Van Meter Keith W
Louisiana State University-Health Sciences Center, Department of Medicine, Section of Emergency Medicine, New Orleans, Louisiana, USA.
Undersea Hyperb Med. 2012 Sep-Oct;39(5):937-42.
As a respiratory pigment, hemoglobin allows blood to carry unnaturally high levels of nascent, molecular oxygen at one atmosphere of pressure in chemical solution to capillary beds and post-capillary venules supplying parenchymal cells of all organ systems in the body. When hemoglobin drops to critical levels to disallow proper oxygen delivery, hyperbaric oxygen therapy may be used as bridge therapy to emergently supply oxygen. Hyperbaric-administered oxygen allows oxygen to be dissolved in increased concentration in red blood cell-poor plasma or crystalloid/ colloid-diluted intravascular fluids in a volume-resuscitated patient. Additionally in both subacutely and chronically anemic patients, pulsed, intermittently provided normobaric or hyperbaric oxygen induces an increase in red blood cell/hemoglobic mass. Transfusions of separate donor red blood cells are transplantations of tissue not uncomplicated by immunomodulatory reactions. In the long term, autologous blood products may be less problematic than transfused, homologous packed red blood cells to reduce patient oxygen debt in illness or injury. Hyperbaric oxygen can reduce oxygen debt decisively in the polar clinical extremes of exsanguination with cardiopulmonary arrest all the way to resuscitation of the severely anemic patient who cannot be transfused with red blood cells for religious reasons, immunologic reasons, or blood availability problems. A hyperbaric oxygen treatment is equivalent in wholesale cost to a unit of packed red blood cells in the western world. By controversy, but true, hyperbaric oxygen provides a low-technology, cost-competitive means of pharmacologically reducing accumulated oxygen debt in the anemic, injured or critically ill patient with little side effect. To address severe anemia in trauma or illness, the future may well afford the use of hyperbaric oxygen therapy in the military far-forward, in pre-hospital EMS settings, in trauma center emergency departments, in operative and recovery units, and in intensive care units of hospitals.
作为一种呼吸色素，血红蛋白使血液能够在一个大气压的化学溶液中携带异常高水平的新生分子氧，将其输送到为身体所有器官系统的实质细胞供血的毛细血管床和毛细血管后微静脉。当血红蛋白降至临界水平而无法实现正常的氧气输送时，高压氧疗法可作为一种过渡疗法来紧急供应氧气。高压给予的氧气能使氧气以更高的浓度溶解在红细胞含量低的血浆或晶体/胶体稀释的血管内液体中，用于已进行容量复苏的患者。此外，对于亚急性和慢性贫血患者，间歇性提供的常压或高压脉冲氧会促使红细胞/血红蛋白量增加。输注来自不同供血者的红细胞属于组织移植，会引发免疫调节反应。从长远来看，自体血制品可能比输注的同源浓缩红细胞问题更少，有助于减少患者在疾病或损伤中的氧债。在临床上，从因心肺骤停而大量失血的极端情况到因宗教、免疫或血液供应问题无法输注红细胞的严重贫血患者的复苏，高压氧都能决定性地减少氧债。在西方世界，一次高压氧治疗的总成本与一单位浓缩红细胞相当。颇具争议但却是事实的是，高压氧提供了一种低技术、成本具有竞争力的方法，能在药理上减少贫血、受伤或重症患者累积的氧债，且副作用很小。为解决创伤或疾病中的严重贫血问题，未来很可能会在军事前沿、院前急救医疗服务环境、创伤中心急诊科、手术和恢复病房以及医院重症监护病房中使用高压氧疗法。
