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Database of Abstracts of Reviews of Effects (DARE)

Produced by the Centre for Reviews and Dissemination
Copyright 2014 University of York



CC DN XUT CA ACID HYALURONIC V TC DNG I VI VT BNG, VT THNG BIU
M DO PHU THUT, VT THNG MN TNH
BI PHN TCH TNG QUT CC TH NGHIM LM SNG NGU NHIN C KIM CHNG
Voigt J, Driver VR


Tm tt ca CRD
Bi phn tch cho thy cc dn xut ca acid hyaluronic c lin quan n ci thin vic lm lnh vt thng so
vi cc phng php chm sc thng c s dng i vi cc vt thng mn tnh, c bit l cc vt bng
v mt vi loi vt lot (ulcer).

Mc tiu nghin cu
xc nh hiu qu ca acid hyaluronic v cc dn xut ca acid ny i vi vic lm lnh vt bng, vt
thng biu m do phu thut v cc vt thng mn tnh so vi cc phng php tr liu khc hoc gi dc.

La chn bnh cho nghin cu
Tiu chun la chn bnh cho cc th nghim lm sng ngu nhin c kim chng nh gi hiu qu lm
lnh vt thng ca acid hyaluronic bao gm: cc bnh nhn b lot bn chn n su ti xng do i tho
ng (theo phn 4 ca Wagner), lot chi di do i tho ng v bnh v thn kinh, cc vt lot tnh
mch chn, bng mt phn hoc bng su din rng, phu thut loi b lp biu m ca da. Cc th nghim
lm sng ph hp phi c nh ga theo tiu ch chnh l lm lnh vt thng hon ton (vt thng c
bao bc hon ton bng lp biu m m khng c bt k biu hin nhim khun no) v tiu ch ph l thu
nh din tch b mt ca vt thng.
Bnh nhn trong nghin cu bao gm c nhng bnh nhn c vt bng da b mt hoc bng da su, cc vt
thng ngoi da do xa hnh xm, lot chn, lot bn chn do i tho ng, lot tnh mch v mch mu,
lot chn do cc bnh v thn kinh. Sn phm c cha acid hyaluronic trong nghin cu l: dng acid
hyaluronic c thm trong mng lt tr (inert pads), acid hyaluronic dng gel hoc kem, mng lt hoc cht
kt dnh thnh phn hon ton l acid hyaluronic v mng thm acid hyaluronic trong cy ghp m t thn.
Cc loi cht i chng so snh l gi dc, gc paraffin, tr liu chun, gel tr v bc sulphadiazin.

nh gi cht lng ca nghin cu
Cht lng phng php lun ca bi nghin cu c nh gi bi 2 ngi nh gi da theo cng c phn
tch ri ro Cochrance Collaboration, lin quan n s pht sinh trnh t ngu nhin, s che giu cch phn b
nghin cu, cch x l d liu th, s chn lc kt qu bo co v cc ri ro khc.

Trch xut d liu
D liu c trch xut tnh ton t l ri ro ca cc kt qu lng phn (dichotomous) v sai phn trung
bnh v tng ng khong tin cy 95% (CIs). Mt ngi nh gi s thc hin vic trch xut d liu v c
kim tra li bi ngi th hai.

Phng php phn tch
T l ri ro gp chung, sai phn trung bnh trng khi (WMD) v khong tin cy 95% c tnh ton nh
gi, bng vic dng c hai m hnh tc ng c nh v tc ng ngu nhin. Tnh khng ng nht trong
2

Database of Abstracts of Reviews of Effects (DARE)
Produced by the Centre for Reviews and Dissemination
Copyright 2014 University of York
thng k c nh gi qua test I
2
. Vi I
2
ln hn 60% vi bt k kt qu no, vic phn tch mc nhy c
thc hin kim tra ngun pht sinh khng ng nht.

