Fife Caroline E, Buyukcakir Cem, Otto Gordon, Sheffield Paul, Love Tommy, Warriner Robert
Department of Anesthesiology, The University of Texas Medical School at Houston, Texas, USA.
Wound Repair Regen. 2007 May-Jun;15(3):322-31. doi: 10.1111/j.1524-475X.2007.00234.x.
The objectives of this study were to report outcomes of a large number of patients receiving hyperbaric oxygen therapy (HBO(2)T) for diabetic lower-extremity ulcers, and to identify likely outcome predictors. Five hyperbaric facilities supplied data on 1,006 patients. A sixth clinic served as a validation sample for the regression-based prediction model, and later additional data from Memorial Hermann Hospital were added. The severity of lower-extremity lesions was assessed upon initiation of HBO(2)T using the Modified Wagner scale, and the outcome described as healed, partially healed, not improved, amputated, or died. Overall, 73.8% of patients improved (granulated or healed). Factors significantly related to outcome included renal failure, pack-year smoking history, transcutaneous oximetry, number of HBO(2)T treatments, and interruption of treatment regimen. Number of treatments per week and treatment pressure (2.0 vs. 2.4 atmospheres absolute) were not significant factors in outcome. Concomitant administration of autologous growth factor gel did not improve outcome. A multiple regression model was fitted to the data that can be used to predict the outcome of diabetic patients undergoing HBO(2)T. Given the high cost of amputation and rehabilitation, these data suggest that hyperbaric oxygen treatment should be an important adjunctive therapy to heal lower-extremity lesions, especially those with a Wagner grade of 3 or higher.
本研究的目的是报告大量接受高压氧疗法（HBO₂T）治疗糖尿病下肢溃疡患者的治疗结果，并确定可能的预后预测因素。五家高压氧治疗机构提供了1006例患者的数据。第六家诊所作为基于回归的预测模型的验证样本，后来又加入了纪念赫尔曼医院的其他数据。在开始HBO₂T治疗时，使用改良的瓦格纳量表评估下肢病变的严重程度，治疗结果描述为愈合、部分愈合、未改善、截肢或死亡。总体而言，73.8%的患者病情得到改善（有肉芽组织生长或愈合）。与预后显著相关的因素包括肾衰竭、吸烟包年史、经皮血氧饱和度、HBO₂T治疗次数以及治疗方案的中断。每周治疗次数和治疗压力（2.0与2.4绝对大气压）不是影响预后的显著因素。同时使用自体生长因子凝胶并未改善治疗结果。对数据拟合了一个多元回归模型，可用于预测接受HBO₂T治疗的糖尿病患者的预后。鉴于截肢和康复的高昂费用，这些数据表明高压氧治疗应成为愈合下肢病变，尤其是瓦格纳分级为3级或更高的病变的重要辅助治疗方法。
