ObjectiveTo study the effect of hyperbaric oxygen combined with nimodipine in the treatment of cerebral dysfunction resulted from traumatic brain injury. MethodWe retrospectively collected and analyzed the data of 124 patients with cerebral dysfunction induced by traumatic brain injury, admitted to the Neurosurgery Department during February 2011 to February 2014. All the patients were divided into the traditional treatment group (n=45), the traditional treatment with hyperbaric oxygen group (HBO group, n=40) and the traditional treatment with nimodipine and hyperbaric oxygen group (integrated group, n=39). The differences among the three groups in neurological injury severity evaluated by National Institute of Health Stroke Scale and the cerebral blood flow were recorded and analyzed at three time points (before the treatment, 2 and 4 weeks after treatment). ResultsThere was no significant difference in neurological injury severity and cerebral blood flow among these three groups before treatment (P>0.05). Evaluated at 2 and 4 weeks after treatments, the neurological injury severity of HBO group and integrated group were significantly less than the traditional treatment group (P<0.05); the neurological severity score of integrated group was significantly lower than the HBO group (P<0.05); the cerebral blood flow of HBO group and integrated group were significantly higher than the traditional treatment group (P<0.05); and the cerebral blood flow of integrated group was significantly higher than the HBO group (P<0.05). ConclusionsThe combination therapy of hyperbaric oxygen combined with nimodipine is effective in the treatment of cerebral dysfunction induced by traumatic brain injury, because of its attenuation of neurological injury severity and increase of cerebral blood flow.
Objective To assess the efficacy and safety of hyperbaric oxygen treatment for patients with post-stroke depression. Methods Randomized controlled trials (RCTs) about hyperbaric oxygen treatment with placebo or open control in patients with post-stroke depression were comprehensively retrieved in PubMed (1966 to 2012.12), EMbase (1974 to 2012.12), EBSCO (1965 to 2012.12), CENTRAL (2012.11), CBM (1978 to 2012.12), CNKI (1980 to 2012.12), and VIP (1989 to 2012.12). References of the included articles were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.0. Results Twelve trials involving 822 patients were included, all of which were randomized non-placebo controlled trials. The results of meta-analysis of 12 trials (n=822) showed, the improvement of depression symptoms in the HBO group was better than that in the control group (MD=4.82, 95%CI 3.12 to 6.52). However, funnel plot showed that publication bias was large. After removing three trials for sensitive analysis, the results showed that the improvement of depression symptoms in the HBO group was still better than that in the control group (MD=3.91, 95%CI 3.35 to 4.47). Adverse events were reported in 2 trials, including dizziness, palpitation, mild earache, tinnitus, etc. However, no severe adverse events occurred. Conclusion Current evidence indicates that, HBO can effectively reduce the score of HAMD and no serious adverse reactions occurred. It’s necessary to further carry out high quality randomized controlled trials with large sample size due to limited quality and quantity of the included studies, so as to assess its effectiveness and safety.
Hypoxia and other factors are related to cognitive impairment. Hyperbaric oxygen therapy can improve tissue oxygen supply to improve brain hypoxia. Based on the basic principle of hyperbaric oxygen therapy, hyperbaric oxygen has been widely used in recent years for cognitive impairment caused by stroke, brain injury, neurodegenerative disease, neuroinflammatory disease and metabolic encephalopathy. This article will review the basic mechanism of hyperbaric oxygen, and summarize and discuss the improvement of hyperbaric oxygen therapy on cognitive and brain diseases, in order to provide relevant reference for clinical treatment.
