高压氧治疗骨坏死的疗程ORNprotocol课件.pptVIP

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高压氧治疗骨坏死的疗程ORNprotocol课件.ppt

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Hyperbaric Oxygen Treatment Protocols for Mandibular Osteoradionecrosis Te-Chun Hsia Abstract from Undersea and Hyperbaric Medical Society, 2003 Introduction 5000 cent-gray Progressive radiation fibrosis Capillary loss Mandible Dense, poorly vascularised bone Neck and head area radiation injury Mark used HBO2 treatment Stimulate angiogenesis and Fibroplasia in affected tissue Method Mail survey Mailings Telephone calls Electronic mail Results 316 htperbaric chamber facilities 315 responded to the survey 12 different protocols Hyperbaric protocols for osteoradionecrosis Results Discussion ? used 2.4 to 2.5 atm 90 min protocol Rabbits studies Pressure-response curve 1.5 to 3.0 atm, increasing effect on angiogenesis Pressure-time response curve Dose response curve Recommended 2.5 atm abs to balance the benefit of HBO2 with an acceptable level of treatment risk for clinical oxygen toxicity Discussion Is 1.9 atm abs enough? Ehler’s study 1.9 atm , only 60% of the capillary density that would be achieved by treatment at 2.5 atm abs. Discussion Marx in 1988 2.4 atm abs 90 min plus appropriate surgery 100% clinical success rate treating 268 cases of mandibular ORN Mc Ginn-Merritt W in 2000 Lower success rate Discussion UHMS Hyperbaric Oxygen Therapy Committee 2.0 – 2.5 atm abs with 90-120 min of 100% O2 administration daily Monoplace, no air break, continuous O2, 2.0 atm abs to minimize risk of central nervous system oxygen toxicity Normobaric O2 administration confers no benefit Conclusion Mandibular ORN is treated in North America with different protocol 1.9 to 2.5 atm abs Animal data More pressure, more angiogenesis in irradiated tissue Clinical experience 2.4 atm abs in human is successful Controlled trials are needed for various protocols * * 120 2.5 4 12 120 2.4 2 11 120 2.0 13 10 60 0.6 80 2.4 1 9 90 2.5 71 8 90 2.4 134 7 85 2.4 1 6 90 2.2 3 5 60 2.0 30 2.5 1 4 90 2.0 48 3 90 1.9 1 2 70-80 2.4 1 1 Oxygen time #2(min) Pressure#2 (atm abs) Oxygen time #1(min) P