高壓氧治療骨壞死的療程ornprotocol概要

1、Hyperbaric Oxygen Treatment Protocols for Mandibular Osteoradionecrosis,Te-Chun Hsia Abstract fromUndersea and Hyperbaric Medical Society, 2003,Introduction,5000 cent-grayProgressive radiation fibrosisCapillary loss

2、MandibleDense, poorly vascularised boneNeck and head area radiation injuryMark used HBO2 treatmentStimulate angiogenesis and Fibroplasia in affected tissue,Method,Mail surveyMailingsTelephone callsElectronic mail

3、,Results,316 htperbaric chamber facilities315 responded to the survey12 different protocols,Hyperbaric protocols for osteoradionecrosis,,Results,27%,49%,22%,2%,Discussion,¾ used 2.4 to 2.5 atm 90 min protocolRabb

4、its studiesPressure-response curve1.5 to 3.0 atm, increasing effect on angiogenesisPressure-time response curveDose response curveRecommended 2.5 atm abs to balance the benefit of HBO2 with an acceptable level of tr

5、eatment risk for clinical oxygen toxicity,Discussion,Is 1.9 atm abs enough?Ehler’s study1.9 atm , only 60% of the capillary density that would be achieved by treatment at 2.5 atm abs.,Discussion,Marx in 19882.4 atm ab

6、s 90 min plus appropriate surgery100% clinical success rate treating 268 cases of mandibular ORNMc Ginn-Merritt W in 2000Lower success rate,Discussion,UHMS Hyperbaric Oxygen Therapy Committee2.0 – 2.5 atm abs with 90

7、-120 min of 100% O2 administration dailyMonoplace, no air break, continuous O2, 2.0 atm abs to minimize risk of central nervous system oxygen toxicityNormobaric O2 administration confers no benefit,Conclusion,Mandibula

8、r ORN is treated in North America with different protocol1.9 to 2.5 atm absAnimal dataMore pressure, more angiogenesis in irradiated tissueClinical experience2.4 atm abs in human is successfulControlled trials are