Publication: Cerrahi yara bakımında kullanılan iki farklı solüsyonun iyileşme sürecine etkileri
Abstract
CERRAHİ YARA BAKIMINDA KULLANILAN İKİ FARKLI SOLÜSYONUN İYİLEŞME SÜRECİNE ETKİLERİ ÖZET Deri bütünlüğünün bozulmuş olduğu cerrahi yaraların bakımında antiseptik kullanımı, J. Lister' e kadar uzanmaktadır. J. Lister (1865), yaralara havadan ve çevreden bulaşabilecek mikroorganizmalara karşı fenol' ü kullanmıştır. Günümüzde de halen aynı amaçla postoperatif yara bakımında çeşitli antiseptik solüsyonlar kullanılmaktadır. Ancak kullanılan bu solüsyonların seçici davranamamaları nedeni ile stostatik etkilerini mikroorganizmaların yanında, iyileşmede anahtar hücre olan fagositler ve fibroblastlar üzerinde de gösterdikleri, yeni oluşmakta olan granülasyon dokusu ve epitelizasyon üzerinde irritan ve toksik etki yaparak iyileşmeyi geciktirdikleri bilinmektedir. Buna karşın, steril koşullarda oluşturulan cerrahi yaraların bakımında %09' luk serum fizyolojik kullanımının, bölgeyi nemli tutarak granülasyon dokusunun oluşumunu ve epitel hücre göçünü, dolayısıyla da yara iyileşme sürecini, hızlandıracağı düşünülmktedir. Araştırma, cerrahi yara bakımında yaygın olarak kullanılan %10' luk povidon iyot ile %09' luk serum fizyolojik solüsyonlarının iyileşme sürecine etkilerini incelemek amacıyla deneysel olarak planlanmıştır. Araştırma evrenini, Kocaeli ilinde bulunan 42 cerrahi yatak kapasiteli İzmit Devlet Hastanesi ve 45 cerrahi yatak kapasiteli Kocaeli Sosyal Sigortalar Kurumu (SSK) Hastanesi cerrahi klinikleri oluşturmuştur. Örneklem grubuna 20 Nisan-16 Aralık 1998 tarihleri arasında elektif abdominal cerrahi girişim geçiren, araştırmaya katılmayı kabul eden, 18-65 yaş arasında 36 hasta alınmıştır. Araştırmaya alınan hastaların bir grubunun yara bakımında %10' luk povidon iyot solüsyonu, diğer grubunda ise, %09' luk serum fizyolojik solüsyonu kullanılmıştır. Araştırmada veriler, bireysel özellikleri içeren Hasta Tanılama Formu ile preoperatif ve postoperatif döneme ait verileri ve yara izlemini içeren İzlem Formu kullanılarak araştırmacı tarafından toplanmıştır. Örneklemi oluşturan hastalar ile cerrahi girişimden bir gün önce görüşülerek araştırmanın amacı açıklanmış ve aydınlatılmış onamları alınmıştır. Yara bakımı ve izlenmesine cerrahi girişimden 24 saat sonra başlanmış ve yedi gün süresince günde bir kez belirlenen solüsyon ile bakım sürdürülmüş ve veriler günlük olarak kayıt edilmiştir. Araştırma sonucunda, yara bakımında %10' luk povidon iyot kullanılan birinci grupta, dördüncü gün inflamasyon aşamasının halen devam ettiği, epitelizasyon, kollajen ve anjiogenezis oluşumunun geciktiği buna karşın yara bakımında %09' luk serum fizyolojik kullanılan ikinci grupta ise, epitelizasyon gelişiminin daha kısa sürede tamamlandığı, kollajen ve angiogenezis oluşumunun istenilen şekilde ilerlediği saptanmıştır. İki grup arasında, yara iyileşme aşamalarına ilişkin bulgular yönünden anlamlı fark olduğu belirlenmiştir. Sonuç olarak %10' luk povidon iyot solüsyonunun, iyileşme sürecini geciktirdiği; %09'luk serum fizyolojik solüsyonunun ise, olumlu etki yaptığı ve enfeksiyon olmadığı sürece yara bakımında kullanımının uygun olacağı düşünülmüştür. EFFECTS OF TWO DIFFERENT SOLUTIONS USED FOR SURGICAL WOUND CARE ON HEALING PROCESS
Usage of antiseptics for care of surgical wounds where skin tissue is distorted is orginated from J. Lister (1865). J. Lister has used fenol against microorganisms that may contaminate the wounds via air and environment. Today, for the same purpose, various antiseptic solutions are used for postoperative wound care. Due to fact of that the solutions used can not behave selective, it is known however, that they show their stostatic effects on fagocites and fibroplasts which are key cells for healing along with on microorganisms and that they retarded healing by making irritant and toxic effect on new forming granulation tissue and epitelization. On the other hand, it is considered that for care of surgical wounds under sterile conditions the use of serum physiologic in proportion of 09 % will accelerate granulation tissue formation keeping the environment humid and ephitel cell migration and thus wound healing process. This research has experimentally been planned purposing to examine the effect of solution composed of a 10 % povidon iode plus 09 % serum physiologic mixture which is commonly used for wound care on healing process. Research environment was comprised of İzmit State Hospital with 42 surgical bed in Kocaeli Province and Kocaeli Socila Security Hospital with 45 surgical bed capacity. In the sampling group, 36 patients with 18 to 65 ages who have undergone to elective abdominal surgical operation