Efficacy of Hyperbaric Oxygen Therapy in Diabetic Foot Ulcers Based on Wagner Classification

Diabetic foot ulcer is a common chronic complication of diabetes mellitus. In addition to conventional primary therapy, there are adjuvant therapy methods such as hyperbaric oxygen therapy for the healing of diabetic foot ulcer wounds. The present study aimed to determine the efficacy of hyperbaric oxygen therapy in diabetic foot ulcers based on Wagner classification. It was performed retrospectively from prospectively collected data. One hundred thirty patients with diabetic foot ulcers were assessed in 2 groups: 1 group received hyperbaric oxygen therapy; the other group did not. Patients were examined according to age, sex, ulcer grade based on Wagner classification; ulcer healing status; whether hyperbaric oxygen therapy was received; duration of diabetes in years; HbA1C, sedimentation, C-reactive protein levels; and presence of accompanying diseases, including peripheral arterial disease, chronic obstructive pulmonary disease, hypertension, chronic kidney disease, neuropathy, and retinopathy. The mean follow-up period was 19.5?±?4.45 months (range 12 to 28 months). Seventy-one (54.6%) patients received hyperbaric oxygen therapy, and 59 (45.4%) patients did not. All patients in Wagner grade 2 healed in both groups. In the group that received hyperbaric oxygen therapy for grade 3 and 4 patients, 35 (87.5%) and 11 (84.6%) healed, respectively. In total, 60 (84.5%) patients in the group that received hyperbaric oxygen therapy healed. The subgroup comparison conducted according to Wagner classification revealed no differences between the 2 groups of grades 2 and 5 patients. It also revealed that treatment had higher levels of efficacy in the healing of ulcers in grade 3 and 4 patients.     

放射性膀胱炎的高压氧及药物治疗

治疗放射性膀胱炎仍然是较棘手的问题,而且治疗效果往往是短期的,在1994年和1995年间,我院随机对19例患者进行高压氧和药物治疗,观察膀胱容量、膀胱粘膜和血尿等变化,结果提示高压氧是治疗该并发症的有效方法,而且效果持久。     

Hyperbaric Oxygen Therapy for Malignancy: A Review

One unique feature of tumors is the presence of hypoxic regions, which occur predominantly at the tumor center. Hypoxia has a major impact on various aspects of tumor cell function and proliferation. Hypoxic tumor cells are relatively insensitive to conventional therapy owing to cellular adaptations effected by the hypoxic microenvironment. Recent efforts have aimed to alter the hypoxic state and to reverse these adaptations to improve treatment outcome. One way to increase tumor oxygen tensions is by hyperbaric oxygen (HBO) therapy. HBO therapy can influence the tumor microenvironment at several levels. It can alter tumor hypoxia, a potent stimulus that drives angiogenesis. Hyperoxia as a result of HBO also produces reactive oxygen species, which can damage tumors by inducing excessive oxidative stress. This review outlines the importance of oxygen to tumors and the mechanisms by which tumors survive under hypoxic conditions. It also presents data from both experimental and clinical studies for the effect of HBO on malignancy.     

The Role of Hyperbaric Oxygen Therapy in Ischaemic Diabetic Lower Extremity Ulcers: a Double-blind Randomised-controlled Trial

OBJECTIVE: ischaemic lower-extremity ulcers in the diabetic population are a source of major concern because of the associated high risk of limb-threatening complications. The aim of this study was to evaluate the role of hyperbaric oxygen in the management of these ulcers. METHOD: eighteen diabetic patients with ischaemic, non-healing lower-extremity ulcers were recruited in a double-blind study. Patients were randomly assigned either to receive 100% oxygen (treatment group) or air (control group), at 2.4 atmospheres of absolute pressure for 90 min daily (total of 30 treatments). RESULTS: healing with complete epithelialisation was achieved in five out of eight ulcers in the treatment group compared to one out of eight ulcers in the control group. The median decrease of the wound areas in the treatment group was 100% and in the control group was 52% (p=0.027). Cost-effectiveness analysis has shown that despite the extra cost involved in using hyperbaric oxygen, there was a potential saving in the total cost of treatment for each patient during the study. CONCLUSION: hyperbaric oxygen enhanced the healing of ischaemic, non-healing diabetic leg ulcers and may be used as a valuable adjunct to conventional therapy when reconstructive surgery is not possible.     

