对澳大利亚高压氧治疗单位中枢神经系统氧中毒发生率的实践审计。

Audit of practice in Australasian hyperbaric units on the incidence of central nervous system oxygen toxicity.

作者信息

Sherlock Susannah, Way Mandy, Tabah Alexis

机构信息

Corresponding author: Hyperbaric Medicine Unit and Anaesthesia, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia.

Hyperbaric Medicine Unit and Anaesthesia, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.

出版信息

Diving Hyperb Med. 2018 Jun 30;48(2):73-78. doi: 10.28920/dhm48.2.73-78.

DOI:10.28920/dhm48.2.73-78

PMID:29888378

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6156828/

Abstract

INTRODUCTION

Central nervous system oxygen toxicity (CNS-OT) is an uncommon complication of hyperbaric oxygen treatment (HBOT). Different facilities have developed local protocols in an attempt to reduce the risk of CNS-OT. This audit was performed to elucidate which protocols might be of benefit in mitigating CNS-OT and to open discussion on adopting a common protocol for Treatment Table 14 (TT14) to enable future multicentre clinical trials.

METHODS

Audit of CNS-OT events between units using different compression profiles for TT14, performed at 243 kPa with variable durations of oxygen breathing and 'air breaks', to assess whether there is a statistical diference between protocols. Data were collected retrospectively from public and private hyperbaric facilities in Australia and New Zealand between 01 January 2010 and 31 December 2014.

RESULTS

Eight of 15 units approached participated. During the five-year period 5,193 patients received 96,670 treatments. There were a total of 38 seizures in 33 patients when all treatment pressures were examined. In the group of patients treated at 243 kPa there were a total of 26 seizures in 23 patients. The incidence of seizure per treatment was 0.024% (2.4 per 10,000 treatments) at 243 kPa and the risk per patient was 0.45% (4.5 in 1,000 patients). There were no statistically significant differences between the incidences of CNS-OT using different TT14 protocols in this analysis.

CONCLUSION

HBOT is safe and CNS-OT is uncommon. The risk of CNS-OT per patient at 243 kPa was 1 in 222 (0.45%; range 0-1%) and the overall risk irrespective of treatment table was 0.6% (range 0.31-1.8%). These figures are higher than previously reported as they represent individual patient risk as opposed to risk per treatment. The wide disparity of facility protocols for a 243 kPa table without discernible influence on the incidence of CNS-OT rates should facilitate a national approach to consensus.

摘要

引言

中枢神经系统氧中毒（CNS - OT）是高压氧治疗（HBOT）一种不常见的并发症。不同机构制定了当地的方案，试图降低CNS - OT的风险。此次审核旨在阐明哪些方案可能有助于减轻CNS - OT，并开启关于采用治疗表14（TT14）通用方案以开展未来多中心临床试验的讨论。

方法

对使用不同TT14压缩方案的各单位之间的CNS - OT事件进行审核，在243 kPa下进行，吸氧时间和“空气间歇”时长可变，以评估各方案之间是否存在统计学差异。数据于2010年1月1日至2014年12月31日从澳大利亚和新西兰的公立和私立高压氧设施中进行回顾性收集。

结果

15个被联系的单位中有8个参与。在这五年期间，5193名患者接受了96670次治疗。当检查所有治疗压力时，33名患者共发生38次癫痫发作。在243 kPa治疗的患者组中，23名患者共发生26次癫痫发作。在243 kPa时每次治疗癫痫发作的发生率为0.024%（每10000次治疗中有2.4次），每位患者的风险为0.45%（每1000名患者中有4.5次）。在该分析中，使用不同TT14方案的CNS - OT发生率之间无统计学显著差异。

结论

高压氧治疗是安全的，中枢神经系统氧中毒并不常见。在243 kPa时每位患者发生CNS - OT的风险为222分之一（0.45%；范围0 - 1%），无论治疗表如何，总体风险为0.6%（范围0.31 - 1.8%）。这些数字高于先前报告的数字，因为它们代表的是个体患者风险，而非每次治疗的风险。对于243 kPa治疗表，各机构方案差异很大，但对CNS - OT发生率无明显影响，这应有助于形成全国性的共识方法。