ObjectiveTo observe the clinical and imaging characteristics of radiation optic neuropathy (RION). MethodsA retrospective clinical study. A total of 43 patients (69 eyes) who were diagnosed with RION at the Chinese PLA General Hospital from 2010 to 2021 were included in this study. There were 23 males (36 eyes) and 20 females (33 eyes). The age of patients at the time of radiation therapy was 49.54±13.14 years. The main dose of radiotherapy for lesions was 59.83±14.12 Gy. Sixteen patients were treated with combined chemotherapeutic agents. The clinical details of best corrected visual acuity (BCVA) and color photography of the fundus were collected. Forty-six eyes underwent optical coherence tomography (OCT), visual field were examined in 30 eyes, magnetic resonance imaging (MRI) were performed in 40 eyes. The BCVA examination was performed using Snellen visual acuity chart, which was converted to minimum resolution angle logarithm (logMAR) visual acuity during recording. Hyperbaric oxygen therapy (HBOT) was performed in 10 patients (13 eyes), 9 patients (12 eyes) were treated with intravenous methylprednisolone (IVMP), 12 patients (23 eyes) were treated with HBOT combined with IVMP and control group of 12 patients (21 eyes) were only treated with basal treatment. And grouped accordingly. To observe the changes in onset, recovery, and final BCVA of the affected eye as well as thickness changes of the retinal nerve fiber layer (RNFL) of the optic disc and inner limiting membrane-retinal pigment epithelium (ILM-RPE) layer of the macular area, and final outcome of BCVA with different treatment modalities in affected eyes. The RNFL and ILM-RPE layer thicknesses were compared between patients with different disease duration as well as between treatment regimens using independent samples t-test. ResultsOf the 43 cases, vision loss was monocular in 17 patients (39.53%, 17/43) and binocular in 26 patients (60.47%, 26/43). The latency from radiotherapy to onset of visual loss was 36.33±30.48 months. The duration of RION ranged from 1 week to 10 years, in which the disease duration of 37 eyes ≤2 months. Subacute visual acuity loss was present in 41 eyes. logMAR BCVA＜1.0, 1.0-0.3, ＞0.3 were 45, 15, and 9 eyes, respectively. Optic disc pallor and optic disc edema were found in 10 (27.03%, 10/37), 3 (8.11%, 3/37) eyes, respectively, within 2 months. The superior RNFL [95% confidence interval (CI) 2.08-66.56, P=0.038] and the outer circle of the inner limiting membrane to retinal pigment epithelium (ILM-RPE) (95%CI 4.37-45.39, P=0.021) layer thinned significantly during the first month. The center of the ILM-RPE layer thickened (95%CI －32.95-－4.20, P=0.015) significantly during the first two months. The inner circle temporal quadrant of the ILM-RPE layer thickened (95%CI －42.22-－3.83, P=0.022) significantly from the third to sixth month, and the RNFL except for the temporal quadrants and the average RNFL, inner circle superior quadrant and outer circle of the ILM-RPE layer thinned significantly after 6 months (P＜0.05). Among the 40 eyes that underwent MRI examination, 33 eyes (82.50%, 33/40) were affected by T1 enhancement of optic nerve, including 23 eyes (69.70%, 23/33) in intracranial segment; 12 eyes with thickening and long T2 signal (36.36%, 12/33). After treatment, BCVA was restored in 17 eyes (24.6%, 17/69) and final BCVA improved in 9 eyes (13.0%, 9/69). There was no significant difference between HBOT, IVMP and HBOT combined with IVMP therapy in improving BCVA recovery or final BCVA compared with the control group, respectively (t=－1.04, 0.61, 1.31, －1.47, －0.42, 0.46; P＞0.05). ConclusionsThe structural damage of the RNFL and ILM-RPE layer occurred during the first month, the RNFL showed progressive thinning during the follow-up period, while the ILM-RPE layer showed thinning-thickening-thinning. MRI shows T1 enhancement of the optic chiasma and segments of the optic nerve, and the enhanced segments are usually accompanied by thickening and long T2. HBOT and IVMP have no obvious effect on RION.
Object To collect and summarize high quality clinical evidence on the use of hyperbaric oxygen (HBO) in health care generally. Method We searched MEDLINE (1980-2006), The Cochrane Library (Issue 1, 2006) and the China Biomedicine Database (1982-2006) for systematic reviews, meta-analyses and randomized controlled trials. The quality of included studies was critically evaluated. Result Thirteen systematic reviews (12 Cochrane reviews) on HBO were included. Results showed that HBO had some beneficial effect on acute coronary syndrome, ischemic stroke, multiple sclerosis, malignant otitis externa, idiopathic sudden sensorineural hearing loss and tinnitus. It might also promote chronic wound healing and relieve radiation damage.Conclusions Since the avaliable randomized controlled trials for the systematic reviews we included are too small, further well-designed multicentre large-scale trials are needed to determine the efficacy and safety of HBO .
ObjectiveTo overview the systematic reviews on efficacy and safety of hyperbaric oxygen in treatment of diabetic foot.MethodsCNKI, CBM, VIP, WanFang Data, The Cochrane Library, PubMed and EMbase databases were searched to collect systematic reviews or meta-analyses on the efficacy and safety of hyperbaric oxygen therapy for diabetic foot from inception to November 17th, 2019. Two researchers independently screened literature and extracted data. Then, AMSTAR 2 tool and PRISMA statement were used to evaluate the methodological quality and reporting quality of included systematic reviews, and the outcome indicators were comprehensively analyzed.ResultsA total of 10 systematic reviews were included. The results of AMSTAR 2 suggested that 6 systematic reviews were of extremely low quality, 3 of low quality, and 1 of high quality. The PRISMA score ranged from 16.5 to 27. The results of the included systematic reviews showed that hyperbaric oxygen therapy might be superior to other interventions in ulcer healing rate and large amputation rate without increasing the risk of adverse events. ConclusionsThe existing systematic reviews/meta-analysis evidence shows that hyperbaric oxygen therapy may have certain curative effect on diabetic foot, however, its methodology and report quality evaluation are insufficient.