and have accepted to attend the research have been included. For wound care of some patients,povidon iode solution of 10 % has been used and for an other group serum physiologic solution of 09 %. The research data has been gathered by researcher who has used Patient Diagnostic Form that includes individual characteristics and Monitoring Form that includes preoperative and postoperative phases and wound control. With the patients attending in the sampling a discussion has been made one day before operative application and the purpose of research has been explained and their approval has been received. Wound care and monitoring has been started 24 hours following surgical attempt and during seven days care is continued with a solution renewed once a day and daily records have been maintened. As a result of the research, it has been found out that for the first group in which povidon iode of 10 % is used for wound care, inflamation phase still remains in the fourth day and ephitelization, collagen and angiogenesis formation is retarted, but contrarily for the second group in which serum physiologic of 09 % is used for wound care, ephitelization formation has been completed in a shorter time and collagen and angiogenesis formation has made advance as appropriate. It is noted that there are no distinctive differents between two groups with regard to data for wound healing phase. Consequently, it is considered that povidon iode solution of 10 % has retarded the healing process and that serum physiologic solution of 09 % has made positive effect and that it can be used for wound care unless any infection occured.
Usage of antiseptics for care of surgical wounds where skin tissue is distorted is orginated from J. Lister (1865). J. Lister has used fenol against microorganisms that may contaminate the wounds via air and environment. Today, for the same purpose, various antiseptic solutions are used for postoperative wound care. Due to fact of that the solutions used can not behave selective, it is known however, that they show their stostatic effects on fagocites and fibroplasts which are key cells for healing along with on microorganisms and that they retarded healing by making irritant and toxic effect on new forming granulation tissue and epitelization. On the other hand, it is considered that for care of surgical wounds under sterile conditions the use of serum physiologic in proportion of 09 % will accelerate granulation tissue formation keeping the environment humid and ephitel cell migration and thus wound healing process. This research has experimentally been planned purposing to examine the effect of solution composed of a 10 % povidon iode plus 09 % serum physiologic mixture which is commonly used for wound care on healing process. Research environment was comprised of İzmit State Hospital with 42 surgical bed in Kocaeli Province and Kocaeli Socila Security Hospital with 45 surgical bed capacity. In the sampling group, 36 patients with 18 to 65 ages who have undergone to elective abdominal surgical operation and have accepted to attend the research have been included. For wound care of some patients,povidon iode solution of 10 % has been used and for an other group serum physiologic solution of 09 %. The research data has been gathered by researcher who has used Patient Diagnostic Form that includes individual characteristics and Monitoring Form that includes preoperative and postoperative phases and wound control. With the patients attending in the sampling a discussion has been made one day before operative application and the purpose of research has been explained and their approval has been received. Wound care and monitoring has been started 24 hours following surgical attempt and during seven days care is continued with a solution renewed once a day and daily records have been maintened. As a result of the research, it has been found out that for the first group in which povidon iode of 10 % is used for wound care, inflamation phase still remains in the fourth day and ephitelization, collagen and angiogenesis formation is retarted, but contrarily for the second group in which serum physiologic of 09 % is used for wound care, ephitelization formation has been completed in a shorter time and collagen and angiogenesis formation has made advance as appropriate. It is noted that there are no distinctive differents between two groups with regard to data for wound healing phase. Consequently, it is considered that povidon iode solution of 10 % has retarded the healing process and that serum physiologic solution of 09 % has made positive effect and that it can be used for wound care unless any infection occured.