[Treatment of bedsores--combination of therapies depended the experimental design method].
The treatment of bedsores is a particular problem in geriatric medicine. We selected standard drugs that may be effective for the decubitus ulcer, and investigated combination therapy to develop efficient treatment The subjects were 16 patients in whom the grade of the bedsore was evaluated as II to IV according to the Shea's depth classification. Treatment was performed while all patients were on air mats. We selected drugs and treatment methods based on the previously established experimental design of Taguchi. Based on this, we created and adapted 16 different component combination treatment programs in accordance with the L16 rectangular cross table. The following component factors were adopted: A: types of covering substances on the wound surface (Elase ointment, isodine sugar, isodine gel solcoseryl ointment); B: Isalopan powder; C: Spray of 10 ml physiological saline containing 500 microg of prostaglandin (concentration 0.005%); D: daily number of treatments; and F: presence or absence of tapping. We serially measured the wound surface area as an index of the speed of wound healing, and measured the interval (day) until the area decreased to one half of the original size (T1/2, half life). We analyzed data on one combination treatment each in 16 patients. Analysis of variance of the above factors showed significant F values for factors A, B, D and F. The contribution rates for factors A, B, D and F were 37.84%, 8.47%, 14.98% and 13.81%, respectively. The error term (e) was 16.37%. Optimal results were seen in the groups in which solcoseryl ointment had been applied twice a day. In this study, prostaglandin, which had been anticipated to be effective, did not show any effects. The error term (e) suggests the presence of other healing factors including individual differences. Concerning this point, it well be necessary to examine a larger number of patients in the future. With ointment treatment alone, without using an air mat, it was confirmed that bedsore area reduction was extremely unstable. Decompression of the affected part may be a basic prevention factor and essential treatment of bedsores.
Miyaji
Hiroko
H
Department of Geriatric Medicine, Tokyo Medical University.
Sakurai
Hirofumi
H
Kikawada
Masayuki
M
Yamaguchi
Katsuhiko
K
Kimura
Akihiro
A
Fujiwara
Takayuki
T
Imada
Nobuo
N
Imai
Mihoko
M
Iwamoto
Toshihiko
T
Takasaki
Masaru
M
D000183:Actihaemyl / Q000008:administration & dosage; D000368:Aged; D001513:Beds / Q000592:standards; D003851:Deoxyribonucleases / Q000008:administration & dosage; D004338:Drug Combinations; D005341:Fibrinolysin / Q000008:administration & dosage; D005782:Gels; D006801:Humans; D009823:Ointment Bases; D009824:Ointments / Q000627:therapeutic use; D011206:Povidone-Iodine / Q000008:administration & dosage*; D011208:Powders; D003668:Pressure Ulcer / Q000188:drug therapy* / Q000473:pathology; D011453:Prostaglandins / Q000008:administration & dosage; D012107:Research Design; D014945:Wound Healing / Q000187:drug effects*
D004338:Drug Combinations; D005782:Gels; D009823:Ointment Bases; D009824:Ointments; D011208:Powders; D011453:Prostaglandins; C021490:deoxyribonuclease, plasmin drug combination; D000183:Actihaemyl; D011206:Povidone-Iodine; D003851:Deoxyribonucleases; D005341:Fibrinolysin