【Abstract】Objective To investigate therapeutic effect and mechanism of hyperbaric oxygen and ulinastatin respectively or combinatively used to treat acute necrotizing pancreatitis (ANP). Methods One hundred and twenty SD rats were divided into 6 groups randomly: group of normal control, group receiving sham operation, group of untreated acute necrotizing pancreatitis (ANP group), group of acute necrotizing pancreatitis treated with hyperbaric oxygen (HBO group), group of acute necrotizing pancreatitis treated with ulinastatin (ULT group), and group of acute necrotizing pancreatitis treated with combined hyperbaric oxygen and ulinastatin (HBO+ULT group). The rat model of acute necrotizing pancreatitis was established according to Aho HJ et al. Concentrations of amylase, TNFα, TXB2 and 6ketoPGF1α in blood were measured through ELISA or radioimmunoassay. Changes of pancreatic histopathology were investigated. SPSS 10.0 was used in statistical analysis. Results The concentrations of amylase, TNFα, TXB2 in the ANPtreated groups were significantly lower than those of ANP group (P＜0.01) except for 6ketoPGF1α and the levels of amylase and TNFα of HBO group were strikingly higher than those in HBO+ULT group. Only the level of AMS was significantly different between ULT group and HBO+ULT group (P＜0.01). Pancreas histopathological scores(HS) and CD8 counts of ANP group were significantly higher than those the other three group, but CD4 counts and CD4/CD8 ratio were on the contrary (P＜0.05). HS of HBO and ULT were strikingly higher than those of HBO+ULT (P＜0.05).Conclusion ①Hyperbaric oxygen or ulinastatin can effectively decrease the blood levels of enzymes and cytokines and improve the pancreatic immunity. ②Hyperbaric oxygen in combination with ulinastatin are more effective than either of them in the treatment of ANP.
ObjectiveTo observe the effect of preoperative hyperbaric oxygen (HBO) pretreatment on systemic inflammatory response after extracorporeal circulation. MethodsA total of 30 patients who were going to receive mitral or aortic valve replacement were randomly allocated into a control group (group C, n=15) and a pretreatment group (group P, n=15).Three sessions of HBO pretreatments were given to the patients in the group P before operation. The changes of serum concentration of inflammatory factors including tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, P-selectin, intercellular adhesion molecule (ICAM)-1, heat shock protein (HSP)-70 between the two groups were compared at four time points:before incision of skin (T1), 30 min after ECC(T2), 1 h (T3) and 24 h (T4) after the end of ECC. ResultsThere was no statistical difference in the serum concentration of IL-6,TNF-α, P-selectin, ICAM-1, IL-10, and HSP-70 at T1 between the two groups (P>0.05). The level of all inflammatory factors ascended in first and descended at last in both groups, which reached a peak at T3 and descended at T4. But the serum concentration at T4 was still higher than the level at T1 (P<0.05). There was a statistical difference in serum level of HSP-70 between T4 and T1 (373.3±96.7 pg/ml vs. 316.3±55.5 pg/ml, P<0.05). There were statistical differences in serum concentration of IL-6 (141.5±25.9 pg/ml vs. 119.2±31.8 pg/ml), HSP-70 (449.8±48.3 pg/ml vs. 373.3±96.7 pg/ml), and IL-10 (64.2±8.2 pg/ml vs. 90.3±14.2 pg/ml) between the group C and the group P at T4 (P<0.05). There was no statistical difference between the two groups in postoperative ICU stay time and thoracic drainage. While time of postoperative ventilation in the group P was shorter than that in the group C with a statistical difference (11.4±5.6 days vs. 15.8±5.1 days, P<0.05). ConclusionHyperbaric oxygen pretreatment before operation can abate the bad inflammatory response after heart valve replacement surgery to some extent and strengthen the anti-inflammatory protection, thereby favoring the reduction in postoperative complications.
