Thorsen E, Aanderud L, Aasen T B
Dept of Hyperbaric Medicine, Haukeland Hospitak, Bergen, Norway.
Eur Respir J. 1998 Dec;12(6):1442-5. doi: 10.1183/09031936.98.12061442.
The prescription of hyperbaric oxygen (HBO) therapy for disorders not related to diving is increasing. Pulmonary oxygen toxicity is well known, but the effect of the cumulative oxygen exposure corresponding to a standard HBO treatment protocol has not been quantified before. Twenty patients (10 male) had 21 HBO treatments at a partial pressure of oxygen of 240 kPa for 90 min daily. None had any previous lung disease and all had normal chest radiography and lung function at the start of the study. Dynamic lung volumes, forced expiratory flows and the transfer factor of the lung for carbon monoxide (TL,CO) were measured before the HBO treatment, on days 7, 14 and 21 during treatment and then 3-4 weeks after treatment. Four patients (one male) reported nonproductive coughing during the last week of treatment. There was a progressive reduction in forced expiratory volume in one second (FEV1) (p<0.001), mean forced mid-expiratory flow rate (FEF25-75%) (p<0.001) and forced expiratory flows at 50 and 75% of forced vital capacity (FVC) expired during HBO treatment. The reduction in FEV1 on day 21 was 4.4+/-1.7% and in FEF25-75% 10.3+/-6.1%. Four weeks after treatment there was a partial normalization. There were no changes in FVC or peak expiratory flow (PEF). TL,CO was slightly reduced on day 21 of treatment only (p<0.01) and fully normalized 1 month later. A reduction in small airways conductance is consistent with other studies where total oxygen exposures have been below the limit causing toxic pulmonary effects traditionally measured as a reduction in vital capacity. This effect is not considered to be of any clinical significance for patients treated with hyperbaric oxygen unless repeated treatment series are to be given.
高压氧（HBO）疗法在非潜水相关疾病治疗中的应用正在增加。肺氧中毒众所周知，但此前尚未对标准HBO治疗方案所对应的累积氧暴露效应进行量化。20例患者（10例男性）接受了21次HBO治疗，氧分压为240 kPa，每日90分钟。所有患者既往均无肺部疾病，研究开始时胸部X线和肺功能均正常。在HBO治疗前、治疗第7天、第14天和第21天以及治疗后3 - 4周测量动态肺容积、用力呼气流量和肺一氧化碳弥散量（TL,CO）。4例患者（1例男性）在治疗最后一周出现干咳。在HBO治疗期间，一秒用力呼气容积（FEV1）（p<0.001）、平均用力呼气中期流速（FEF25 - 75%）（p<0.001）以及在用力肺活量（FVC）的50%和75%时的用力呼气流量均逐渐降低。第21天时FEV1降低了4.4±1.7%，FEF25 - 75%降低了10.3±6.1%。治疗4周后部分恢复正常。FVC或呼气峰值流速（PEF）无变化。仅在治疗第21天时TL,CO略有降低（p<0.01），1个月后完全恢复正常。小气道传导性降低与其他研究结果一致，在这些研究中，总氧暴露低于传统上以肺活量降低来衡量的引起毒性肺效应的限值。除非进行重复治疗系列，否则这种效应对于接受高压氧治疗的患者不被认为具有任何临床意义。
