2014年9月26日 星期五

優碘可促進傷口癒合(4)

游朝慶醫師

優碘粉的實證—動物及人體實驗

   最後來討論另一種優碘---cadexomer-iodine優碘粉(iodosorb),大多數對優碘粉的研究都是人體實驗,只有3篇是使用豬的研究,Mertz1於1994年發表使用感染MRSA(methicillin-resistant Staphylococcus aures)的豬的部分皮層(partial thickness)傷口(n=120),比較優碘粉cadexomer-iodine,cadexomer不含優碘的粉及沒有治療,結果發現,優碘粉可促進表皮位移(epidermal migration),並剪少細菌(MRSA)的量,於1999年Mertz2又重複類似的實驗,但這次只作對於MRSA的抗菌研究,結果還是優碘粉可有效對抗有抗藥性的MRSA細菌,Lamme3則是將優碘粉用在豬的全層皮膚(full thickness)傷口,和生理食鹽水做對照比較,結果表皮再生(epidermal regeneration)及上皮化(epitheliation)都明顯增加(p<0.05)。

   在人體實驗方面,就糖尿病足部傷口(diabetic foot ulcer)而言,Apelqvist4比較12個患者使用優碘粉,另12個患者接受標準治療(gentamicin solution, streptokinase or saline gauze),結果兩組差不多。

   就壓瘡(pressure ulcer)而言,Moberg比較16個患者使用優碘粉,18個患者使用標準治療(saline, enzyme-base or non-adhesive dressings),結果優碘粉可有效降低膿瘍、去除壞死組織及降低疼痛,並且能促進傷口癒合(8週後傷口各縮小76%及57%)。

   就靜脈性潰瘍(venous leg ulcer)而言,Danieslen6研究優碘粉在19個靜脈性潰瘍並綠膿桿菌感染的效果(此研究無對照組),所有患者並接受彈繃加壓治療,結果結果在第一週有65%培養不到細菌,12週時則有75%培養不出細菌,平均在12週時傷口縮小32.9%。Hansson比較優碘粉(n=56),人工皮(hydrocolloid dressing, n=48)及油性紗布(paraffin gauze,n=49),所有患者均有接受彈繃加壓治療,結果平均傷口面積各縮小62%,42%及24%。而最常被引用的是Skog8的研究,其將93個靜脈性潰瘍患者隨機使用優碘粉或其他標準治療(enzyme preparations, dextranomer, fucidic acid, typure pwder, polymix of silver nitrate),兩組都接受彈繃加壓治療,經過6個禮拜的治療,優碘粉組的傷口面積縮小34%,而對照阻止有縮小5%,且證明優碘組可有效殺菌。

   然而若都不使用彈繃加壓治療,Stewart9比較優碘粉(n=42)及保濕凝膠(intrasite gel,n=46),結果傷口癒合速兩者差不多,可見,在靜脈性潰瘍的治療,『彈繃加壓』是很重要的因素,而優碘粉能輔助加速彈繃加壓的作用

   接下來有7篇類似的研究,但都沒有說明有無使用彈繃加壓治療。其中有兩篇10,11認為優碘粉對傷口癒合無明顯改善,但另外7篇12-18則認為可有效幫助傷口癒合,降低細菌量及減少感染。

   總之,在慢性傷口方面沒有任何研究說優碘粉有害傷口癒合,相反地,大部分研究都認為優碘粉對慢性傷口是有幫助的,只不過在靜脈性潰瘍部分,建議還是需要搭配彈性繃帶(或彈性襪)加壓治療。

附註:本系列單元主題的架構主要來自於Angel, DE; Morey, P; Storer, J, The Great Debate over Iodine in Wound Care Continues: A Review of the Literature, Wound Practice & Research: Journal of the Australian Wound Management Association, Vol. 16, No. 1, Feb 2008: 6-21, http://www.awma.com.au/journal/1601_01.pdf

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