Hyperbaric oxygen therapy in the management of crush injuries: A randomized double-blind placebo-controlled clinical trial
Hyperbaric oxygen therapy in the management of crush injuries: A randomized double-blind placebo-controlled clinical trial
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DOI：
10.1097/00005373-199608000-00023
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发表时间：
1996-08-01
影响因子：
--
通讯作者：
Alquier, P
中科院分区：
文献类型：
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作者：
Bouachour, G;Cronier, P;Alquier, P
高压氧（HBO）疗法被提倡用于治疗与手术相关的四肢严重创伤，因为其对外周氧运输、肌肉缺血性坏死、筋膜室综合征和感染预防的作用，然而，迄今为止还没有进行对照人体试验来详细说明HBO在挤压伤管理中的作用，36例挤压伤患者在术后24小时内以盲法随机分配接受HBO治疗（100%O-2，2.5大气压绝对压力（ata），持续90分钟，每天两次，持续6天）或安慰剂所有患者均接受相同的标准治疗（21%O_2，1.1ata，90 min，每日2次，共6天）（抗凝剂、抗生素、伤口敷料），经皮氧分压（PtCO 2）测量在（患者呼吸正常空气）和治疗期间（HBO或安慰剂）在第一，第四，第八和第十二届会议，两组HBO组18例，安慰剂组18例，两组在年龄、危险因素、血管损伤、神经损伤或骨折的数量、类型或位置、HBO组17例患者完全愈合，安慰剂组10例患者完全愈合（p < 0.01），新的外科手术高压氧组有一名患者接受了手术治疗（如皮瓣和移植，血管手术，甚至截肢），而安慰剂组有六名患者接受了手术治疗。（p < 0.05），年龄和损伤严重程度匹配的患者组分析显示，在40岁以上III级软组织损伤患者亚组中，7例患者伤口愈合HBO组中有87.5%的患者与安慰剂组中有3例患者（30%）（p < 0.05），两组患者的住院时间和伤口敷料的数量无显著差异。对于完全愈合的患者，在正常空气中测量的创伤肢体的PtCO 2值，在第一次和第十二次治疗之间显著上升（p < 0.001）。愈合失败的患者PtCO 2值无显著变化，双侧灌注指数（BPI =受伤肢体的PtCO 2/未受伤肢体的PtCO 2）在第一次治疗中从1ata空气显著增加到2.5ata O-2（p < 0.05），在完全愈合的患者中，在随后的疗程中，2.5 ata O-2时的BPI持续大于0.9，而空气中的BPI在第一和第十二届会议之间逐渐上升（p < 0.05），在治疗结束时达到正常值。总之，本研究表明HBO在促进伤口愈合和减少重复手术方面的有效性，我们认为，高压氧是一个有用的辅助管理严重（三级）挤压伤的四肢患者超过40岁。
Hyperbaric Oxygen (HBO) therapy is advocated for the treatment of severe trauma of the limbs in association with surgery because of its effects on peripheral oxygen transport, muscular ischemic necrosis, compartment syndrome, and infection prevention, However, no controlled human trial had been performed until now to specify the role of HBO in the management of crush injuries, Thirty-six patients with crush injuries were assigned in a blinded randomized fashion, within 24 hours after surgery, to treatment with HBO (session of 100% O-2 at 2.5 atmosphere absolute (ata) for 90 minutes, twice daily, over 6 days) or placebo (session of 21% O-2 at 1.1 ata for 90 minutes, twice daily, over 6 days), All the patients received the same standard therapies (anticoagulant, antibiotics, wound dressings), Transcutaneous oxygen pressure (PtCO2) measurements were done before (patient breathing normal air) and during treatment (HBO or placebo) at the first, fourth, eighth, and twelfth sessions, The two groups (HBO group, n = 18; placebo group, n = 18) were similar in terms of age; risk factors; number, type or location of vascular injuries, neurologic injuries, or fractures; and type, location, or timing of surgical procedures, Complete healing was obtained for 17 patients in the HBO group vs, 10 patients in the placebo group (p < 0.01), New surgical procedures (such as skin flaps and grafts, vascular surgery, or even amputation) were performed on one patient in the HBO group vs, six patients in the placebo group (p < 0.05), Analysis of groups of patients matched for age and severity of injury showed that in the subgroup of patients older than 40 with grade III soft-tissue injury, wound healing was obtained for seven patients (87.5%) in the HBO group vs, three patients (30%) in the placebo group (p < 0.05), No significant differences were found in the length of hospital stay and number of wound dressings between groups, For the patients with complete healing, the PtCO2 values of the traumatized limb, measured in normal air, rose significantly between the first and the twelfth sessions (p < 0.001). No significant change in PtCO2 value was found for the patients whose healing failed, The Bilateral Perfusion Index (BPI = PtCO2 of the injured limb/PtCO2 of the uninjured limb) at the first session increased significantly from 1 ata air to 2.5 ata O-2 (p < 0.05), In patients with complete healing, the BPI was constantly greater than 0.9 at 2.5 ata O-2 during the following sessions, whereas the BPI in air progressively rose between the first and the twelfth sessions (p < 0.05), reaching normal values at the end of the treatment, In conclusion, this study shows the effectiveness of HBO in improving wound healing and reducing repetitive surgery, We believe that HBO is a useful adjunct in the management of severe (grade III) crush injuries of the limbs in patients more than 40 years old.