高压氧个体化治疗方案的实施

Individualization of Hyperbaric Oxygen Therapy

目的：探讨个体化高压氧（HBO）治疗方案的临床应用与疗效。方法：A组3200例，根据患者年龄、病种、病情、心理状况结合氧舱内治疗生命体征监护数据选择不同的个体化治疗方案，包括渐进式治疗；单独开舱；升、减压速率相对慢的1．75ATA压力；1．3～1．6ATA、升、减压速率3～4kPa／min、吸氧40～60min;升、减压速率5kPa／min及2．0ATA稳压吸氧60min的常规治疗。另以未采用个体化治疗方案前使用传统常规治疗方案的1820例为B组作为对照。比较2组患者的治愈率、总有效率、对治疗医嘱的依从性及治疗安全性。结果：治疗10～20d后，A组患者总有疗效和治愈率均优于B组（94．4％、64．9％与90．3％、55．0％，P〈0．01）；与B组比较，A组患者中昏迷、气管切开的比例增加2．2％、婴幼儿增加6．2％、≥70岁高龄老年患者增加7．4％（均P〉0．01），且在治疗过程中均未出现不良病情变化；实施个体化治疗方案后愿意接受HBO治疗的患者从64．5％增加至77．6％（P〈0．01）。结论：采用个体化治疗方案进行HBO治疗，可明显提高疗效、医嘱依从性和治疗的安全性，是更为科学和人性化的选择。

Objective： To explore the clinical application and efficacy of individualized hyperbaric oxygen therapy （HBO）. Methods：Individualized HBO was selected for 3200 patients according to their ages, diseases, conditions, psychologic status, combined with the data from intra-oxygen chamber vital sign monitoring （group A）. Program A was a gradual pattern with an air pressure arising from 0. 1 to 0. 2 ATA. Program B referred to an open-chamber therapy for a single patient with a severe case. Program C focused on the patients subject to specific diseases including apoplexy, post-operated encephalic angioma set at 1.75 ATA with a comparatively slow velocity in air pressure reduction procedure. Program D was aimed to neonates, infants and old aged patients at a pressure of 1.3--1.6 ATA , a velocity of 3--4 kPa/min and an oxygen inhalation for 40--60 min- Program E inherited a conventional therapy at a pressure of 2.0 ATA , a velocity of 5 kPa/min and a constant oxygen inhalation for 60 min- Additional 1820 patients served as group B who were conducted by conventional therapy prior to the individualized program setting. Comparison was made between groups A and B for their curative rate, total effective rate, compliance to the doctofs orders and safety. Results：Curative effect and curative rate was higher in group A than in group B （P〈0. 01） with an increase of unconscious and tracheal incision patients by 2.2%, of infants by 6.20%, of aged older than 70 by 7.4% （P〈0. 01）. No negative effect was found during the procedure. Percentage of patients willing to receive HBO went significantly up from 64.5 % before individualization to 77.6 Y00 after individualization. Conclusion.. Therapeutic efficacy, compliance to doctor＇s orders and safety are increased significantly by the individualized HBO, a more scientific, humanized and reasonable HBO on the bases of patients, diseases and conditions.