Patient Outcomes and Factors Associated with Healing in Calciphylaxis Patients Undergoing Adjunctive Hyperbaric Oxygen Therapy.
Patient Outcomes and Factors Associated with Healing in Calciphylaxis Patients Undergoing Adjunctive Hyperbaric Oxygen Therapy.
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DOI：
10.1016/j.jccw.2016.08.004
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发表时间：
2015-12-01
期刊：
影响因子：
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通讯作者：
Heyboer, Marvin 3rd
中科院分区：
文献类型：
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作者：
McCulloch, Norman;Wojcik, Susan M;Heyboer, Marvin 3rd
钙化性尿毒症动脉病变，又称钙质疏松症，是一种原因不明的小血管钙化的罕见综合征，导致疼痛的紫罗兰色皮肤病变，进展为慢性不可愈合的溃疡和坏疽。高压氧疗法(HBOT)可作为治疗这些溃疡的辅助疗法。然而，由于病例稀少，关于HBOT的临床益处和确定与愈合相关的因素的数据有限。本研究的目的是确定接受高压氧治疗的钙质疏松症患者的预后和与愈合相关的因素。对2012年5月至2016年1月期间被诊断为钙质疏松症并接受高压药咨询的患者进行了回顾性图表回顾。收集和分析临床结果、人口学资料、危险因素、实验室数据、伤口分布和高压氧治疗资料。我们确定了8名患者。在8名接受钙剂治疗的患者中，有5名患者同意接受高压氧治疗(2名男性和3名女性)。所有患者都同时患有终末期肾病和糖尿病。所有男性都能耐受住在房间里，并接受了治疗(至少20HBOT)，溃疡完全消失。一名女性因活检报告不一致而停用HBOT，另外两名女性因继发性感染性休克或呼吸骤停及严重尿毒症死亡。钙质疏松症是一种高死亡率的破坏性疾病。我们的结果显示对HBOT有积极的反应，特别是当接受至少20次治疗时。大多数钙剂中毒病例是女性，事实上，女性被认为是这种疾病的风险因素。然而，目前的文献还没有赋予性别或HBOT接收的数量与结果之间的关系。我们的结果显示，如果男性接受至少20次HBOT治疗，他们的结果会更有利。需要进一步的前瞻性研究来阐明这些结果。
Calcific uremic arteriolopathy, also known as calciphylaxis, is a rare syndrome of small vessel calcification of unknown etiology causing painful, violaceous skin lesions that progress to form chronic non-healing ulcers and gangrene. Hyperbaric oxygen therapy (HBOT) can be used as adjunctive therapy in the treatment of these ulcers. However, due to paucity of cases, there is limited data on the clinical benefit of HBOT and identifying factors associated with healing. The purpose of this study was to determine patient outcomes and factors associated with healing in patients with calciphylaxis undergoing HBOT. A retrospective chart review was completed on patients who were diagnosed with calciphylaxis and had hyperbaric medicine consultation between May 2012 and January 2016. Clinical outcomes, demographics, risk factors, laboratory values, wound distribution, and HBOT profiles were collected and analyzed. We identified 8 patients. Out of 8 patients consulted for calciphylaxis, five were consented and underwent HBOT (2 males and 3 females). All had coexisting ESRD and Diabetes. All males were able to tolerate being in the chamber and received therapeutic treatments (at least 20 HBOT) with complete resolution of ulcers. HBOT was discontinued in one female due to an inconsistent biopsy report and two others due to death secondary to septic shock or respiratory arrest and severe uremia. Calciphylaxis is a devastating disease with a high mortality rate. Our results demonstrated a positive response to HBOT especially when receiving at least 20 treatments. A majority of calciphylaxis cases are females and indeed female gender has been cited as a risk factor for this disease. However, current literature has not conferred a relationship between gender nor the number of HBOT received and outcomes. Our results showed that males had a more favorable outcome provided they received at least twenty HBOT. Further prospective studies are needed to elucidate these outcomes.