Efrati S, Gall N, Bergan J, Fishlev G, Bass A, Berman S, Hamad-Abu R, Feigenzon M, Weissgarten J
The Institute of Hyperbaric Medicine and Wound Care Clinic, Nephrology Division, Research & Development Unit, Assaf Harofeh Medical Center Zerifin, Israel.
Undersea Hyperb Med. 2009 Jan-Feb;36(1):1-12.
Hyperbaric oxygen therapy (HBO2) increases tissue oxygenation, thus serving as an adjunct therapy for diabetic wounds. However, in some patients there is insufficient increase in tissue O2.
To investigate the pathophysiology of insufficient HBO2 and the possible role of N-acetylcysteine (NAC).
Prospective, randomized, cross-over trial included 50 diabetic patients with non-healing ulcers. Each patient received two treatments with 100% oxygen/2ATA. NAC was administered i.v. at one of the two treatments. Basal and post-treatment peri-wound transcutaneous O2 (TcPO2) pressure, malondialdehyde (MDA), total anti-oxidant status (TAOS) and nitric oxide (NO) were assessed. An ulcer oxygenation increase above 200 mmHg was accepted as sufficient.
During HBO2, 17 patients (34%) demonstrated insufficient increase in TcPO2. Concomitantly, their TAOS and NO decreased, while MDA increased. NAC administration attenuated these parameters, thus improving the HBO2 outcome. In those affected by NAC, the cure rate was 75%. By contrast, in 66% of patients with sufficient increase in TcPO2 TAOS was increased and MDA decreased irrespective of NAC administration. The cure rate in this subgroup was 82%.
Insufficient increase of ulcer oxygenation during HBO2 results from exaggerated oxidative stress and decreased NO bioavailability. NAC administration-induced modulation of both parameters and may improve ulcer oxygenation during HBO2.
高压氧疗法（HBO2）可增加组织氧合，因此可作为糖尿病伤口的辅助治疗方法。然而，部分患者的组织氧增加不足。
探讨HBO2效果不佳的病理生理学机制以及N-乙酰半胱氨酸（NAC）的可能作用。
前瞻性、随机、交叉试验纳入了50例患有不愈合溃疡的糖尿病患者。每位患者接受两次100%氧气/2ATA治疗。在其中一次治疗时静脉注射NAC。评估基础状态及治疗后伤口周围的经皮氧分压（TcPO2）、丙二醛（MDA）、总抗氧化状态（TAOS）和一氧化氮（NO）。溃疡氧合增加超过200 mmHg被认为是充足的。
在HBO2治疗期间，17例患者（34%）的TcPO2增加不足。与此同时，他们的TAOS和NO下降，而MDA增加。给予NAC可使这些参数得到改善，从而提高HBO2的治疗效果。在接受NAC治疗的患者中，治愈率为75%。相比之下，在TcPO2增加充足的患者中，66%的患者无论是否给予NAC，TAOS均升高而MDA均下降。该亚组的治愈率为82%。
HBO2治疗期间溃疡氧合增加不足是由氧化应激过度和NO生物利用度降低所致。给予NAC可调节这两个参数，并可能改善HBO2治疗期间的溃疡氧合。
