高压氧辅助治疗促进尿道下裂患儿术后伤口的愈合

目的 探讨高压氧辅助治疗对尿道下裂(后型)患儿术后促进转移包皮皮瓣存活及预防尿瘘的作用.方法 选取2006年1月-2010年12月在本院住院的年龄1～4岁的尿道下裂后型术后(Dukett尿道成型术)患儿,在常规使用相同抗生素治疗基础上,200例尿道下裂术后高压氧治疗患儿为高压氧治疗组.高压氧治疗组术后第2天开始高压氧治疗,疗程5 d,治疗压力2.3绝对压(ATA),加压20 min,面罩吸入纯氧40 min(舱内空气氧体积分数<250 mL·L-1),间隔吸入空气10 min,再吸纯氧40 min,减压33 min.每天1次,每次治疗143 min.选取200例术后未行高压氧治疗的患儿作为对照组.术后第2天、第7天行动脉血气分析,同时观察患儿转移包皮皮瓣存活情况及尿瘘发生率.采用指标包括手指末梢血氧分压[pa(O2)]、氧饱和度[Sa(O2)]、转移包皮皮瓣存活情况和尿瘘发生率.结果 高压氧治疗组术后第2天、第7天pa(O2)分别为(93.33±2.50)mmHg(1 mmHg=0.133 kPa)、(95.22±1.77)mmHg,Sa(O2)分别为(94.86±1.61)%、(96.08±1.60)%,均高于对照组(Pa<0.05).高压氧治疗组转移包皮皮瓣显著存活157例(显著有效存活率78.5%),明显高于对照组(显著有效存活136例,存活率为68.0%)(P<0.05);且尿瘘的发生率(14.0%)明显低于对照组(22.5%)(P<0.05).结论 高压氧治疗可增加机体血氧含量、提高pa(O2),明显改善缺血、缺氧组织的血供,增强微循环功能,从而促进尿道下裂术后转移皮瓣的存活,降低尿瘘发生.

Hyperbaric Oxygen Auxiliary Therapy Ameliorating Postoperative Dermal Wound Healing of Hypospadias

Objective To explore the effect of hyperbaric oxygen auxiliary therapy on postoperative hypospadias(post type) by promoting survival of transferred foreskin flap and preventing of urinary fistula.Methods Selecting hypospadias(post type) children(Dukett urethra angioplasty) whose age were 1-4 years in Wuhan Children′s Hospital from Jan.2006 to Dec.2010,200 cases treated with hyperbaric oxygen auxiliary therapy after surgery were the group of hyperbaric oxygen therapy on the basis of using same antibiotics.The group of hyperba-ric oxygen therapy was treated with hyperbaric oxygen therapy on the 2nd day after surgery,and the course of treatment was 5 days,and pressure was 2.3 ATA(absolute pressure).This group was pressurized 20 min,with mask inhalation of pure oxygen 40 min(oxygen concentration of air in chamber <250 mL·L-1),interval inhaled air 10 min,and then inhaled pure oxygen 40 min,decompressed 33 min.The treatment was once a day,and every treating time was 143 min.Two hundred cases were selected without postoperative hyperbaric oxygen therapy as a control group.The children were detected with blood gas analysis on the 2nd day,and the 7th day after surgery,while observing survival condition of transferred foreskin flap and possibility of urinary fistula.Index included partial pressure of oxygen [pa(O2)],oxygen saturation [Sa(O2)] in finger peripheral blood,survival condition of transferred foreskin flap and possibility of urinary fistula.Results pa(O2) on the 2nd day and the 7th day after surgery were(93.33±2.50)mmHg(1 mmHg=0.133 kPa),(95.22±1.77) mmHg,and Sa(O2) were(94.86±1.61)%,(96.08±1.60)%.They were higher than those in control group(Pa<0.05).Hyperbaric oxygen therapy promoted survival of transferred foreskin flap(cases of significant utility were 157 vs 136,P<0.05),and reduced the possibility of occurrence of urinary fistula(14.0% vs 22.5%,P<0.05).Conclusions Hyperbaric oxygen therapy can significantly improve blood supply of ischemia,hypoxia tissue and enhance micro circulation by increasing blood oxygen content and pa(O2).Thereby it can contribute to survival of postoperative transferred foreskin flap and reduce possibility of urinary fistula.