The Effect of Low Level Laser Therapy (LLLT) on Stage III Decubitus Ulcers (Pressure Sores); a Prospective Randomised Single Blind, Multicentre Pilot Study

. This study had four main objectives (a) multicentre trial feasibility in nursing homes; (b) the applicability of registration methods; (c) the extent of wound size reduction and (d) the LLLT effect(s) on pressure sores stage III. The study was designed as a prospective randomised, single blind, multicentre clinical trial in four nursing homes, using the same prospective protocol. A total of 20 patients were enrolled into the study: 16 patients were randomised, and four patients were excluded. Treatment was the prevailing consensus decubitus treatment (n=8); one group (n=8) had 904 nm LLLT in addition, five times a week over a period of 6 weeks. The main outcome measure was the median wound size at six weeks after intervention. No statistical significant difference in wound size was found between the two groups (Mann Whitney U test; p=0.47). The sores in the LLLT group healed to a median of 83%, wounds in the control group to a median of 95% of their initial size. There was significant wound decrease within treatment arms (Friedman two-way analysis, p<0.001). It was concluded that (a) a multicentre study is feasible in nursing homes; (b) the evaluation methods are accurate, adequate and reproducible; (c) there was significant sore area reduction within groups, but there were no significant differences between treatments; and (d) the efficacy of LLLT in healing of full thickness pressure sores stage III was not demonstrated and is still a matter of debate. Paper received 7 July 1999; accepted after revision 8 October 1999.     

Fournier's Disease: Adjunctive Hyperbaric Oxygen Therapy to Classic Therapy

Fournier's diseasv is a very rate and highly iatal necrolizing fasciitis of genital and perineal tissues. Conventional treatment of Fournier's disease includes surgeal debridement and antibiotic therapy. We describe a case of Foumier's disease where we added hyperbaric oxygen therapy to the conventional treatment regimen.     

气管切开患者高压氧治疗吸氧装置的选择

目的 探讨气管切开患者高压氧舱内吸氧装置的合理选择.方法 将300例行高压氧(HBO)治疗的气管切开患者随机分成两组各150例,分别采用自制头罩(头罩组)和球囊连接管(连接管组)2种装置吸氧;对两组治疗完成率、吸痰次数进行统计,其中成功完成治疗且连续治疗2个疗程的209例患者于HBO治疗前、治疗1、2个疗程结束时进行GCS评分.结果 头罩组治疗完成率高于连接管组,吸痰次数少于连接管组(均P＜0.01);连接管组治疗1、2个疗程时GCS评分显著优于头罩组(均P＜0.05).结论 气管切开患者HBO治疗选择球囊连接管效果优于头罩,但依从性较差.可首选球囊连接管吸氧,不能完成治疗者及时改用头罩吸氧.     

Scoping Review and Meta-analysis of Hyperbaric Oxygen Therapy for Radiation-Induced Hemorrhagic Cystitis

Purpose of review

To critically review and summarize existing literature assessing the effectiveness of hyperbaric oxygen therapy (HBOT) for the treatment of radiation-induced urologic injury.

Recent findings

Though 5 of the included 13 studies were published in the last 2–3 years, the only randomized controlled study was performed in 2012. Recent studies have confirmed the safety and efficacy of HBOT as well as identified risk factors for success vs. failure of HBOT for hemorrhagic radiation cystitis (HRC).

Summary

Of the 602 patients that received HBOT for HRC, 84% had a partial or complete resolution. In the 7 studies that utilized RTOG/EORTC, 75% of patients saw an improvement in hematuria of at least one grade (out of possible 5 total). Of the 499 patients with documented follow-up, 14% experienced recurrence, with a median time to recurrence of 10 months (6 to 16.5 months).

     

高压氧治疗在脊髓损伤中的应用

目的探讨高压氧综合治疗脊髓损伤的临床疗效及其对患者炎症因子水平的影响。方法 85例确诊为急性脊髓损伤患者按治疗方法分为两组:对照组42例,行椎弓根系统内固定及椎板切除减压手术等常规外科治疗及其他对症治疗;观察组43例,在应用对照组治疗方法的基础上加行高压氧治疗。比较两组患者临床疗效(总有效率);分别于治疗前后应用功能独立性评分表(FIM)、美国脊髓损伤协会(ASIA)评分、改良Barthel指数评分(MBI)对患者康复效果进行评估,并于治疗前后测定血清白细胞介素-6,8(IL-6、8)及肿瘤坏死因子-α(TNF-α)水平。结果观察组总有效率显著高于对照组(97.67 vs 57.14%,P0.05)。两组患者治疗后ASIA运动、感觉评分,FIM评分及MBI评分较术前均显著提高,且治疗后观察组各项评分均高于对照组(P0.05)。两组治疗后IL-6、IL-8及TNF-α水平显著低于治疗前,且观察组治疗后IL-6、IL-8、TNF-α水平显著低于对照组(P0.05)。结论对脊髓损伤患者,应用高压氧治疗可有效抑制炎症因子的生成,有助于降低继发性炎性损伤的发生,从而提高临床疗效,改善脊髓功能。