Y Hpc TP. H^ Chi M i n h * TUp 20 » So 5 * 2016 N g h i e n cmi Y hpc
N H A N XET HIEU QUA DIET KHUAN CUA D U N G DICH/KEM BETAINE 0,1% - POLYHEXANIDE 0,1% TRONG CHAM SOC VET THU'DNG M A N TINH TAI BENH
VIEN T R U N G VU'ONG
Pham Triiih Quoc Khanh*
TOM
TATMuc tiew Nhqn xet Hnh trqng nhiim khuah vet thucmg tru&c vd sau khi sie dung Aung dich/kem betaine 0,1% - polyhexanide 0,1%.
Boi tugmg vd phuang phdp nghien dac Md td hdng loqt ca; tieh hdnh ldm sqch mo hoqi tie (n&i co) vd cay dich viing mo viem loet mqn tinh; sie dung dung dich/kem betaine 0,1%- polyhexanide 0,1% (Prontosan) riea vei thuang vd thay bang ihuang quy, cmj Iqi dich vii thuang sau 4-7 ngdy sie dung dung dich tren.
Kei qua: dieu tri 30 binh nh&n (14 nii) gdm 18 ca loet bdn chan ddi thdo du&ng, 7 cavei thucmg c^ tinh chuyen mqn, 5 ca viem md ti'bdo. Kii qud cho thay binh nhan hodn todn khdng cdm thai/ dau hem khi dap hoac riea vii thiecmg bang Prontosan; Ichdng ghi nhqn truang hgp ndo bi kich ung da hoqc di ung. KB qud cay Idiudn tru&c khi su diing Prontosan: 6 tru&ng hgp cdy khudn Sm tinh; 24 tru&ng hap c^y khuan (+), bao gdm cdc chiing Staphylococcus epidermidis, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecalis, Proteus mirabilis, Escherichia coli Sau sie dung Prontosan 4-7 ngdy: 6/6 tru&ng hap cay khudn dm tinh truac dd cokB qud cay I&n 2 dm Hnh; chi cdn lai 5/24 tru&ng hap cay khuan (+) tru&c docokB qud cay Tan 2 f+J, cac vi khuan cm/ ducyc Id Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis. Cdc v&: thucmg co do xudi tin dich viea phdi; md hqt tie'n trim thu&n lai.
Kei ludm dung didi/kem betaine 0,1%- polyhexanide 0,1% hieu qud trong ngan ngiia ding nhu dieu tri nhiem khudn vei thucmg mqn tinh; qua do, giup cho tiin trinh lin md hqt dim Hm thudn lai.
TH khoa: dung djch/kem betaine 0,1%- polyhexanide 0,1%, vii thucmg mqn Hnh, cay khuan.
REMARKS ON BACTERICIDAL EFFECTS OF BETAINE 0.1% - POLYHEXANIDE SOLUTION/GEL IN CHRONIC WOUND CARE AT TRUNG VUONG HOSPTTAL
Pham Trinh Quoc Khanh * Y Hoe TP. Ho Chi Minh * Vol. 20 - No 5 - 2016:31 - 35 ABSTRACT
Objective: R£viewing the status of infectious wounds before and after using solution/gel betaine 0.1%- 0.1%) polyhexanide.
Methods: descripHve study; debridemmt (if any) and 1" culture of wound exudates; wound deansings and dressings with solution/gel betaine 0.1%- 0.1% polyhexanide (Prontosan), 2"^ culture ofivound exudates afier 4r7 days cf using that solution/gel.
Results: 30 paHents (14 womm) compose erf 18 dicdyetic fixit ulcers, 7 rdarded wounds, arui 5 cellulitis.
Results showed that paHmts do not completely feel the pain whm dressings with Prontosan; not any cases of skin irritaHon or allergic reactions. Results afV bacterial culture be/ore using Prontosan: 6 cases ofnegaHve resultat, 24 posiHve cases, including Staphylococcus epidermidis, Pseudomonas aeruginosa. Staphylococcus aureus, Enterococcus faecalis, Proteus mirabilis, Escherichia coll Afier 4-7 days of using Prontosan: 6/6 cases previously had 1^ negaHve cultures that had negaHve results of 2"^ cultures; there is only 5/24 cases having V posiHve results
* Khoa Bong- Tao hinh Th^m my, B§nh vi^n TnmgVuong
Tdc gid liin lac: TS.BS Ph^im Trjnh QuS'c Khanh DT: 0918 394 362 Email: [email protected]
Nghien cuu Y hpc Y Hpc TP. Hb Chi M i n h * T^p 20 * So 5 * 2016
that have 2"^ posiHve results: Staphylococcus aureus, Pseudomonas aeruginosa, and Enterococcus faecalis. The wound exudates are moderate, the development of granulation tissue is progressively fadlitated.
