高压氧治疗对严重烧伤患者血中sIL-2R和Fn含量变化的影响

目的通过观察高压氧治疗(Hyperbaric Oxygen Therapy,HBOT)对烧伤患者血中可溶性白介素2受体(Soluble interleukin-2 receptor,sIL-2R)及纤维连接蛋白(Fibronectin,Fn)含量的影响,探讨 HBOT 防治烧伤感染的价值。方法选择42例严重烧伤患者(烧伤面积>30%或Ⅲ度面积>10%),随机分为 HBOT 组(25例)和非 HBOT 组(17例),另选40名健康献血员作正常对照组。于伤后8h 及1,2,3,5,7,10,14,17,21,28,35天采集静脉血,ELISA 法测定血清 sIL-2R,火箭免疫电泳法测定其血浆 Fn,同时观察两组患者脓毒症发生率。结果非 HBOT 组:与正常对照组相比,伤后各时相点血清 sIL-2R 水平显著升高,而血浆 Fn 含量明显降低(P<0.05或 P<0.01);HBOT 组:与正常对照组相比,除伤后21天外,其余各时相点血清 sIL-2R 升高不明显;除伤后8h外,其余各时点血浆 Fn 降低不明显(P>0.05)。但与非 HBOT 组相比,伤后各时相点血清 sIL-2R均显著降低,而血浆 Fn 则明显增高(P<0.05或 P<0.01);与此同时,脓毒症发生率亦明显降低(P<0.05)。结论 HBOT 可显著降低严重烧伤患者血清 sIL-2R,而明显增高血浆 Fn,故对防治烧伤感染可能有益。     

Management of necrotising fasciitis secondary to abdominal liposuction using a combination of surgery,hyperbaric oxygen and negative pressure wound therapy in a patient with burn scars

Liposuction is the one of the most frequently performed cosmetic operations and usually has an easy recovery, with a reportedly low overall complication rate. Here, we report the case of a 60‐year‐old woman with type II diabetes mellitus and a previous burn injury of the abdomen who underwent abdominal liposuction and subsequently developed necrotising fasciitis. Following radical debridement, systemic antibiotic administration, negative pressure wound therapy and hyperbaric oxygen therapy, the wound healed completely. This case demonstrates the success of the combination treatment and highlights the need for clinicians to be aware of the risk of serious complications in selected patients.     

高压氧在手外科创伤中的应用

目的探讨高压氧在手外科常见创伤中的应用与临床效果。方法2002年3月～2005年12月对手外科常见创伤:断指再植术后血管危象、肢体顽固性溃疡、手部骨折、肢体压砸伤等按常规治疗组和高压氧治疗组进行观察。结果断指再植术后血管危象常规治疗组和高压氧治疗组无明显差异(t检验,P>0.05);肢体顽固性溃疡、手部骨折、肢体压砸伤等的常规治疗组和高压氧治疗组差异有显著性(t检验,P<0.05)。结论高压氧在手外科常见创伤中合理选择应用,可以取得较好的临床效果。     

Effects of hyperbaric oxygen therapy on caustic esophageal injury in rats

Background/purpose

Caustic esophageal burn is a serious problem in pediatric surgery. Even though many clinical and experimental studies had been performed, the complication rate could not be reduced to a satisfying level. In this study, the authors evaluated the effects of hyperbaric oxygen (HBO) therapy in caustic esophageal burn in rats.

Methods

Rats were divided into 4 groups, and caustic burn at the distal esophagus was created by applying 50% NaOH for 3 minutes in all groups. The first and third groups did not receive HBO therapy. HBO therapy was applied to the second group for 2 days and to the fourth group for 28 days. To evaluate the effects of short-term HBO therapy, the first 2 groups were compared for ulceration, inflammation, and submucosal vascular thrombosis after 2 days. The third and fourth groups were compared for the long-term effects of HBO therapy. Rats in these groups were killed after 28 days and compared for the collagen content, weight, and mortality rate.

Results

In the second group, which received 2 days of HBO therapy, ulcer depth and vascular thrombosis were significantly lower than these in the first group (P = .022 and P = .020, respectively). The fourth group, which received 4 weeks of HBO therapy, had a significantly reduced mortality rate, weight loss, and collagen score and hydroxyproline level if compared with the third group (P = .035; P = .016; P = .028; and P = .033, respectively).

