Ambiru Satoshi, Furuyama Nobuaki, Aono Mitsuo, Otsuka Hiroaki, Suzuki Takuji, Miyazaki Masaru
Surgical Center and Division of Hyperbaric Medicine, Chiba University Hospital, Chiba 260-8677, Japan.
J Crit Care. 2008 Sep;23(3):295-300. doi: 10.1016/j.jcrc.2007.08.002. Epub 2007 Dec 11.
The aim of this study was to verify independent risk factors of pressure equalization problems associated with hyperbaric oxygen (HBO(2)) therapy.
We reviewed a single-institutional study of 1609 patients with 17604 treatments who had HBO(2) therapy in a multiplace chamber, in which the factors examined and their relationship to complications were assessed, using multivariate analyses, to determine the significantly independent risk factors of complications related to HBO(2) therapy.
The compression rate was 0.067 atmospheres absolute/min (6.8 kPa/min). Pressure equalization problems of the middle ear, expressed as pain or discomfort, such as cranial sinus pain, and teeth pain were observed in 156 patients (9.7%). Sixty-six of them could not continue HBO(2) therapy because of these problems. Peripheral circulatory disorders with refractory ulcers or nonhealing wounds and the interval between clinical symptoms and the first day of HBO(2) therapy were independent risk factors of pressure equalization problems. Independent risk factors of cessation due to pressure equalization problems were identified as age more than 61 years, female sex, and interval between symptoms and the first day of HBO(2) therapy.
It is suggested that chamber compression must be performed with particular care when patients have peripheral circulatory disorders and have short interval between clinical symptoms and the first day of HBO(2) therapy.
本研究旨在验证与高压氧(HBO₂)治疗相关的压力平衡问题的独立危险因素。
我们回顾了一项单机构研究,该研究纳入了1609例患者,共进行了17604次在多人舱内的HBO₂治疗。通过多变量分析评估所检查的因素及其与并发症的关系,以确定与HBO₂治疗相关并发症的显著独立危险因素。
加压速率为0.067绝对大气压/分钟(6.8千帕/分钟)。156例患者(9.7%)出现中耳压力平衡问题,表现为疼痛或不适,如颅窦疼痛和牙痛。其中66例因这些问题无法继续HBO₂治疗。伴有难治性溃疡或不愈合伤口的外周循环障碍以及临床症状与HBO₂治疗首日之间的间隔是压力平衡问题的独立危险因素。因压力平衡问题导致治疗中断的独立危险因素被确定为年龄超过61岁、女性以及症状与HBO₂治疗首日之间的间隔。
建议当患者存在外周循环障碍且临床症状与HBO₂治疗首日之间的间隔较短时,进行舱内加压操作必须格外小心。