Conclusion: solution/gel betaine 0.1%- 0.1% polyhexanide has effects in prevenHng and treaHng chronic wound infections; thereby, the process ofgranulaHon Hssue is progressively fadlitated.
Key words: solution/gel betaine 0.1%> - 0.1% polyhexanide, chronic wounds, culture.
DAT VAN DE Doi ttrong nghien cthi
Vet thirong man tinh luon la thaeh thiie doi 30 benh nhan eo vet thuang man tinh moi voi cac bac si ngoai khoa va noi khoa*"'. Van ae
nhilm khuah trong vet thuong man tinh gop phan lam cham tien trinh lanh vet thuong'^'. Do do, mot hrong nhiing yeu to quan tcQng eua dieu tri vet thuang man tinh la phai loai bo yeu to nhiem khuMi t?i eho vet ttiuong. Theo cac nghien cim nuac ngoai, dimg dich/kem betaine 0,1% - polyhexanide 0,1% da dupe ghi nhan co kha nang phSn hiiy mang sinh hoe vi khuan va ngan can si;i: hinh thanh mang sinh hoe vi khuah tren vet thuong m?n tinh giiip cho qua trinh lanh vet thuong dien ti&i ttiu|n Ipit^JPK^). Tuy nhien, tai Viet Nam, kha nang di?t vi khuan khuan eiia dung dich/kem betaine 0,1%
polyhexanide 0,1% chira diroc nghien eiiu nhieu tai Viet Nam.
Tai Benh vien Tnmg Vuong trong hai nam qua, chiing toi ghi nhan hon 500 tnrong hgp CO vet thuang man tinh ciing nhu cac ton ttiuong hoai tii mo mem. Chlnh vi vay chiing toi tien hanh nghien a i u de tai: "Nh&n xet hiiu qud diet khudn ciia dung dich/kem betaine 0,1% - polyhexanide 0,1% trong cham soc vei thuang mqn tinh tqi binh vien Trung Vuang" nham giiip bac st eo them mpt chon lua cho dieu tri vet thuang man tinh eung nhu cac ton thuong hoai tli mo mem.
Muc tieu nghien cuu
Nhan xet tanh trang nhiem khuah vet thuong truoc va sau khi sis dung dung djeh/kem betaine 0,1% - polyhexanide 0,1%.
DdlTUONG-PHU'ONGPflAPNGHIENCUlJ Thiet ke nghien cuu:
Mo ta hang loat ea.
nhap vien ho|ic chuyen tir cac khoa khac deh khoa Bong - Tao hinh Tham my.
Tieu chuan dign b$nh:
Benh nhan eo vet thucmg man tmh +/- m6 hoai tli, chua duoe six dung dung dich/kem betaine 0,1% - polyhexanide 0,1% dieu trj truac do.
Tieu chuan loai trie
Benh nhan dj ung dung dich/kem betaine 0,1% - polyhexanide 0,1% hoac khong dong y tham gia nghien cihi.
Ky thuat thuc hien Trang thiei bj
Dimg eu thay bang thuang quy.
Dung cu eay khuan.
Dung dieh/kem betaine 0,1% - polyhexanide 0,1% do c6ng ty B.Braun san xuat vol ten ggi Prontosan, da dupe Hiep Hpi Thuoc va ThiK pham Hoa Ky cong nhan va dupe B6 Y te Vi^t Nam cho phep sii d i ^ g rOng rai.
Ciic hu6c tien hdnh
Chpn lp:a vet thuong phu hpp vci tieu chuan chpn b?nh.
Thuc hien danh gia lam sang, loai bo mo hoai hi va cay khuan, lay cae bieh so can tiiu thap.
Tiai hanh thay bang voi dung djch/kem betaine 0,1% - polyhexanide 0,1%: ghi nhan cac chi so va thuc hien cac xet nghiem theo cae bien so can thu thap.
Theo doi va ghi nhan eae bieh so trong then gian eham soc vet thuang va thue hien cay khuah sau 4-7 ngky sii dung Prontosan.
Y Hoc TP. Hb Chi M i n h * T^p 20 * Sb 5 * 2016 N g h i e n ciiu Y hpc
Cac bien so thu thap Tuoi, gioi, benh hen Phan loai vet thuang
Tinh trang nhiem khuan vet thuong truac stc dung dung dich/kem betaine 0,1%
polyhexanide 0,1%: cay dich vet thirong.