Conclusions

These results indicate that HBO therapy is useful in caustic esophageal burn both in short-term and long-term use.     

A retrospective study of diabetic foot ulcers treated with hyperbaric oxygen therapy

A retrospective review of patient medical records was conducted to assess what factors influence the outcomes of diabetic foot ulcers treated with hyperbaric oxygen (HBO) therapy. Patients referred to the Diving Diseases Research Centre for HBO therapy for the treatment of diabetic foot ulcers during a 2‐year period were included in this study. Data collected from 30 sets of patient records were entered into SPSS and statistical analysis was undertaken to investigate whether any underlying pathologies or confounding factors appeared to influence patient outcome. A 73·3% of patients achieved a successful outcome of partial healing, major amputation no longer required, amputation level lower than anticipated prior to HBO or healing at the end of HBO therapy and 70% remained successful 3 months later. A 13·3% of patients were lost to follow‐up at 3 months and one patient (3·3%) had a major amputation. Steroid therapy, peripheral vascular disease, previous minor amputation, type of diabetes, previous HBO therapy, larvae therapy, the use of interactive dressings and haemoglobin A1c levels were all observed to have had a significant relationship with patient outcome (P < 0·05). These results were compared with data from other published research conducted in this area on similar patient groups. A larger scale study focussing on the factors found to be significant in this study is recommended. An improvement of patient documentation would allow patient outcomes to be more consistently monitored in the future.     

Effect of extracorporeal shock wave therapy for burn scar regeneration: A prospective,randomized, double-blinded study

PurposeThis study aimed to investigate the regeneration effect of extracorporeal shock wave therapy (ESWT) on hypertrophic scar regeneration using objective measurements.MethodsThis was a double-blinded, randomized, controlled trial of 48 participants who had undergone autologous split-thickness skin grafting (STSG) with same artificial dermis. The ESWT group (n = 25) received shock waves with low-energy flux density (0.05–0.30 mJ/mm²). The interval between treatments is a 1-week. The ESWT group also received recommended treatment. The control group (n = 23) only received standard treatment. We measured skin characteristics before treatment and after 6 weeks for both groups.ResultsNo significant intergroup difference was noted at the initial evaluations (p > 0.05). The pre- to post-treatment change in the scar thickness (p = 0.03) and erythema (p = 0.03), greater reduction was found in the ESWT group than control group. The pre- to post-treatment change in the sebum level (p = 0.02), more increase was found in the ESWT group. We found no significant differences in the change measurements between the two groups for melanin levels (p = 0.62) and transepidermal water loss (TEWL) (p = 0.94). The changes (skin distensibility, biological skin elasticity, gross skin elasticity, and skin viscoelasticity) measured with the Cutometer showed no significant differences between the two groups (p = 0.87, p = 0.32, p = 0.37, and p = 0.29, respectively).ConclusionThis is the first report of ESWT on hypertrophic scar after burn using objective tools (melanin, erythema, sebum, TEWL, elasticity and thickness). ESWT has objective beneficial effects on burn-associated scar characteristics.     

高压氧治疗急性氯气中毒5例临床分析

目的观察高压氧治疗急性氯气中毒的疗效。方法对5例急性氯气中毒患者在内科常规治疗的同时,根据患者中毒的程度,给予不同次数的高压氧治疗。结果 5例急性氯气中毒患者治疗效果明显,均痊愈出院。结论高压氧可以作为辅助治疗急性氯气中毒的一种有效的方法。     

Diabetic foot ulcers treated with hyperbaric oxygen therapy: a review of the literature

Hyperbaric oxygen therapy (HBO) has been used as an adjunct for healing diabetic foot ulcers (DFUs) for decades. However, its use remains controversial. A literature search was conducted to locate clinical studies and assess the available evidence. Ten prospective and seven retrospective studies evaluating HBO for DFUs were located. These were reviewed and the outcomes were discussed. One study reported no difference in outcomes between patients receiving hyperbaric oxygen and the control group. However, their regime differed from all other studies in that the patients received hyperbaric oxygen twice rather than once daily. Reduced amputation rates and improved healing were the most common outcomes observed.     

