏览!

压迫疗法预防腿部复发性蜂窝织炎
Compression Therapy to Prevent Recurrent Cellulitis of the Leg


Elizabeth Webb ... 其他 • 2020.08.13
相关阅读
• 压迫疗法预防腿部复发性蜂窝织炎

摘要


背景

腿部慢性水肿是发生蜂窝织炎的危险因素。目前推荐每天在腿部使用压力衣预防蜂窝织炎复发,但关于其效果的试验证据有限。

 

方法

在这项单中心、随机、非盲法试验中,我们以1∶1的比例将患腿部慢性水肿和复发性蜂窝织炎的参与者随机分组,两组分别接受腿部压迫疗法+蜂窝织炎预防策略相关教育(压迫组)或者仅接受教育(对照组)。本试验每6个月对患者进行一次随访,直至3年或直至本试验中发生45次蜂窝织炎发作。主要结局是蜂窝织炎复发。发生蜂窝织炎的对照组参与者跨组至压迫组。次要结局包括蜂窝织炎相关住院以及生活质量评估。

 

结果

共计183例患者接受了筛选,其中84例被纳入研究;41例参与者被分配至压迫组,43例被分配至对照组。本试验在发生23次蜂窝织炎发作后进行了计划的期中分析,当时压迫组6例参与者(15%)和对照组17例参与者(40%)已发生蜂窝织炎发作(风险比,0.23;95%置信区间[CI],0.09~0.59;P=0.002;相对危险度[事后分析],0.37;95% CI,0.16~0.84;P=0.02),本试验因压迫组效果良好而终止。压迫组3例参与者(7%)和对照组6例参与者(14%)因蜂窝织炎住院(风险比,0.38;95% CI,0.09~1.59)。两组的大多数生活质量结局无差异。本试验期间未发生不良事件。

 

结论

在患腿部慢性水肿和蜂窝织炎的患者中进行的这项小规模、单中心、非盲法试验表明,压迫疗法与保守疗法相比降低了蜂窝织炎的复发率(由澳大利亚Calvary Public Hospital Bruce资助;在澳大利亚新西兰临床试验注册系统[Australian and New Zealand Clinical Trials Registry]的注册号为ACTRN12617000412336)。





作者信息

Elizabeth Webb, M.P.H., Teresa Neeman, Ph.D., Francis J. Bowden, M.D., Jamie Gaida, Ph.D., Virginia Mumford, Ph.D., and Bernie Bissett, Ph.D.
From the Physiotherapy Department, Calvary Public Hospital Bruce, Bruce, ACT (E.W.), the Biological Data Science Institute, the Australian National University Joint Colleges of Science, Health, and Medicine (T.N.), and the Medical School (F.J.B.), Australian National University, the University of Canberra Research Institute for Sport and Exercise (J.G.), and the Discipline of Physiotherapy, Faculty of Health, University of Canberra (E.W., B.B.), Canberra, ACT, and the Australian Institute of Health Innovation, Macquarie University, Sydney (V.M.) — all in Australia. Address reprint requests to Ms. Webb at the Physiotherapy Department, Calvary Public Hospital Bruce, 5 Mary Potter Cct., Bruce, ACT 2617, Australia, or at elizabeth.webb@calvary-act.com.au.

 

参考文献

1.Levell NJ, Wingfield CG, Garioch JJ. Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care. Br J Dermatol 2011;164:1326-1328.

2. Cox NH, Colver GB, Paterson WD. Management and morbidity of cellulitis of the leg. J R Soc Med 1998;91:634-637.

3. Cox NH. Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg: a series with community follow-up. Br J Dermatol 2006;155:947-950.

4. Thomas KS, Crook AM, Nunn AJ, et al. Penicillin to prevent recurrent leg cellulitis. N Engl J Med 2013;368:1695-1703.

5. Dalal A, Eskin-Schwartz M, Mimouni D, et al. Interventions for the prevention of recurrent erysipelas and cellulitis. Cochrane Database Syst Rev 2017;6:CD009758-CD009758.

6. Thomas KS, Brindle R, Chalmers JR, et al. Identifying priority areas for research into the diagnosis, treatment and prevention of cellulitis (erysipelas): results of a James Lind Alliance 1. Priority Setting Partnership. Br J Dermatol 2017;177:541-543.

7. Mortimer PS, Levick JR. Chronic peripheral oedema: the critical role of the lymphatic system. Clin Med (Lond) 2004;4:448-453.