Ket qua tai chS sau dieu tri
+ Khao sat cam giac dau chii quan cua benh nhan khi su dung Prontosan.
+ Khao sat tinh trgng nhiem khuan sau dieu tri 4-7 ngay: dua vao ket qua cay dich vet thuang.
+ Khdo sat tinh trgng vet ttiucmg: xuat tiet, mui, mau sac.
+ Khao sat dac diem in6 hat.
KET QUA NGHIEN CUtJ- B A N LUAN D^c diem n h o m nghi€n cuu
30 benh nhan Tudi
Tuoi tnmg binh: 54,07 tuoi; tr^ nhafc 21 tuoi, eao tuoi nhat: 89 tuoi. Viet Nam Ik mpt nuoc dang phat trien, doi song nguoi dan ngay cang dupe nang cao, tuoi thp trung binh cung tang len keo ttieo mo hinh benh tat thay doi; kem theo do la cac b?nh ly 6 ngiroi 1cm tuoi: tang huyet ap, tieu duong..., cung nhu cac bi&i chiing ciia cac b$nh Iy tren: vet thuong mgn tinh. Nhom benh nhan nghien eiiu ciia chiing toi cung nam trong quy luat tren, phu hop voj nghien cuu ciia to chiic y te the gioi, ngoai nhimg veui de cua cae benh ly man tinh, tinh trang nhi&n khuan ciing ehiem ti le cao trong mo Wnh benh tat noi chung.
Gi&i
16 nain/14 nu. Nam va nii c h i ^ ti le tuong duong.
Ve loai vet thuang
Tmh hinh mac b?nh dai thao duong 6 Vi?t Nam da va dang co chieu huang gia tang nhanh chong 6 hau khap mpi mien a i a ea
nuac, dac biet la tai cac thanh pho Ion va khu cong nghiep. Theo To chiic Y te the gioi va Lien doan Dai thao duang, Vi?t Nam la mpt trong nhiing nuac eo ty le gia tang b$nh dai thao duong nhanh nhat the giai. Rat nhieu nguai benh va gia dinh eiing nhu eae ea sa y te dang phai chiu nhung ganh nang ve kinh te cho chi phi rat Ion trong dieu tri can b?nh nay. Tai Viet Nam, trong 10 nam qua, so benh nhan mac dai thao duong da tang den 211%
vai gan 5 trieu nguai mac va cii 10 ea thi co 6 ea dupe ehuah doan co bieh chiing. Ket qua nghien ciin ciia chiing toi cung phu hpp voi cac nhan dinh tren da so (18 vet thuang) vet thuang/b?nh nhan dai thao duang; ngoai ra, la 5 vet thuang cap tinh cham Uen, 7 truang hap viem mo te bao.
Mo hoai tii o be mat vet thuong man tinh la moi truong thugn loi cho vi khu&i phat trien'".
Mo hoai tii can dupe loai bo som de tiai trinh lanh vet thuong dien ra thugn lgi. Trong 16 nghien eiiu ciia chiing toi ghi nhgn dugc 9 vet thuong eo mo hogi tii can cat lam saeh truac khi sii dung Prontosan.
Ket qua danh gia
Cam gjac dau, kieh iing da, di iing: nhiing tieu chi can eo ciia dung dich/kem nia vet thuong la khong gay dau them cho benh nhan, khong gay kieh ring da, ciing nhu khong gay di ling cho benh nhan. Ket qua ghi nhan ciia chiing toi cho thay benh nhan hoan toan khong cam thay dau han khi dap hoac nia vet tiiuong b^ng Prontosan; chiing toi ciing khong ghi nhan tnrong hpp nao bi kich iing da hoae di iing;
dieu nay chiing to Prontosan an toan khi sii dung. Ket qua tren cimg phu hpp voi ghi nhan ciia Lenselink E..Andriessen A., day la chat thieh hpp tuyet hao cho mo, khong gay dpc te bao, khong kich iing, khong gay dauP>. Chi co hai ea di iing dupe bao cao; trong do, mpt ca chi dupe suy doan di iing polyhexanide dua tren benh sii don thuan, mpt ca dupe chan doan di ling voi polyhexanide thong qua viec viee xac dinh chat trung gian chuy&i hoa viem IgE;
33
N g h i e n c u u Y hpc Y Hpc TP. H b Chi M i n h * Tgp 20 * So 5 * 2016
trong khi do, di iing voi cac chat sat khu&i khac dupe biet ro qua viec xae dinh chat trung gian chuyoi hoa viem IgE<*'. Chua co mot nghien a i u nao ve yeii to quyet dinh di iing cua polyhexanide dupe tiipc hien<^'>.
