高压氧疗法治疗辐射损伤的疗效：一项观察性队列研究。
Outcomes of Radiation Injuries Using Hyperbaric Oxygen Therapy: An Observational Cohort Study.
作者信息
Niezgoda Jeffrey A, Serena Thomas E, Carter Marissa J
机构信息
Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS, is President, American College of Hyperbaric Medicine; President/Chief Medical Officer, WebCME; President/Chief Medical Officer, AZH; and Industry Consultant for Hyperbaric and Wound Care, Milwaukee, Wisconsin. Thomas E. Serena, MD, FACS, FACHM, MAPWCA, is Founder/Chief Executive Officer/Medical Director, SerenaGroup, Cambridge, Massachusetts; President, American Professional Wound Care Association; and Vice President, American College of Hyperbaric Medicine. Marissa J. Carter, PhD, MAPWCA, is President, Strategic Solutions, Inc, Cody, Wyoming. Drs Niezgoda and Serena have disclosed that the American College of Hyperbaric Medicine has received funding from the Eric P. Kindwall, MD, Foundation. Dr Carter has disclosed that her company is remunerated for participation in review activities such as data monitoring boards, statistical analysis, and end point committees, and received payment for writing or reviewing the manuscript; and she is a consultant to the SerenaGroup.
出版信息
Adv Skin Wound Care. 2016 Jan;29(1):12-19. doi: 10.1097/01.ASW.0000473679.29537.c0.
BACKGROUND
The late effects of radiation therapy following the treatment of cancer are a well-known consequence. Evidence increasingly supports the use of hyperbaric oxygen (HBO) as an adjunctive treatment in a variety of radiation injuries.
OBJECTIVE
To present the findings of a new registry of radiation injuries that was developed to evaluate the outcomes and treatment parameters of HBO treatment (HBOT) when applied to patients experiencing the late effects of radiation therapy.
DESIGN
Observational cohort.
SETTING
Hyperbaric oxygen clinical treatment facilities in the United States.
PATIENTS
A total of 2538 patients with radiation-induced injuries.
MEASUREMENTS
Injury type, patient age, gender, diabetes, end-stage renal disease, collagen vascular disease, coronary artery disease/peripheral vascular disease, on anticoagulant medication, on systemic steroid medication, patient is current smoker, patient abuses alcohol, symptoms reported, duration of symptoms, symptom progression prior to HBOT, transfusion units, HBOT time, HBOT count, HBO chamber pressure, HBO time in chamber, and patient outcomes.
RESULTS
A total of 2538 patient entries with 10 types of radiation injuries were analyzed. The 5 most common injuries were osteoradionecrosis (33.4%), dermal soft tissue radionecrosis (27.5%), radiation cystitis (18.6%), radiation proctitis (9.2%), and laryngeal radionecrosis (4.8%). Clinical outcomes following HBOT were positive with symptoms that improved or resolved varying from 76.7% to 92.6%, depending on injury type. Overall, although the mean symptom improvement score between some groups is statistically significant, the differences are probably not clinically meaningful. Patients with osteoradionecrosis had the highest mean symptom improvement score (3.24) compared with a mean of 3.04 for laryngeal radionecrosis.
LIMITATIONS
Limited data were available on patient comorbidities and symptom severity.
CONCLUSIONS
Outcomes from a large patient registry of radiation-induced injuries support the continued therapeutic use of HBOT for radiation injuries.
背景
癌症治疗后放射治疗的晚期效应是一个众所周知的后果。越来越多的证据支持将高压氧（HBO）用作多种放射性损伤的辅助治疗。
目的
介绍一个新的放射性损伤登记处的研究结果，该登记处旨在评估高压氧治疗（HBOT）应用于遭受放射治疗晚期效应患者时的疗效和治疗参数。
设计
观察性队列研究。
地点
美国的高压氧临床治疗机构。
患者
总共2538例放射性损伤患者。
测量指标
损伤类型、患者年龄、性别、糖尿病、终末期肾病、胶原血管病、冠状动脉疾病/外周血管疾病、是否使用抗凝药物、是否使用全身性类固醇药物、患者是否为当前吸烟者、患者是否酗酒、报告的症状、症状持续时间、HBOT前症状进展情况、输血量、HBOT时间、HBOT次数、HBO舱压、在舱内的HBO时间以及患者结局。
结果
共分析了2538例有10种放射性损伤类型的患者记录。5种最常见的损伤为放射性骨坏死（33.4%）、皮肤软组织放射性坏死（27.5%）、放射性膀胱炎（18.6%）、放射性直肠炎（9.2%）和喉放射性坏死（4.8%）。HBOT后的临床结局为阳性，症状改善或缓解的比例在76.7%至92.6%之间，具体取决于损伤类型。总体而言，尽管某些组之间的平均症状改善评分在统计学上有显著差异，但这些差异可能在临床上并无意义。放射性骨坏死患者的平均症状改善评分最高（3.24），而喉放射性坏死患者的平均评分为3.04。
局限性
关于患者合并症和症状严重程度的数据有限。
结论
一个大型放射性损伤患者登记处的结果支持继续将HBOT用于放射性损伤的治疗。
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