8. Moffatt C, Keeley V, Quere I. The concept of chronic edema — a neglected public health issue and an international response: the LIMPRINT study. Lymphat Res Biol 2019;17:121-126.

9. Inghammar M, Rasmussen M, Linder A. Recurrent erysipelas — risk factors and clinical presentation. BMC Infect Dis 2014;14:270-270.

10. Dupuy A, Benchikhi H, Roujeau JC, et al. Risk factors for erysipelas of the leg (cellulitis): case-control study. BMJ 1999;318:1591-1594.

11. Karppelin M, Siljander T, Vuopio-Varkila J, et al. Factors predisposing to acute and recurrent bacterial non-necrotizing cellulitis in hospitalized patients: a prospective case-control study. Clin Microbiol Infect 2010;16:729-734.

12. Moffatt C, Partsch H, Schuren J, et al. Compression therapy: a position document on compression bandaging. Frederiksberg, Denmark: International Lymphoedema Framework, 2012 (https://www.lympho.org/wp-content/uploads/2016/03/Compression-bandaging-final.pdf. opens in new tab).

13. Swartz MN. Cellulitis. N Engl J Med 2004;350:904-912.

14. Chlebicki MP, Oh CC. Recurrent cellulitis: risk factors, etiology, pathogenesis and treatment. Curr Infect Dis Rep 2014;16:422-422.

15. Lymphoedema Framework. Template for practice: compression hosiery in lymphoedema. London: MEP, 2006 (https://www.lympho.org/wp-content/uploads/2016/03/Compression_hosiery.pdf. opens in new tab).

16. O’Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev 2012;11:CD000265-CD000265.

17. Keeley V, Crooks S, Locke J, Veigas D, Riches K, Hilliam R. A quality of life measure for limb lymphoedema (LYMQOL). J Lymphoedema 2010;5:26-37.

18. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001;33:337-343.

19. Arsenault K, Rielly L, Wise H. Effects of complete decongestive therapy on the incidence rate of hospitalization for the management of recurrent cellulitis in adults with lymphedema. Rehabil Oncol 2011;29(3):14-20.

20. Ko DS, Lerner R, Klose G, Cosimi AB. Effective treatment of lymphedema of the extremities. Arch Surg 1998;133:452-458.

21. R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing, 2018.

22. Pavlotsky F, Amrani S, Trau H. Recurrent erysipelas: risk factors. J Dtsch Dermatol Ges 2004;2:89-95.

23. Chira S, Miller LG. Staphylococcus aureus is the most common identified cause of cellulitis: a systematic review. Epidemiol Infect 2010;138:313-317.

24. Australian Commission on Safety and Quality in Health Care. Antimicrobial stewardship in Australian health care 2018. Sydney: ACSQHC, 2018 (https://www.safetyandquality.gov.au/sites/default/files/migrated/AMSAH-Book-WEB-COMPLETE.pdf. opens in new tab).

25. Yasuhara H, Shigematsu H, Muto T. A study of the advantages of elastic stockings for leg lymphedema. Int Angiol 1996;15:272-277.

26. Pappas CJ, O’Donnell TF Jr. Long-term results of compression treatment for lymphedema. J Vasc Surg 1992;16:555-562.

27. Rathbun SW, Kirkpatrick AC. Treatment of chronic venous insufficiency. Curr Treat Options Cardiovasc Med 2007;9:115-126.

28. Nelson EA, Bell-Syer SE. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev 2014;9:CD002303-CD002303.

29. Elwell R. The management and treatment of hyperkeratosis. Br J Nurs 2017;26:468-470.

30. Rich A. How to care for uncomplicated skin and keep it free of complications. Br J Community Nurs 2007;12:S6-S9.

31. Miteva M, Romanelli P, Kirsner RS. Lipodermatosclerosis. Dermatol Ther 2010;23:375-388.

32. Al-Niaimi F, Cox N. Cellulitis and lymphoedema. J Lymphoedema 2009;4:38-42.

33. Stephens M, Liao S. Neutrophil-lymphatic interactions during acute and chronic disease. Cell Tissue Res 2018;371:599-606.

34. Liao S, Cheng G, Conner DA, et al. Impaired lymphatic contraction associated with immunosuppression. Proc Natl Acad Sci U S A 2011;108:18784-18789.

35. Ko LN, Garza-Mayers AC, St John J, et al. Effect of dermatology consultation on outcomes for patients with presumed cellulitis: a randomized clinical trial. JAMA Dermatol 2018;154:529-536.

服务条款 | 隐私政策 | 联系我们