Papaína, bromelina, actinidina e ficina no desbridamento de feridas cutâneas: revisão sistemática
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Data
2023-03-22
Autores
Augusto, Fabiana da Silva [UNIFESP]
Orientadores
Ferreira, Lydia Masako [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: O tecido inviável retarda a cicatrização de feridas, e o desbridamento com enzimas vegetais é uma estratégia promissora de tratamento. Objetivo: Avaliar os efeitos da papaína, bromelina, actinidina e ficina no desbridamento, por meio de revisão sistemática. Método: Revisão, segundo diretrizes da Cochrane. Incluíram-se ensaios clínicos randomizados com pacientes com feridas tratadas com papaína, bromelina, actinidina ou ficina. A busca ocorreu sem restrição de data e idioma nas bases MEDLINE, CENTRAL, EMBASE e outras, utilizando-se os descritores “wounds and injuries”, “papain”, “bromelain”, “actinidin” e “ficin”. Avaliaram-se os desfechos área dos tecidos inviáveis, dor, área da ferida e tempo de cicatrização. Dois pesquisadores selecionaram os artigos e extraíram os dados. Analisou-se o risco para viés pelo ROB 2.0 e a qualidade da evidência pelo GRADE. Realizou-se metanálise (IC=95%). Resultados: Foram localizados onze estudos envolvendo 601 participantes. A papaína apresentou melhor desbridamento que a colagenase (DM: -7,05[-12,18; -1,92]; n=16) e a bromelina foi similar ao hidrogel (DM: 3,90[-6,72; 14,52]; n=73). A dor foi semelhante entre a papaína e o hidrogel (DM: 0,50[-1,03; 2,03]; n=28). A redução da área da ferida foi similar entre produtos diversos e a papaína (DM: -4,24[-36,81; 28,33]; n=98), bromelina (DM: -4,10[-16,33; 8,13]; n=73) ou actinidina (DM: -22,09[-50,48; 6,30]; n=77). O tempo de cicatrização foi similar entre a papaína e o hidrogel (RR: 1,05[0,67, 1,66]; n=98). A certeza da evidência foi muito baixa. Conclusão: Não houve evidências suficientes para determinar os efeitos destas enzimas vegetais no desbridamento. Os estudos possuíam limitações metodológicas e certeza da evidência muito baixa.
Introduction: Nonviable tissues delay wound healing, and debridement with plant enzymes is a promising treatment strategy. Objective: To assess the effects of papain, bromelain, actinidin and ficin on debridement, by means of a systematic review. Method: A review that followed the Cochrane guidelines. The materials included were randomized clinical trials conducted with patients that had wounds treated with papain, bromelain, actinidin or ficin. The search was conducted with no date or language restrictions in the MEDLINE, CENTRAL, EMBASE and other databases, using ―wounds and injuries‖, ―papain‖, ―bromelain‖, ―actinidin‖ and ―ficin‖ as descriptors. The following outcomes were evaluated: nonviable tissue area, pain, wound area, and healing time. Two researchers selected the articles and extracted the data. Risk of bias was analyzed following ROB 2.0, and quality of the evidence by means of GRADE. A metaanalysis was performed (CI=95%). Results: Eleven studies involving 601 participants were found. Papain presented better debridement than collagenase (MD: 7.05[ 12.18; 1.92] ; n=16) and bromelain was similar to hydrogel (MD: 3.90[6.72; 14.52]; n=73). Pain was similar between papain and hydrogel (MD: 0.50[1.03; 2.03]; n=28). The wound area reduction was similar between several products and papain (MD: 4.24[ 36.81; 28.33]; n=98), bromelain (MD: 4.10[ 16.33; 8.13]; n=73) or actinidin (MD: 22.09[ 50.48; 6.30]; n=77). Healing time was similar between papain and hydrogel (RR: 1.05[0.67; 1.66]; n=98). Certainty of the evidence was very low. Conclusion: There was not enough evidence to determine the effects of these plant enzymes on debridement. The studies had methodological limitations and very low certainty of the evidence.
Introduction: Nonviable tissues delay wound healing, and debridement with plant enzymes is a promising treatment strategy. Objective: To assess the effects of papain, bromelain, actinidin and ficin on debridement, by means of a systematic review. Method: A review that followed the Cochrane guidelines. The materials included were randomized clinical trials conducted with patients that had wounds treated with papain, bromelain, actinidin or ficin. The search was conducted with no date or language restrictions in the MEDLINE, CENTRAL, EMBASE and other databases, using ―wounds and injuries‖, ―papain‖, ―bromelain‖, ―actinidin‖ and ―ficin‖ as descriptors. The following outcomes were evaluated: nonviable tissue area, pain, wound area, and healing time. Two researchers selected the articles and extracted the data. Risk of bias was analyzed following ROB 2.0, and quality of the evidence by means of GRADE. A metaanalysis was performed (CI=95%). Results: Eleven studies involving 601 participants were found. Papain presented better debridement than collagenase (MD: 7.05[ 12.18; 1.92] ; n=16) and bromelain was similar to hydrogel (MD: 3.90[6.72; 14.52]; n=73). Pain was similar between papain and hydrogel (MD: 0.50[1.03; 2.03]; n=28). The wound area reduction was similar between several products and papain (MD: 4.24[ 36.81; 28.33]; n=98), bromelain (MD: 4.10[ 16.33; 8.13]; n=73) or actinidin (MD: 22.09[ 50.48; 6.30]; n=77). Healing time was similar between papain and hydrogel (RR: 1.05[0.67; 1.66]; n=98). Certainty of the evidence was very low. Conclusion: There was not enough evidence to determine the effects of these plant enzymes on debridement. The studies had methodological limitations and very low certainty of the evidence.