McCulloch Norman, Wojcik Susan M, Heyboer Marvin
Fellowship in Undersea & Hyperbaric Medicine, Department of Emergency Medicine, Division of Hyperbaric Medicine and Wound Care, SUNY Upstate Medical University, Syracuse, NY, USA.
Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.
J Am Coll Clin Wound Spec. 2016 Aug 30;7(1-3):8-12. doi: 10.1016/j.jccw.2016.08.004. eCollection 2015 Dec.
Calcific uremic arteriolopathy, also known as calciphylaxis, is a rare syndrome of small vessel calcification of unknown etiology causing painful, violaceous skin lesions that progress to form chronic non-healing ulcers and gangrene. Hyperbaric oxygen therapy (HBOT) can be used as adjunctive therapy in the treatment of these ulcers. However, due to paucity of cases, there is limited data on the clinical benefit of HBOT and identifying factors associated with healing. The purpose of this study was to determine patient outcomes and factors associated with healing in patients with calciphylaxis undergoing HBOT. A retrospective chart review was completed on patients who were diagnosed with calciphylaxis and had hyperbaric medicine consultation between May 2012 and January 2016. Clinical outcomes, demographics, risk factors, laboratory values, wound distribution, and HBOT profiles were collected and analyzed. We identified 8 patients. Out of 8 patients consulted for calciphylaxis, five were consented and underwent HBOT (2 males and 3 females). All had coexisting ESRD and Diabetes. All males were able to tolerate being in the chamber and received therapeutic treatments (at least 20 HBOT) with complete resolution of ulcers. HBOT was discontinued in one female due to an inconsistent biopsy report and two others due to death secondary to septic shock or respiratory arrest and severe uremia. Calciphylaxis is a devastating disease with a high mortality rate. Our results demonstrated a positive response to HBOT especially when receiving at least 20 treatments. A majority of calciphylaxis cases are females and indeed female gender has been cited as a risk factor for this disease. However, current literature has not conferred a relationship between gender nor the number of HBOT received and outcomes. Our results showed that males had a more favorable outcome provided they received at least twenty HBOT. Further prospective studies are needed to elucidate these outcomes.
钙化性尿毒症小动脉病，也称为钙化防御，是一种病因不明的罕见小血管钙化综合征，可导致疼痛的紫红色皮肤病变，进而发展为慢性不愈合溃疡和坏疽。高压氧治疗（HBOT）可作为这些溃疡治疗的辅助疗法。然而，由于病例稀少，关于HBOT临床益处以及确定与愈合相关因素的数据有限。本研究的目的是确定接受HBOT的钙化防御患者的治疗结果及与愈合相关的因素。对2012年5月至2016年1月期间被诊断为钙化防御并接受高压氧医学咨询的患者进行了回顾性病历审查。收集并分析了临床结果、人口统计学、危险因素、实验室值、伤口分布和HBOT资料。我们确定了8例患者。在8例因钙化防御而咨询的患者中，5例同意并接受了HBOT（2例男性和3例女性）。所有患者均合并终末期肾病（ESRD）和糖尿病。所有男性都能耐受舱内治疗并接受了治疗性治疗（至少20次HBOT），溃疡完全愈合。1例女性因活检报告不一致而停止HBOT，另外2例因感染性休克或呼吸骤停及严重尿毒症死亡而停止。钙化防御是一种死亡率很高的毁灭性疾病。我们的结果表明对HBOT有积极反应，尤其是接受至少20次治疗时。大多数钙化防御病例为女性，事实上女性性别被认为是该疾病的一个危险因素。然而，目前的文献尚未证实性别或接受HBOT的次数与治疗结果之间的关系。我们的结果表明，男性只要接受至少20次HBOT，就会有更有利的结果。需要进一步的前瞻性研究来阐明这些结果。