高压氧辅助治疗严重手外伤的疗效观察

目的：探讨高压氧（hyperbaric oxygen, HBO）辅助治疗严重手外伤的临床疗效。方法对我院2008年10月—2011年6月收治的48例严重手外伤患者,随机分为高压氧辅助治疗组（高压氧组）和传统治疗组（对照组）,术后平均随访1.5年,根据全国手功能评定具体方案中断指再植功能评定标准进行两组手功能恢复状况的评价。结果高压氧治疗组功能评定结果明显优于传统治疗组。结论高压氧辅助治疗严重手外伤可明显提高术后再植手指的成活率,改善手部功能。     

高压氧对兔耳创面模型早期瘢痕组织形成的影响

目的 通过观察高压氧对兔耳创面愈合及瘢痕形成的影响,以探讨在临床中应用高压氧防治早期瘢痕的可行性.方法 选取新西兰白兔16只建立兔耳增生性瘢痕模型,每只兔左耳4个创面,右耳4个创面,共128个,随机分为高压氧组与对照组2组,每组8只,64个创面.高压氧组术后立即开始高压氧处理,2个大气压,吸氧60 min,每日1次,疗程以创面愈合为准.期间观察记录创面愈合情况以及兔耳瘢痕大小、厚度、颜色、硬度.待创面全部愈合后,切取创面进行HE染色,Masson染色和苦味酸天狼星红染色,行病理学观察、检测及分析.结果 高压氧组愈合时间为(16.7±1.8)d;对照组为(20.2±2.3)d,差异有统计学意义(P＜0.05).高压氧组瘢痕增生发生率较对照组低,实验组发生率为(38/64,59.4％),对照组发生率为(52/64,81.2％),差异有统计学意义(P＜0.05).光镜下观察,高压氧组真皮层较对照组薄,成纤维细胞数量较少,胶原较疏松,排列较整齐,胶原结节和漩涡状结构少.瘢痕增生指数,高压氧组为3.48±0.94,对照组为4.65 ±0.76,差异有统计学意义(P＜0.01).成纤维细胞密度,高压氧组为186.5±27.3,对照组为246±41.6,差异有统计学意义(P＜0.05).胶原纤维面密度,高压氧组为(31.42±5.36)％,对照组为(43.62±7.36)％,差异有统计学意义(P＜0.05).Ⅰ型和Ⅲ型胶原含量,高压氧组分别为(71.42±5.36)％和(28.58±5.36)％,对照组为(62.46±7.32)％和(37.54±7.32)％,差异有统计学意义(P＜0.05).Ⅰ型和Ⅲ型胶原比例,高压氧组为2.499,对照组为1.664,高压氧组比例更为接近正常皮肤Ⅰ型和Ⅲ型胶原约4∶1的比例.结论 高压氧可促进创面愈合,并对兔耳早期增生性瘢痕有较明显的抑制作用.     

The prevalence and development of burn scar contractures: A prospective multicenter cohort study

ObjectiveThe objective of this study was to identify the prevalence and development of after burn joint limitation by scar contracture.MethodsIn 2011–2012, consecutive patients were enrolled in this prospective multi center cohort study. Eligible were all patients admitted to the 2 participating Dutch Burn Centers with acute burns across or adjacent to the neck, shoulder, elbow, wrist, hip, knee and ankle. Passive range of motion was measured in week 3 and subsequently every 3 weeks until discharge, on discharge from the hospital and during follow-up at the outpatient clinic at 3–6–9–12 months after burn.ResultsLimited range of motion of non-operated burned joints (N = 195) was restored back to normal within 6–9 months. From the operated burned joints (N = 353), 58.6% demonstrated a limited range of motion at 3–6 weeks declining to 20.9% at 12 months. The upper part of the body was affected more often by scar contracture than the lower part. At 12 months, the shoulder was limited most often (51.3%) and the hip least often (0%). Reconstructive surgery was performed in 13.3% of the operated burned joints.ConclusionsPersistent joint limitations at 12 months were exclusively present in joints that needed skin grafting for rapid wound closure. The upper part of the body was more prone to contracture formation than the lower part, from which the shoulder was most often involved. More than half of the limited range of motion seen in the acute phase, resolved in the long term. The need for reconstructive surgery was less than expected.     

