Maynor M L, Moon R E, Klitzman B, Fracica P J, Canada A
Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
Acad Emerg Med. 1997 Mar;4(3):184-92. doi: 10.1111/j.1553-2712.1997.tb03738.x.
Loxosceles reclusa (brown recluse) spider bites can produce severe skin lesions that may necessitate extensive surgical repair. This study delineated the effects of hyperbaric oxygen (HBO) therapy on these lesions by performing a prospective controlled animal study.
After approval by the Institutional Animal Care and Use Committee, 41 New Zealand white rabbits received 64 intradermal injections of 73 microL of raw venom extract mixed with physiologic buffered saline (Dulbecco's solution). Control injections were made with buffer. The animals were divided into 5 groups: 1) venom and no HBO; 2) venom and 1 immediate HBO treatment (100% O2); 3) venom and immediate HBO with 10 treatments (100% O2); 4) venom and then delayed (48 hr) HBO therapy with 10 treatments (100% O2); and 5) venom and immediate hyperbaric treatment with normal inspired PO2 for 10 treatments (8.4% O2). Three animals in group 2 also received a control sodium citrate buffer injection. HBO treatments were at 2.5 atm absolute (ATA) for 90 minutes twice daily. Daily measurements were made of the lesion diameter, and skin blood flow using a laser Doppler probe.
There was no significant effect of HBO on blood flow at the wound center or 1-2 cm from the wound center. Standard HBO significantly decreased wound diameter at 10 days (p < 0.0001; ANOVA), whereas hyperbaric treatment with normoxic gas had no effect. Histologic preparations from 2 animals in each group revealed that there were more polymorphonuclear leukocytes in the dermis of all the HBO-treated animals when compared with the venom-alone and sodium-citrate controls.
HBO treatment within 48 hours of a simulated bite from L. reclusa reduces skin necrosis and results in a significantly smaller wound in this model. The mechanism appears unrelated to augmented local blood flow between treatments.
褐蛛（棕色遁蛛）叮咬可导致严重皮肤损伤，可能需要进行广泛的手术修复。本研究通过开展一项前瞻性对照动物研究，阐述了高压氧（HBO）治疗对这些损伤的影响。
经机构动物护理和使用委员会批准，41只新西兰白兔接受了64次皮内注射，每次注射73微升与生理缓冲盐水（杜尔贝科溶液）混合的粗毒液提取物。对照注射使用缓冲液。动物被分为5组：1）毒液组且不进行HBO治疗；2）毒液组且立即进行1次HBO治疗（100%氧气）；3）毒液组且立即进行10次HBO治疗（100%氧气）；4）毒液组，然后延迟（48小时）进行10次HBO治疗（100%氧气）；5）毒液组且立即进行10次常压吸氧高压治疗（8.4%氧气）。第2组中的3只动物还接受了对照柠檬酸钠缓冲液注射。HBO治疗在绝对压力2.5个大气压（ATA）下进行，每天两次，每次90分钟。每天使用激光多普勒探头测量损伤直径和皮肤血流。
HBO对伤口中心或距伤口中心1 - 2厘米处的血流没有显著影响。标准HBO在第10天时显著减小了伤口直径（p < 0.0001；方差分析），而常压吸氧高压治疗则没有效果。每组2只动物的组织学标本显示，与仅注射毒液和柠檬酸钠对照组相比，所有接受HBO治疗的动物真皮中的多形核白细胞更多。
在本模型中，模拟褐蛛叮咬后48小时内进行HBO治疗可减少皮肤坏死，并使伤口明显变小。其机制似乎与治疗期间局部血流增加无关。
