RESUMO
RESUMEN Introducción: el temido pie diabético es secuela de dos complicaciones crónicas de la diabetes mellitus, la neuropatía periférica y la insuficiencia vascular. Objetivo: evaluar el impacto de la extensión en la aplicación intralesional del fármaco Heberprot-P a pacientes con úlceras del pie diabético en la provincia de Pinar del Río de enero 2012 a mayo del 2014. Métodos: se realizó un estudio de intervención descriptivo, retrospectivo y transversal en pacientes con úlceras del pie diabético tratados con Heberprot-P en el periodo 2012-2014. El universo se constituyó por 2 225 pacientes diabéticos y una muestra de 2 060 con pie diabético. Se empleó la estadística descriptiva mediante frecuencias absolutas y relativas porcentuales. Resultados: predominó la diabetes mellitus tipo 2 (88 %), se incluyeron 20 escenarios para el tratamiento, preferentemente ambulatorio, el 75 % de las atenciones por el aumento del empleo en la atención primaria de salud y en general por años, frecuente el pie diabético neuroinfeccioso (88 %) y el Wagner 2 (64 %), necesitaron una amputación mayor el 0,9 % de los casos. Conclusiones: la extensión en la aplicación del Heberprot-P al pie diabético es beneficiada, pues se cuenta con múltiples escenarios. El adiestramiento del personal médico, de enfermería y podología posibilitó elevar las atenciones ambulatorias en la atención primaria, el diagnóstico precoz de las lesiones, lo que disminuyó los costos y estadías hospitalarias. Se obtuvo el 99,0 % de efectividad y un porciento bajo de amputación; de esta forma se mejora la calidad de vida.
ABSTRACT Introduction: the fear to diabetic foot is a sequela of two chronic complications of diabetes mellitus, peripheral neuropathy and vascular insufficiency. Objective: to assess the impact of the intra-lesion application of Heberprot-P to patients with diabetic-foot ulcers in Pinar de Rio province from January 2012 to May 2014. Methods: an intervention, descriptive, retrospective and cross-sectional study was carried out in patients with diabetic-foot ulcers treated with Heberprot-P in the period 2012-2014. The target group comprised 2 225 diabetic patients and a sample of 2 060 with diabetic foot, using the descriptive statistics by means of absolute frequencies and relative percentages. Results: type-2 diabetes mellitus prevailed (88 %), having 20 health facilities for the treatment, mainly outpatient clinics, 75 % of the consultations were possible due to increased employment in Primary Health Care and generally for years, neuroinfectious diabetic foot (88 %) and Wagner's 2 (64 %) predominated; it was necessary to perform major amputation for 0,9 % of the cases. Conclusions: the extension on the application of Heberprot-P to diabetic foot is beneficial thanks to the multiple health facilities involved in this task along with the training of doctors of medicine, nursing care personnel and podiatrists, making possible the increase of ambulatory care in Primary Health Care and the early diagnosis of the lesions, decreasing at the same time, the costs of the hospital stays, reaching the service to those who needed it, with 99,0 % of effectiveness and a low percentage of amputation, improving the quality of life.
RESUMO
RESUMEN Fundamento: la evaluación de programas aplicados es importante, como medida para comprobar la eficacia, efectividad, utilidad, eficiencia y seguridad, así como el costo-beneficio de una nueva o mejorada tecnología o servicio de salud, además del impacto. Objetivo: brindar una herramienta para la evaluación del protocolo a seguir en pacientes con úlcera del pie diabético y uso del Heberprot-P® en el nivel primario de atención. Métodos: se realizó una investigación en sistemas y servicios de salud de desarrollo tecnológico, que permitió la creación de una guía para expresar juicios de valor a partir de la comparación de los resultados alcanzados con estándares establecidos. Se estudiaron la disponibilidad del protocolo, existencia de materiales educativos sobre el uso del Heberprot-P®. Para el proceso, se propuso evaluar las principales actividades realizadas por los recursos humanos encargados. Para operacionalizar criterios, indicadores y estándares se contó con la colaboración de expertos. Resultados: la guía propuesta constó de 35 criterios e indicadores para evaluar las diferentes dimensiones. Se tuvieron en cuenta las enfermeras(os), podólogas(os) disponibles para ejecutar el programa, la capacitación de estos, la opinión de trabajadores y pacientes por los servicios recibidos y otros indicadores como: diagnóstico correcto, tratamiento oportuno, articulación necesaria para una atención multidisciplinaria, atención inmediata, disminución de estadía y costos hospitalarios, disminución de la tasa y el nivel de las amputaciones. Conclusiones: esta guía contribuirá a evaluar la ejecución del protocolo a seguir y, por tanto, a identificar las brechas entre lo deseado y lo observado.