Kt qu ca bi phn tch
Mi th nghim lm sng (599 bnh nhn, mi th nghim t 10 - 110 bnh nhn) c a vo bi phn
tch tng hp. th biu hin kt qu ca vic nh gi cht lng cho thy rng s ngu nhin ha v m
i (blinding) ca ngi tham gia nghin cu v ngi lm nghin cu c bo co mt cch tng thch
trong mt na cc nghin cu lm sng v vic sp xp thit k m c bo co trong hai th nghim lm
sng, m n ca ngi nh gi kt qu c bo co trong mt th nghim. Tt c cc th nghim lm sng
u c bo co cc d liu cha tham gia hon thnh nghin cu.
Lot chn (hai th nghim lm sng): Mt th nghim cho thy phn trm thu nh din tch b mt ca vt
thng tng ln ng k khi s dng dng acid hyaluronic thm trong mng lt tr trong vng t 3 n 8 tun
so vi chm sc chun. Trong mt th nghim khc, thi gian cy ghp da gim ng k khi mt bn ca vt
thng s dng mng c acid hyaluronic so vi mt bn khc ca vt thng ch s dng mt dng gel.
Vt bng (ba th nghim): Mt th nghim cho thy vt bng c cha lnh nhanh hn thy r khi s dng
kem c acid hyaluronic so vi s dng gi dc. Trong mt th nghim tr liu bng bc x, vt bng lnh
nhanh hn khi s dng kem cha acid hyaluronic so vi gi dc. Mt th nghim th ba cho thy vt bng s
lnh nhanh hn khi s dng kem cha acid hyaluronic phi hp vi bc sulphadiazin so vi s dng bc
sulphadiazin n thun.
Lot mu bn chn v lng bn chn do i tho ng: Mt nghin cu v vt lot chn phn 1-2 theo
Wagner cho thy mng lt c acid hyaluronic kt hp vi t bo keratin ghp t thn lm lnh vt lot mu
bn chn nhanh hn cc cch chm sc thng thng l dng gc paraffin (p=0,049) nhng khng c s khc
bit c ghi nhn gia cc nhm v vic lm lnh hon ton vt lot c mu bn chn v lng bn chn sau
11 tun s dng. Mt nghin cu th hai vi cng bin php can thip v so snh nhn thy c s thu hp 50%
din tch vt lot t c nhanh hn nhm s dng acid hyaluronic so vi nhm s dng gc paraffin
(40 ngy so vi 50 ngy, p=0,018) v vt lot mu bn chn lnh nhanh hn ng k nhm c tr liu
(p=0,047). Phn tch tng hp kho st tt c vt lot chn v mu bn chn t hai nghin cu v nhn ra
rng khng c s khc bit gia nhm s dng acid hyaluronic v nhm s dng gc paraffin trong vic lm
lnh vt thng.
Lot chn do bnh v thn kinh: Cc dn xut ca acid hyaluronic c tc ng ng k i vi vic lm lnh
vt lot trong vng 12 tun so vi cch chm sc thng thng.
Xa hnh xm: Mt th nghim kim chng tc ng i vi vic lm lnh vt thng do xa hnh xm ca
acid hyaluronic cho thy khng c s khc bit v t l lm lnh vt thng hai nhm.

Kt lun ca tc gi
Cc dn xut ca acid hyaluronic c lin quan n tc ng thc y vic lnh vt thng so vi cc cch
chm sc thng thng hoc gi dc i vi cc vt thng do bng, suy tnh mch, tiu ng v bnh suy
gim v thn kinh.

ngh ca tc gi
Tc gi a ra ngh cc th nghim cn ko di hn vi vic iu tr cc vt thng ln hn (>5 cm
2
).
Nghin cu xa hn cn nh gi hiu qu ca acid hyaluronic vi vt l do gim chc nng ng mch
(arterial ulcer) v vic lnh hon ton vt l tnh mch, vt bng nng v vt thng biu m do phu thut.

Chi tit trch dn bi
Voigt J, Driver VR. Hyaluronic acid derivatives and their healing effect on burns, epithelial surgical wounds,
and chronic wounds: a systematic review and meta-analysis of randomized controlled trials. Wound Repair
and Regeneration 2012; 20(3): 317-331