ObjectiveTo explore the safety of ventilator support in hyperbaric oxygen chamber and the prevention of related complications.MethodsFrom July 2016 to December 2018, there were 127 intensive care unit patients underwent hyperbaric oxygen therapy with ventilator. Medical professionals in hyperbaric medicine or intensive care medicine were arranged to accompany the patients in the treatment process, to observe the patients’ condition changes closely, monitor their heart rate, respiration, blood pressure, and oxygen saturation, and perform sputum suction at any time if needed and monitor the airway peak pressure change to prevent pneumothorax.ResultsDuring the process of hyperbaric oxygen therapy, 13 patients (10.24%) were treated with analgesia/sedation for patient-ventilator asynchrony, 4 patients (3.15%) exited the champer emergently for acute left heart failure, 3 patients (2.36%) had epileptic seizures, 3 patients (2.36%) had aspiration, and 1 patient (0.79%) had breath and cardiac arrest. After emergency treatment, all the patients returned to the ward safely.ConclusionDuring the treatment of hyperbaric oxygen therapy for intensive care unit patients with ventilator, the accompany of qualified professionals in hyperbaric medicine or intensive care medicine in the hyperbaric oxygen chamber can treat the patients’ symptoms timely and reduce the risk greatly.
ObjectiveTo observe the changes of central visual acuity and extracentral visual acuity in eyes with non-arteritic central retinal artery occlusion (NA-CRAO). MethodsA retrospective clinical study. From January 1, 2017 to December 31, 2024, 140 patients (140 eyes) diagnosed with NA-CRAO through ophthalmic examination at Department of Ophthalmology of First People's Hospital of Xianyang City were included in the study. All affected eyes underwent best corrected visual acuity (BCVA), visual field, intraocular pressure, fundus color photography, optical coherence tomography (OCT), and fluorescein angiography (FFA) examinations. After a clear diagnosis, conservative treatment such as reducing intraocular pressure, relieving spasms, and dilating blood vessels should be given immediately. Simultaneously, intravenous and/or arterial thrombolysis therapy should be administered based on the patient's overall condition. Under the same treatment conditions as other treatments, 33 eyes were treated with hyperbaric oxygen therapy within 24 hours after seeking medical attention. The changes in central visual acuity (BCVA) and peripheral visual acuity of the affected eye one month after treatment were observed. BCVA improvement of ≥ 1 line was defined as the increase of no light sensitivity to light sensitivity or above, and the increase of light sensitivity to 0.01 or above. The visual acuity outside the center was determined by the 0 ° axis in front of the eyeball at eye level, and was 10 ° outside visual acuity on the temporal side. Multivariate analysis using logistic regression analysis. ResultsAmong the 140 cases (140 eyes), there were 84 males (84 eyes) and 56 females (56 eyes). The mean age was (63.89±10.78) years. The duration of illness from the onset of symptoms to the time of diagnosis was 48 (2-720) hours. 6, 1, 14, 47, 41, 16, and 15 eyes were diagnosed with BCVA without light perception, uncertain light perception, manual/anterior, digital/anterior, 0.01-0.10, and ≥ 0.10, respectively. FFA examination revealed delayed arm retinal circulation time and filling of the retinal artery trunk to the peak, with changes in the "arterial front" observed in 126 eyes. OCT examination showed extensive edema and unclear structure in the inner layer of the retina in all patients. Out of 140 eyes, 122 were treated with intravenous thrombolysis and 4 with arterial thrombolysis; 14 eyes did not receive thrombolytic therapy. After treatment, 38 eyes (27.1%) showed an improvement of BCVA ≥ 1; 67 eyes (47.9%) did not show an improvement in BCVA, and the affected eye had a BCVA of approximately 0.6 without light perception; 17 eyes (12.1%) showed improvement in peripheral vision, and the peripheral vision of the affected eyes ranged from 0.01 to 0.1, all of whom were patients undergoing intravenous thrombolysis, and prior to treatment, this group of patients had complete blindness in the coarse side visual field of the Amsler grid, and their out of center visual acuity could not be measured. Among the 33 eyes treated with hyperbaric oxygen therapy, 24 eyes (72.7%) showed an increase in BCVA after treatment; 9 eyes did not improve, among which 4 eyes (12.1%) showed improvement in out of center visual acuity. Among the 107 eyes that did not receive hyperbaric oxygen therapy, 49 eyes (45.8%) showed an increase in BCVA after treatment. There was no improvement in 58 eyes (54.2%), among which 13 eyes (12.1%) showed an improvement in out of center visual acuity. The results of logistic regression analysis showed that intravenous thrombolysis and hyperbaric oxygen therapy were independent predictive factors for the improvement of central and extra central visual acuity (P＜0.05). ConclusionsHyperbaric oxygen therapy within 24 hours of seeking medical attention for patients with NA-CRAO disease course ≤ 1 month has a significant effect on the recovery of central and extra central vision. Intravenous thrombolysis and hyperbaric oxygen therapy are independent predictive factors for the improvement of central and extra central vision.