Lalieu Rutger C, Mulder Willem, Raap René D Bol, Stolk Saskia, Smit Casper, Dubois Emile Fl, van Hulst Rob A
Hyperbaar Geneeskundig Centrum, Rijswijk, the Netherlands.
Amsterdam University Medical Centers, Department of Anesthesiology, Amsterdam, the Netherlands.
J Wound Care. 2021 Sep 2;30(9):722-728. doi: 10.12968/jowc.2021.30.9.722.
Hard-to-heal diabetic foot ulcers (DFUs) may increase the risk of amputation. This study reports the positive influence of hyperbaric oxygen therapy (HBOT) on hard-to-heal DFUs involving underlying bone.
A single-centre, retrospective cohort study reporting the results of HBOT and wound care on hard-to-heal University of Texas grade 3 DFUs (i.e., involving underlying bone) between 2013 and 2019. Outcome measures were primarily (near-) complete wound healing (i.e., ≥80% ulcer surface area reduction) and amputation rate (minor or major), and secondarily the number of hyperbaric sessions and improvement in quality of life (QoL) and pain score.
The study included 206 patients, of whom 74 (36%) achieved complete wound healing, and 75 (36%) near-complete healing. Amputations were performed in 27 patients (13%): 12 (6%) minor and 15 (7%) major. The median number of HBOT sessions was 42. Participants who achieved complete healing received a median of 43 sessions, compared with 10 for those who required major amputation. Patients with at least 30 sessions were less likely to undergo amputation (odds ratio: 0.08; 95% confidence interval (CI): 0.03-0.21). Mean QoL increased by 7.6 points (95%CI: 3.9-11.3; p<0.01) and median pain score fell from 3 to 1 (0-3) (p<0.01).
The addition of HBOT to standard wound care may lead to a decreased amputation risk, improved wound healing and increased QoL for people with a University of Texas grade 3 DFU. An adequate number of HBOT sessions is required to achieve optimal clinical results. Objective selection criteria and shared decision-making are suggested to improve dropout rates.
难愈合的糖尿病足溃疡（DFUs）可能会增加截肢风险。本研究报告了高压氧疗法（HBOT）对累及深层骨骼的难愈合DFUs的积极影响。
一项单中心回顾性队列研究，报告了2013年至2019年间HBOT和伤口护理对德克萨斯大学3级难愈合DFUs（即累及深层骨骼）的治疗结果。主要结局指标为（接近）完全伤口愈合（即溃疡表面积减少≥80%）和截肢率（小截肢或大截肢），次要结局指标为高压氧治疗次数、生活质量（QoL）改善情况和疼痛评分。
该研究纳入了206例患者，其中74例（36%）实现了完全伤口愈合，75例（36%）接近完全愈合。27例患者（13%）接受了截肢手术：12例（6%）小截肢，1例（7%）大截肢。HBOT治疗的中位数为42次。实现完全愈合的参与者接受的中位数为43次，而需要大截肢的参与者为10次。接受至少30次治疗的患者截肢可能性较小（比值比：0.08；95%置信区间（CI）：0.03 - 0.）。平均QoL提高了7.6分（95%CI：3.9 - 11.3；p<0.01），疼痛评分中位数从3降至1（0 - 3）（p<0.01）。
在标准伤口护理中添加HBOT可能会降低德克萨斯大学3级DFU患者的截肢风险，改善伤口愈合情况并提高生活质量。需要足够次数的HBOT治疗才能取得最佳临床效果。建议采用客观的选择标准和共同决策以提高患者留存率。