ABSTRACT Background: the evaluation of applied programs is important, as a measure to check the effectiveness, utility, efficiency and safety, as well as the cost-benefit of a new or improved technology or health service, in addition to the impact. Objective: to provide a tool for the evaluation of the protocol to be followed in patients with diabetic foot ulcer and the use of Heberprot-P® at the primary care level. Methods: a research on systems and health services of technological development was carried out, which allowed the creation of a guide to express value judgments based on the comparison of the results achieved with established standards. It was studied the availability of the protocol existence of educational materials on the use of Heberprot-P®. For the process, it was proposed to evaluate the main activities carried out by the human resources in charge. In order to operationalize criteria, indicators and standards, experts collaborated. Results: the proposed guide consisted of 35 criteria and indicators to evaluate the different dimensions. The nurses, podiatrists available to execute the program, the training of these, the opinion of workers and patients for the services received and other indicators such as, correct diagnosis, timely treatment, articulation necessary for a multidisciplinary care, immediate attention, decreased stay and hospital costs, decrease in the rate and level of amputations. Conclusions: this guide will help to evaluate the execution of the protocol to be followed and, therefore, to identify the gaps between the desired and the observed.
RESUMO
O diabetes mellitus é doença crônica que afeta mais de 120 milhões de pessoas no mundo, muitas delas acometidas por úlceras no pé, podendo levar à amputação do mesmo, o que acarreta acentuados prejuízos para o paciente e o sistema de saúde. A ozonoterapia apresenta-se como promissora alternativa coadjuvante no tratamento dessas lesões, pois é bioxidativa com efeitos antimicrobianos e promotora de neoangiogênese. Causa, ainda, aumento local no número médio de fibroblastos, melhora a capacidade de transporte de oxigênio (O2) por parte dos eritrócitos, além de estimular o sistema imunológico. O caso clínico relatado refere-se ao tratamento de uma paciente diabética, aterosclerótica, com história de úlcera infectada associada à osteomielite em quarto pododactilo direito, com perfusão sanguínea, incompatível com cicatrização. Foram realizadas revascularizações e debridamentos cirúrgicos sucedidos de infecções recorrentes. A ozonoterapia tópica com hidro-ozononoterapia, bagging (mistura gasosa de O3/O2) e curativos com óleo de girassol e creme ozonizados foram introduzidos como adjuvante na terapia convencional. Seguindo o tratamento, observou-se redução do exudato purulento, formação rápida de tecido de granulação, reparação de grande área da ferida e alívio da dor. Houve um episódio de recorrência de infecção, o qual foi tratado cirurgicamente com resposta terapêutica semelhante. A cicatrização total se deu em cerca de 90 dias.
Diabetes mellitus is a chronic disease that attacks more than 120 million people in the world, many of them having foot ulcers which may lead to foot amputation, what causes great damages to the patient and the health care system. Ozone therapy is a promising coadjuvant alternative for the treatment of such lesions, due to its bioxidative, antimicrobial effects, and its role in neoangiogenesis. It also increases the average number of fibroblasts, improves oxygen transport by erythrocytes, and stimulates the immune system. The present case reports treatment of a patient with diabetes and atherosclerosis, with a history of an infected ulcer associated to osteomyelitis in the right fourth toe, and blood perfusion incompatible with cicatrization. Surgical debridements and revascularization had been followed by recurrent infections. Topic ozone, hydro-ozone therapy, bagging (gaseous mixture of O3/O2) and dressings with ozonated sunflower oil and cream were introduced as coadjuvant to the conventional therapy. The treatment showed reduction of the purulent exsudate, rapid formation of granulation tissue, reparation of a large area of the wound, and relief of pain. There was an episode of infection recurrence, which was surgically treated and resulted in similar therapeutic response. Complete healing occurred in approximately 90 days.
