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Previous issue date: 2009-12-11 / Analytical study of therapeutic nonrandomized intervention type, intra-group controlled, with the aim of analyzing the cost-effectiveness of compression therapy with manipulated Unna boot in relation to conventional therapy in the healing of venous ulcers (VU) of patients treated in ambulatory clinic. The study population was composed by patients with VU treated by angiologists in Surgical Clinic Ambulatory of the Onofre Lopes University Hospital (HUOL) with a sample of 18 patients. It obtained the assent of the HUOL Ethics in Research Committee (Protocol 276/09). Data collection was performed over a period of four months by the own master's student and 34 nursing students, through the application of the research instrument in the admission of patients to the study and in the ten subsequent evaluations, performed at the time of changing Unna boot, weekly, for a maximum period of 10 weeks. The data were analyzed with SPSS 15.0 software, using descriptive and inferential statistics, and presented as tables, charts and graphs. Among those surveyed, prevailed: females, mean age 57.6 years, low education and income levels, most retired, unemployed or off work, with the standing position more than six hours per day and up to eight hours daily of domestic or occupational activities. In health status profile of respondents there were predominantly sleep, rest and inadequate elevation of the lower limbs, no smoking and/or alcohol use, presence of hypertension and no use of drugs. Most presented the first VU for over 10 years, recurrences, present VU for more than five years, involvement of left leg, in malleolar and / or distal leg region, mild edema, hyperpigmentation, lipodermatosclerosis, telangiectasies, reticular and varicose veins, mild pain, serous exudate in moderate quantity, small lesions (up to 50cm2), with predominance of granulation tissue and / or epithelialization and demarcated, elevated and irregular borders, with crusts and macerated. Most patients reported that in the 10 weeks prior to admission, made bandages at home and / or Basic Health Unit and / or ambulatory, with nursing aides or technicians, daily, and on weekends or holidays, performed by patients themselves, using healing ointment on the lesion, being observed granulation / epithelialization and increase in VU prevalent in the 10 weeks of traditional treatment. After follow up with manipulated Unna boot, was observed a decrease of lesions in all study patients, with complete healing in 27.8% of those between 1 and 5 weeks of treatment, with satisfactory evolution of the lesions, pain and ankle and calf circumferences, and unsatisfactory development of the borders of ulcers, edema, sleep, rest and elevation of the lower limbs, especially in more chronic patients. Furthermore, patients who achieved total healing and exhibited the greatest percentage reduction of lesions had a higher number of wound healing factors (ρ = 0.01 and ρ = 0.027, respectively). The manipulated Unna boot showed better results in those patients with shorter duration of injury, leading them to a satisfactory outcome within a short period of treatment. After the cost-effectiveness analysis, we conclude that the manipulated Unna boot is more effective than conventional therapy in the healing process of VU and is more cost-effective in patients with shorter lesions (ρ = 0.001), shorter treatment (ρ = 0.000) and greater number of wound healing factors (ρ = 0.005). / Estudo anal?tico de interven??o do tipo terap?utico n?o randomizado com controle intragrupo, com o objetivo de analisar o custo-efetividade da terapia compressiva com bota de Unna manipulada em rela??o ? terapia convencional, no processo de cicatriza??o de ?lceras venosas (UV) de pacientes atendidos em ambulat?rio. A popula??o alvo do estudo foi composta por portadores de UV atendidos por angiologistas no ambulat?rio de Cl?nica Cir?rgica do Hospital Universit?rio Onofre Lopes (HUOL), com amostra de 18 pacientes. Obteve parecer favor?vel do Comit? de ?tica em Pesquisa do HUOL (Protocolo n? 276/09). A coleta de dados foi realizada num per?odo de quatro meses pela pr?pria mestranda e 34 acad?micos de enfermagem, por meio da aplica??o do instrumento de pesquisa na admiss?o dos pacientes ao estudo e nas dez avalia??es subsequentes, realizadas no momento das trocas da bota de Unna semanais, por um per?odo m?ximo de 10 semanas. Os dados foram analisados no SPSS 15.0, atrav?s de estat?stica descritiva e inferencial, e apresentados na forma de tabelas, quadros e gr?ficos. Entre os pesquisados, predominaram: o sexo feminino, idade m?dia de 57,6 anos, baixo n?vel de escolaridade e de renda, maioria aposentada, desempregada ou afastada do trabalho, com posi??o ortost?tica maior que seis horas por dia e com at? oito horas di?rias de atividades dom?sticas ou ocupacionais. No perfil do estado de sa?de dos pesquisados houve predom?nio de sono, repouso e eleva??o dos membros inferiores inadequados, aus?ncia de tabagismo e/ou etilismo, presen?a de hipertens?o arterial e a n?o utiliza??o de medicamentos. A maioria apresentou a primeira UV h? mais de 10 anos, recidivas, UV atual h? mais de cinco anos, acometimento do MIE, em regi?o maleolar e/ou distal da perna, edema discreto, hiperpigmenta??o, lipodermatoesclerose, telangiectasias, veias reticulares, veias varicosas, dor leve, exsudato seroso, em moderada quantidade, les?es pequenas (at? 50cm2), com predomin?ncia de tecido de granula??o e/ou epiteliza??o e bordas delimitadas, elevadas, irregulares, com crostas e maceradas. A maioria dos pacientes relatou que, nas 10 semanas anteriores ? admiss?o, realizaram curativos em domic?lio e/ou UBS e/ou ambulat?rio, com auxiliares ou t?cnicos de enfermagem, diariamente, sendo nos fins de semana ou feriado executados pelos pr?prios pacientes, com utiliza??o de cicatrizantes na les?o, sendo observada granula??o/epiteliza??o predominantes e aumento das UVs nas 10 semanas de tratamento tradicional. Ap?s o acompanhamento com bota de Unna manipulada, foi observada redu??o das les?es em todos os pacientes do estudo, com cicatriza??o total em 27,8% destes entre 1 e 5 semanas de tratamento, com evolu??o satisfat?ria do leito lesional, da dor e das circunfer?ncias do tornozelo e panturrilha, e evolu??o insatisfat?ria da borda das ?lceras, edema, sono, repouso e eleva??o dos MMII, principalmente nos pacientes mais cr?nicos. Al?m disso, os pacientes que obtiveram cicatriza??o total e os que apresentaram maior percentual de redu??o das les?es tinham maior n?mero de fatores de cicatriza??o (ρ=0,01 e ρ = 0,027, respectivamente). A bota de Unna manipulada apresentou melhores resultados naqueles pacientes com menor tempo de les?o, levando-os a uma evolu??o satisfat?ria num curto per?odo de tratamento. Ap?s as an?lises de custo-efetividade, conclu?mos que a bota de Unna manipulada ? mais efetiva do que a terapia convencional no processo de cicatriza??o de UV, sendo mais custo-efetiva em pacientes com menor tempo de les?o (ρ= 0,001), menor tempo de tratamento (ρ =0,000) e com maior n?mero de fatores de cicatriza??o (ρ= 0,005).
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/14683 |
| Date | 11 December 2009 |
| Creators | Bezerra, Eurides Araujo |
| Contributors | CPF:51326728415, http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4708368Z6&dataRevisao=null, Lima, Carlos Bezerra de, CPF:03333230410, Menezes, Rejane Millions Viana, CPF:23039310453, http://lattes.cnpq.br/9130470143761299, Torres, Gilson de Vasconcelos |
| Publisher | Universidade Federal do Rio Grande do Norte, Programa de P?s-Gradua??o em Enfermagem, UFRN, BR, Assist?ncia ? Sa?de |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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