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Title:Vpliv transdermalne aplikacije CO2 na oksigenacijo tkiva pri celjenju kronične rane pri bolnikih s sladkorno boleznijo
Authors:ID Ančimer, Bernardka (Author)
ID Frangež, Igor (Mentor) More about this mentor... New window
Files:.pdf 3955$$bernardka_ancimer_magistrsko_delo.pdf_koncna.pdf (1,31 MB)
MD5: 2C9CDE85AC234459C4273E245FEA4666
 
Language:Slovenian
Work type:Master's thesis/paper
Organization:UNM FZV - University of Novo mesto - Faculty of Health Sciences
Abstract:Izhodišče: Celjenje ran pri bolnikih s sladkorno boleznijo je pogosto moteno zaradi kompleksnih patofizioloških sprememb. Dolgotrajna hiperglikemija povzroča strukturne in funkcionalne okvare ožilja, kar vodi v nezadostno prekrvitev in zmanjšano dostavo kisika ter hranil v prizadeta tkiva. Sočasno prisoten oslabljen imunološki odziv ovira prehod iz vnetne v proliferativno fazo celjenja. Takšno okolje zavira regeneracijo in pogosto vodi v razvoj kronične rane. Transdermalna aplikacija ogljikovega dioksida (CO2) je terapevtski pristop, ki neposredno deluje na izboljšanje mikrocirkulacije in tkivne oksigenacije. Terapevtska aplikacija 99,9-% medicinskega CO2 v plinastem stanju na prizadeto okončino povzroči vazodilatacijo, poveča sproščanje kisika iz hemoglobina v tkiva (Bohrov učinek) in spodbuja razvoj endotelijskega rastnega dejavnika (VEGF). Na ta način se izboljša perfuzija in preskrba tkiv s kisikom ter hranili, kar ustvarja ugodne pogoje za prehod v fazo obnove in pospešeno celjenje kroničnih ran, zlasti pri bolnikih s prisotno mikrovaskularno disfunkcijo. Metode: V raziskavo je bilo vključenih 30 bolnikov s sladkorno boleznijo in kronično rano, nevropatske, nevroishemične etiologije, ali perzistentno rano na mestu predhodne amputacije. Bolniki so bili razdeljeni v dve enako veliki skupini. Preiskovana skupina (n = 15) je poleg standardne oskrbe kronične rane prejela 20 transdermalnih terapij CO2, kontrolna skupina (n = 15) pa je prejemala zgolj standardno oskrbo. Pri vseh udeležencih so bile pri vsaki peti terapiji od skupno 20 izvedene hiperspektralne meritve parcialne saturacije kisika (StO2) v rani, ocena rane po Falangi in ocena bolečine po lestvici VAS. Rano smo fotografirali pred in po končanem zdravljenju. Rezultati: Ugotovili smo, da transdermalna aplikacija CO2 statistično vpliva na hitrejše nastajanje granulacij, zmanjšanje izločka in izboljšanje oksigenacije. Poleg tega pripomore k zmanjšanju velikosti kronične rane in pospešuje njeno celjenje. Zaključek: Celjenje ran pri bolnikih s sladkorno boleznijo je pogosto oteženo zaradi motenj mikrocirkulacije in oslabljenega imunskega odziva, kar vodi v razvoj kroničnih ran. V raziskavi smo preučili vpliv transdermalne aplikacije CO2, ki je izboljšala mikrocirkulacijo, povečala oksigenacijo tkiv in spodbudila nastajanje granulacij, kar je pripomoglo k pospešenemu celjenju ran. Terapija CO2 se je izkazala za učinkovito adjuvantno metodo zdravljenja, ki dopolnjuje druge terapevtske pristope, kot je debridement, ki pomaga pri čiščenju ran in izboljšanju regeneracije poškodovanih tkiv. Poleg tega uporaba sodobnih oblog, ki zagotavljajo optimalno vlažnost in preprečujejo okužbe, podpira proces celjenja in zmanjšuje tveganje za nadaljnje poškodbe. Naši rezultati potrjujejo, da je kombinacija terapije CO2, debridementa in sodobnih oblog učinkovit pristop za izboljšanje zdravljenja kroničnih ran pri bolnikih s sladkorno boleznijo.
Keywords:Kronična rana, transdermalna terapija CO₂, oksigenacija tkiva, sladkorna bolezen.
Year of publishing:2025
PID:20.500.12556/ReVIS-12391 New window
Publication date in ReVIS:09.10.2025
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Downloads:0
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Secondary language

Language:English
Title:Effect of transdermal CO2 application on tissue oxygenation in chronic wound healing in diabetic patients
Abstract:Background: Wound healing in patients with diabetes is often impaired due to complex pathophysiological changes. Prolonged hyperglycemia causes structural and functional vascular damage, leading to insufficient blood flow and reduced delivery of oxygen and nutrients to affected tissues. At the same time, an impaired immune response hinders the transition from the inflammatory to the proliferative phase of healing. This environment inhibits regeneration and often results in the development of chronic wounds. Transdermal application of carbon dioxide (CO₂) is a therapeutic approach that directly improves microcirculation and tissue oxygenation. The therapeutic use of 99.9% medical-grade CO₂ in gaseous form on the affected limb induces vasodilation, enhances oxygen release from hemoglobin into tissues (Bohr effect), and promotes the expression of vascular endothelial growth factor (VEGF). These effects improve perfusion and the supply of oxygen and nutrients to tissues, creating favorable conditions for transition into the reparative phase and accelerating the healing of chronic wounds, particularly in patients with microvascular dysfunction. Methods: The study included 30 patients with diabetes and a chronic wound of neuropathic or neuroischemic etiology, or a persistent wound at a previous amputation site. Participants were divided into two equally sized groups. The study group (n = 15) received 20 transdermal CO₂ treatments in addition to standard chronic wound care, while the control group (n = 15) received standard care only. Every fifth treatment (out of 20 in total), hyperspectral measurements of tissue oxygen saturation (StO₂) in the wound were performed, together with Falanga wound bed assessment and pain evaluation using the VAS scale. Wounds were photographed before and after the complete treatment protocol. Results: Transdermal CO₂ application had a statistically significant effect on faster granulation tissue formation, reduction in wound exudate, and improved oxygenation. In addition, it contributed to a decrease in chronic wound size and accelerated wound healing. Conclusion: Wound healing in diabetic patients is frequently hindered by microcirculatory disorders and a weakened immune response, leading to the development of chronic wounds. In our study, transdermal CO₂ application improved microcirculation, increased tissue oxygenation, and stimulated granulation, thereby accelerating wound healing. CO₂ therapy proved to be an effective adjunctive treatment, complementing other therapeutic approaches such as debridement, which facilitates wound cleansing and supports tissue regeneration. Furthermore, the use of modern dressings that maintain optimal moisture and prevent infection enhances the healing process and reduces the risk of further tissue damage. Our results confirm that the combination of CO₂ therapy, debridement, and advanced wound dressings represents an effective approach to improve chronic wound healing in patients with diabetes.
Keywords:chronic wound, transdermal CO₂ therapy, tissue oxygenation, diabetes mellitus


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