Treatment of diabetic foot complications with hyperbaric oxygen therapy: A retrospective experience

BackgroundThe aim of this study is to evaluate the role of hyperbaric oxygen in the treatment of diabetic foot ulcers.MethodsWe performed a retrospective observational study of all patients with diabetic foot ulcers treated at the Institution's hyperbaric chamber between January 2010 and August 2012. Patient data was obtained upon patient hospital visit and prospective clinical record consultation.ResultsTwenty-six foot lesions including 13 foot ulcers Wagner grade 2 or greater and 13 amputation stump ulcers were submitted to hyperbaric oxygen therapy between January 2010 and August 2012 in our Institution. Of these, 23 foot lesions completed treatment and complete epithelialization of the primary lesion was achieved in 15 (65%). The mean healing period since the first hyperbaric oxygen therapy session was 16 weeks. Above-ankle amputations were performed in 3 limbs and transmetatarsal amputations in 2 limbs.ConclusionHyperbaric oxygen may be associated with ulcer healing in selected diabetic foot ulcers with impaired cicatrization.     

高压氧后处理对大鼠神经病理性痛及脊髓小胶质细胞活化的影响

目的 探讨高压氧(hyperbaric oxygen,HBO)后处理对大鼠神经病理性疼痛(neuropathic pain,NP)镇痛效果及脊髓小胶质细胞活化的影响. 方法 雄性SD大鼠24只,采用随机数字表法将大鼠分成4组(每组6只):假手术组(S组)、坐骨神经慢性压迫组(C组)、HBO后处理2.0组(H2.0组)与HBO后处理2.5组(H2.5组).采用坐骨神经慢性压迫损伤法建立NP模型,H2.0和H2.5组于术后1d开始给予相应压力的HBO后处理,1次/d连续7次,每天出HBO舱后1h测定各组大鼠机械缩足反射阈值(mechanical withdrawal threshold,MWT)和热缩足反射潜伏期(thermal withdrawal latency,TWL),术后7d测定MWT和TWL后处死,用免疫组化法测定大鼠脊髓小胶质细胞的活化情况. 结果 与S组比较,C组MWT降低及TWL缩短,脊髓内小胶质细胞数量与活化率上升为(156±9)个和44.9％(P＜0.05);与C组比较,H2.0组和H2.5组MWT升高及TWL延长,H2.0组和小胶质细胞数量与活化率分别为(64±7)个和5.7％(P＜0.05),H2.5组小胶质细胞数量与活化率分别为(62±5)个和6.1％(P＜0.05);H2.0组与H2.5组小胶质细胞数量与活化率差异无统计学意义(P＞0.05). 结论 HBO后处理可减轻大鼠NP,其机制与抑制脊髓内小胶质细胞活化有关.     

Effects of hyperbaric oxygen therapy on rabbit skeletal muscle during extremity lengthening

Introduction  Extremity lengthening through distraction osteogenesis is limited by the surrounding skeletal muscle and neurovascular structures rather than the bone itself. The purpose of this study is to evaluate the effects of hyperbaric oxygen therapy on skeletal muscle during distraction osteogenesis. Materials and methods  Twenty New Zealand white rabbits were randomly divided into two groups. Right tibia of all rabbits was distracted at a rate of 0.125 mm per 6 h (0.5 mm/day) for 10 days with circular external fixator. Experimental group rabbits (N = 10) underwent 2.5 ATA hyperbaric oxygen therapy for 2 h everyday for 20 days, control group rabbits (N = 10) did not receive any corresponding treatment. Skeletal muscle perfusion was evaluated with scintigraphy before and after the distraction period. Serum CPK, LDH and AST levels were measured before and after the distraction period. All animals were killed on the 27th day. The right tibias of all animals were removed and tibialis posterior muscle was harvested for histopathologic and histomorphometric assessment with light and electron microscopy. Results  Skeletal muscle perfusion was decreased in the control group in comparison with pre-distraction level (P = 0.008). However, no significant decrease was observed in the experimental group (P = 0.678). There were no statistical differences in serum CPK, LDH and AST levels between groups (P = 0.340, P = 0.077, P = 0.796). The mean area of the muscle fibers was measured as 398.66 ± 9.16 μ² in the experimental group and 349.44 ±5.76 μ² in the control group (P = 0.000) with light microscopy. Mild fibrosis was observed in connective tissue component of muscle tissue in control group. An average of 26 myofibrils (20–32) was counted in a 16-cm² unit area in experimental group and 50 myofibrils (35–65) in the control group with electron microscopy. Enlargement in the sarcoplasmic reticulum, degenerative changes in nuclear cytoplasm and increase in myofibril diameter were observed in the control group, which was not observed in the experimental group Conclusion  Results of this study suggest that HBO treatment alleviates the detrimental effects of distraction on skeletal muscles and preserves its ultrastructure.     