Cay k h u a n
Tru6c khi sie dung Prontosan
6 tnrcmg hpp cay khuan am tinh. 24 truong hpp cay khuah (+), bao gom cac chiing Staphylococcus epidermidis, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecalis, Proteus mirabilis, Escherichia coli. Trong
qua trinh Hen v^t thuong, nhiem khuan la biai ehiing n|ng va hay ggp, lam cham qua trinh lien vet thuong; nguon nhiem khuan eo the xuat phat tCf moi trucmg xung quanh hoac tai cho ton thucmg; cac npi dpc to, ngoai d^c to va cac men do vi khuah tiet ra 6 ton thirong eo anh hirong tgi cho va toan thSn^J. Ve chung logi vi khuan, theo Christian Echinard, Jacques Latarjet (1995), cac vi khuah tiiucmg gap ttiupc nhom Gram {+) la Staphylococcus epidermidis vk Streptococcus nhom D; cae vi khuSui thuoc nhom Gram (-) thuong ggp la Pseudomonas aeruginosa, Enterobacteries va Adnetobader. Theo Charles Marks (1997), tac nhan ehii yeii dan d a i nhiem triing tai cho vet thuang va nhiem trimg toan than la Pseudomonas aeruginosa va Staphylococcus aureus. Theo Anturson M.G. (2002), cac chung vi khuan thucmg gap trong bong la Staphybcoccus aureus, cac loai thupe chiing Streptococcus, Pseudomonas aeruginosa. Theo Cynthia Villarreal va cpng su (2002), o tiiap ky 1990-1999, tac nhan Gram (+) chiem ti le vupt trpi trong nhiem trung vet thuong, eae chiing Enterococd chion vi tri khiem ton hon, Psmdomonas aeruginosa cung chion ti 1^ cao trong thoi gian nay; theo lipslty B.A. vk epng svc (2012), vet ttiuong cap tinh thuong ton tgi vi khuan thuang tni 6 da, nhu hi cSu va cac true trung. 6 vSt tiiuang man tinh voi moi truong dgc biet thuong co so lupng Cling nhu cac ehung vi khuan nhieu hom 6 vet tiiuang cap tfnh. Vet thuong man tinh co lien
quan d o i vi khuan ky khi va nhieu chung vi khuan eung liic tren vet thuang'^. Ket qua nghien ciin eua ehiing t6i eiing ghi nhan cae ehiing vi khuan nhu cac tac giei tren da neu.
Sau khi svc di^ng Prontosan
6 tnrong hpp cay khuan am tinh truoc do Cling CO ket qua eay lan 2 am tinh (sau 4-7 ngay sii dung Prontosan). Vai 24 truang hpp cay khu&i (+), chi eon lai 5 tru6ng hpp eay khuan (+), eae vi khuan cay dupe la Staphylotxccus aureus, Psmdomonas aeruginosa, Enterococcus faecalis. Ket qua ciia chiing toi phii hpp voi nhan djnh a i a Minnieh K.E., dung dich/kem betaine 0,1% - polyhexanide 0,1% dupe su dung r$ng rai nhu la mot tac nhan lam sgch trong dfeu tn tgi cho vet thuong man tinh. Tren Ihuc nghidm, eae nghien ciiu da chiing to dung dich va kem voi nbng dp tren eo tac dung khang khuan hi^
qua, chiing eo hi?u qua Iam giam su tang truong tren eae ehiing vi khuah . brasiliensis, Staphylococcus
Pseudomonas aeruginosa, SerraHa marcescens, Candida albicans. Staphylococcus aureus, vancomycin-resistant Enterococcus fiteadis, Protms mirabilis, Escherichia coli, methidUin- resistant Staphylococcus aureus, Adnetobader baumannii, Enterobader cloacae, va Enterobader faecalis'^^•''•'^°\ Theo Bjamsholt T. mang sinh hpc vi khuan Iam cham tioi tiinh lanh vet thuongP*; co nhieu nghien ciiu nuoc ngoai cho thay Prontosan co kha nang phan huy va phong ngira hinh thanh mang sinh hpc vi khu&i tren vet thirong, dac biet la vet thuong man tinh;
polyhexanide la chat khang khuah dupe sit dung rpng rai trong thue is nhu dung dich tiia kinh ap trong, bang vet thuang, lam sgch ho va six dung trong tham my.
