Sains Malaysiana 52(9)(2023): 2633-2643

http://doi.org/10.17576/jsm-2023-5209-13

Perkembangan Terkini dalam Rawatan Topikal Ulser Tekanan: Suatu Tinjauan Sistematik

(Recent Development in the Topical Treatments of Pressure Ulcers: A Systematic Review)

MOHD HANIF ZULFAKAR* & GRACE TING ENG CHI 

Pusat Teknologi Penghantaran Dadah dan Vaksin, Fakulti Farmasi, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia

Received: 10 April 2023/Accepted: 8 August 2023

Abstrak

Ulser tekanan adalah kecederaan setempat pada kulit atau tisu lembut yang mendasari bahagian tulang yang menonjol. Walaupun terdapat pelbagai rawatan topikal (agen topikal dan pembalut luka) yang tersedia untuk merawat ulser tekanan, rawatan ulser tekanan tetap mencabar. Ini telah mendorong penyelidikan untuk mengembangkan rawatan topikal yang baharu dan lebih berkesan untuk pengurusan dan penyembuhan ulser tekanan. Oleh itu, kajian ini akan memberi tumpuan kepada kajian terdahulu mengenai perkembangan rawatan topikal dalam tempoh 10 tahun kebelakangan ini untuk mengenal pasti agen topikal dan formulasinya serta pembalut luka yang telah dibangunkan selama tempoh ini. Selain tu, kajian ini juga akan mengkaji kesan agen topikal dan pembalut luka terhadap rawatan bagi semua tahap ulser tekanan (Tahap I - IV). Dengan melakukan kajian ini, rawatan topikal bagi rawatan setiap tahap ulser tekanan boleh dikenal pasti. Carian sistematik melalui PubMed, MEDLINE, EBSCOHost, Science Direct dan Google Scholar telah dilakukan. Kata kunci ‘pressure ulcer’, ‘bedsore’, ‘decubitus ulcer’ ‘dressings’, ‘bandages’, ‘topical agents’, ‘topical treatment’ dan gabungannya telah digunakan. Sinonim perkataan juga akan digunakan untuk memperluas pencarian. Sejumlah 18 artikel dikenal pasti memenuhi kriteria inklusi dan eksklusi. Hasil daripada tinjauan ini membuktikan bahawa formulasi salap adalah lebih berkesan berbanding jenis formulasi lain, manakala formulasi gel bukan pilihan yang baik untuk rawatan luka tekanan. Dari aspek keberkesanan rawatan topikal, kesemua formulasi topikal yang dikenalpasti adalah berkesan, kecuali gel sukralfat 15%. Akhir sekali, berdasarkan tahap luka tekanan, agen topikal adalah didapati berkesan dan paling banyak diindikasikan untuk ulser tahap I dan II, manakala pembalut pula untuk ulser tahap II dan III.

Kata kunci: Agen topikal; pembalut luka; rawatan topikal;  ulser tekanan

Abstract

Pressure ulcers are localized injuries to the skin or underlying soft tissue over a bony prominence. Although there are a variety of topical treatments available (topical agents and dressings) to treat pressure ulcers, pressure ulcer treatments remain challenging. This has prompted research to develop new and more effective topical treatments for pressure ulcers. Therefore, this review summarizes all the the topical treatments developed over the last 10 years in RCTs and animal studies to study the most suitable type of topical formulation in the delivery of topical agents for pressure ulcers, to evaluate the effectiveness of each topical treatments developed and to identify the topical treatments that are mostly indicated and effective for different stages of pressure ulcers (Phase I-IV). A systematic search through PubMed, Ovid and EBSCOHost was performed. The keywords ‘pressure ulcer’, ‘bedsore’, ‘decubitus ulcer’ ‘dressings’, ‘bandages’, ‘topical agents’, ‘topical treatment’ and combination of them were used. The synonyms of the words were used to extend the search. A total of 18 articles that met the inclusion and exclusion criteria were identified. Findings from this review have demonstrated that ointment formulation is superior to other formulations while gel  formulation is not a good option for the treatment of pressure ulcers. In terms of effectiveness, all the topical treatments identified except topical sucralfate 15% gel are effective in the treatment of pressure ulcers. Lastly, in terms of stage of pressure ulcers, topical agents are shown to be mostly indicated and effective for stage I and II pressure ulcers while topical dressings are shown to be mostly indicated and effective for stage II and III pressure ulcers.

Keywords: Dressings; pressure ulcer; topical agents; topical treatment

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*Corresponding author; email: hanifzulfakar@ukm.edu.my