高压氧辅助治疗对儿童急性耐甲氧西林金黄色葡萄球菌性骨髓炎疗效的影响

目的:探讨高压氧辅助治疗儿童急性耐甲氧西林金黄色葡萄球菌性骨髓炎的疗效及对炎症指标水平的影响。方法:选择2016年1月至2019年12月郑州大学第一附属医院小儿外科收治的符合纳入标准的急性耐甲氧西林金黄色葡萄球菌性骨髓炎患儿56例,按治疗方法分为观察组和对照组,每组28例。对照组采用常规负压封闭引流术联合静脉抗生素治疗...     

Effect of cold pack therapy for management of burn scar pruritus: A pilot study

Purpose

Pruritus, a common, chronically disabling condition is often refractory to treatment. The pruritus sensation is mediated in the spinal cord and post-burn pruritus is considered a form of neuropathic pain. We investigated cold pack therapy as a treatment modality for post-burn pruritus.

Prediction of neurologic outcome in patients with spinal cord injury by using hyperbaric oxygen therapy

The effectiveness of hyperbaric oxygen therapy (HBO) in predicting neurological recovery in patients with spinal cord injury was evaluated. HBO has been used to treat spinal cord injury, but HBO does not appear to greatly alter the neurological outcome. This is the first report of the use of HBO as a diagnostic tool to evaluate neurological recovery after spinal cord injury. The study group consisted of 22 patients, aged 21–73 years, with spinal cord injuries. The effect of HBO was evaluated on admission and categorized as one of four grades (excellent, good, fair, or poor). The neurological status was evaluated on admission and at the time of follow-up, according to Frankel grade and the American Spinal Injury Association (ASIA) motor score. Correlations between the HBO effect and Frankel grade recovery and correlations between the HBO effect and recovery rate of the ASIA motor score were evaluated. The recovery in Frankel grade from admission to the final follow-up became better as the effectiveness of HBO increased (r = 0.445; P = 0.0414). The Frankel grade (r = 0.036; P = 0.871) and ASIA motor score (r = 0.029; P = 0.893) on admission did not correlate with the recovery in Frankel grade. There was a significant correlation between the HBO effect and the recovery rate of the ASIA motor score (r = 0.586; P = 0.0072), but this correlation was weaker than that for the ASIA motor score on admission (r = 0.752; P = 0.0006). We conclude that HBO can be employed to assess the status of spinal cord function recovery after spinal cord injury. Received: January 27, 2001 / Accepted: May 11, 2001     

高压氧对人前列腺癌细胞株小鼠荷瘤模型作用的研究

目的 为评估高压氧治疗前列腺癌放疗后出血性膀胱炎的安全性,探讨高压氧对体内前列腺癌细胞生长的影响. 方法 采用人前列腺癌PC-3细胞株皮下接种构建小鼠荷瘤模型(n=40),随机分组,实验组(n=20)每周连续进行5次200 kPa高压氧暴露,共20次,对照组(n=20)常压常氧条件下饲养.连续4周观察2组移植瘤生长体积的变化,免疫组织化学方法分析2组瘤体组织相关病理学特征,包括瘤体微血管密度(CD34)、瘤细胞增殖(Ki-67蛋白)以及瘤细胞凋亡(p53、p27蛋白)等指标. 结果 肿瘤接种后第28天,实验组移植瘤体积为(425.8±13.9)mm3,对照组为(433.6±12.8)mm3,2组比较差异无统计学意义(P>0.05);实验组移植瘤微血管密度及Ki-67、p53、p27蛋白表达的阳性率分别为69.7±9.5、(55.2±6.7)%、(31.2±5.3)%、(80.4±5.7)%,对照组分别为77.15±8.7、(50.65±7.3)%、(30.5±4.7)%、(85.3±6.4)%,2组比较差异均无统计学意义(P>0.05). 结论 高压氧对于前列腺癌细胞生长无促进作用,临床应用高压氧治疗因前列腺癌放射治疗引起的出血性膀胱炎患者可能是安全的.