Tinh trq.ng xuSit titt tt^i vei thuang Cae vet thuong trong 16 nghien cihi cua chiing toi co d6 xuat tiet djch viia phai. Tinh brang xuat tiet tai vet ttiuong la mot trong nhung yeii tb anh huong d o i hieu qu^ cua Prontosan. Theo Kapalsehinski N. va eong su,
Y Hpc TP. Hb C h i M i n h * T | p 20 * Sb 5 * 2016
Nghien cihi Y hpc
nbng dp albumin tai vet thuong anh huong tai hieu luc khang khuah ciia dung djch/kem betaine 0,1%) - polyhexanide 0,1%; nhiing vet thuang xuat ti^t nhieu vai nbng dp albumin eao nen dupe lam giam tiet djch de tang hieu qua khang khu&i eiia chat trent^). Voi ket qua tren, ehiing toi nhgn thay co tiie do tinh trang xuat tiet viia ph^i b cac vet thuong trong 16 nghien ciiu gjiip cho ti le nhiem khuah giam ro ret sau khi sii dung Prontosan. De c6 nhan dinh chinh xac chiing t6i can thirc hien nhiing nghien a i u sau hon.
Dac diem md hat
Cac vet thuong trong 16 nghien ciiu deu co ti^ trioi thuan Ipi, cac vet thucmg deu tu lien tot hoae eo ket qua manh da ghep, vat da song tbt. Ket qua nay phii hpp voi nhgn dinh ciia Kevin E. Minnieh, polyhexanide la mpt ehpn lua trong dieu tri vet thuang man tinh va v^t thuang bong do dung dich tren khong lam cham tioi trinh lanh vet ttiuemg't.
KETLUAJSf
Viec sir dung dung dich/kem betaine 0,1% - polyhexanide 0,1% tren vet thuong man tinh giiip ngan ngua nhiem khuan mpt each hieu qua va cting hieu qua trong dieu tri cae truong hpp nhiem trimg, giiip cho tien trinh hinh thanh mo hat Cling nhu bieu mo hoa dien tioi mpt each thuan loi.
TAI LIEU THAM KHAO
1 Baranoski S, AyeUo EA, Langemo DK P012). Wound Assessment Wound Care Essentials, lippincott Williams &
Wilkins. Six Edition, pp. 101-125.
2 Bjamsholt T (2013). The role of bacterial biofllms in chronic infections APMISSupplementum,V.l%,pp 1-51.
3 Gardner SE, Frantz RA (2012). Wound Biobuiden and Infection. Wound Cart Essentials, Lippincott Williams &
Wilkins. Six Edition, pp, 126-156.
4 Gilliver S (2009), PHMB: a well-tolerated antiseptic with no reported toxic effects. /. Wound Care, V. Activa Health Supplement p p . 9-14.
5 Kapalsehinski N , Seipp HM, Onderdonk AB, Goertz O, Daigeler A, Lahmer A, Lehnhardt M, Hitsch T (2013).
Albumm reduces the antibacterial activity of polyhexanide- biguanide-based antiseptics against Staphylococcus aureus and MESA Bums, V, 39, pp.1221-1225.
6. tCautz O, Schumann H, E)egeibeck F, Venemalm L, Jakob T (2010). Severe anaphylaxis to the antiseptic polyhexanide.
Allergy. V, 65(8), pp. 1068-1070.
7 Lenselink EAndriessen A (20H). A cohort study on die efGcacy of a pwlyhexanide-conlaining biocellulose dressing in the treabnent of biofilms in wounds. /. Wound Care, V. 20(11), pp. 536-539.
8 Upsky BA, Embil JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E (2012). 2012 Mectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot bifections. Oxfiird Journal of Clinical Infectious Diseases, V.S4(12), pp.132-173
9 Minnieh KE. Stolarick R. Wilkins RG. Chilson G, Prilt SL.
Unverdorben M (20121 The effect of a Wound Care Solution containing Polyhexanide and Betaine on Bacterial Counts:
Results of an in vitro Study. Ostomy Wound Manage, V. 58(101.
pp. 32-36
10. ValenzuelaAK,PeruchoNSp008).lheEfifectivenesso£a0,l%
polyhexanide gel. Revisla de Enjermena, V. 31(4), p p . 7-12.
Ngdy nhdn bdi bdo: 08/8/2016 Ngay phdn biin nhqn xet hdi bdo: 12/8/2016 Ngay bM bdo dugc c&ng: 10/10/2016
