Adir Y, Halpern P, Nachum Z, Bitterman H
Israeli Naval Hyperbaric Institute, Haifa.
Eur J Vasc Surg. 1991 Dec;5(6):677-9. doi: 10.1016/s0950-821x(05)80905-3.
We present a case of accidental injection of oral methadone and flunitrazepam into the ulnar artery, with resultant severe ischaemia of the hand. Initial therapy consisted of systemic vasodilators, low molecular weight dextran and aspirin. When this therapy failed to produce improvement and amputation of the involved hand seemed inevitable, the patient was referred for hyperbaric oxygen (HBO) therapy. In spite of a 12 day delay in the initiation of HBO, the response was dramatic, with almost complete resolution of the ischaemic signs and symptoms. Intra-arterial injection, which is only rarely encountered in drug addicts, frequently results in severe ischaemia of an extremity, and carries with it a poor prognosis with currently accepted therapy. Given the presently reported experience and the known physiology of HBO, we conclude that HBO should be started early in the treatment of intra-arterial injection of drugs, and should also be considered following prolonged delays.
我们报告一例意外将口服美沙酮和氟硝西泮注入尺动脉的病例，导致手部严重缺血。初始治疗包括全身血管扩张剂、低分子右旋糖酐和阿司匹林。当这种治疗未能改善病情且受累手部截肢似乎不可避免时，患者被转诊接受高压氧（HBO）治疗。尽管在开始HBO治疗时有12天的延迟，但反应显著，缺血体征和症状几乎完全消退。动脉内注射在吸毒者中很少见，常导致肢体严重缺血，采用目前公认的治疗方法预后较差。鉴于目前报道的经验和已知的HBO生理机制，我们得出结论，HBO应在动脉内注射药物治疗早期开始，并且在长时间延迟后也应考虑使用。
