高压氧治疗放射性骨坏死OSTEORADIONECROSIS.pptVIP

MARX PROTOCOL FOR TREATMENT OF ORN STAGE III After 30 initial dives the patient undergoes resection to bleeding, healthy bone HBO is then continued for a total of 60 dives MARX PROTOCOL FOR TREATMENT OF ORN STAGE III-R 10 weeks after resection the patient is given an additional 20 dives Reconstructive surgery is performed Patient then receives an additional 10 dives COMPLICATIONS Rare, however, primarily associated with barometric pressure changes or 02 toxicity Middle ear dysfuntion - TM rupture, hemorrhage, otitis media O2 toxicity - may cause seizures, pulmonary alveolar collapse and edema Decompression sickness (Bends) - formation of air bubble outside/inside CVS COMPLICATIONS Pnuemothorax - can develop from rupture of air spaces within the lungs or expansion of free air w/in the pleural cavity Arterial Gas Embolism (AGE) - lethal - occurs in very high pressure situations far above those used in HBO - sudden cerebral air embolism or rupture of overexpanded lungs COMPLICATIONS Psychological - claustrophobia, psychosis If pt. is intubated must inflate endotracheal tube balloon with normal saline vs. air as the air filled balloon will expand and rupture or cause pressure necrosis of the cords CONTRAINDICATIONS TO HBO THERAPY Pneumothorax - absolute contra: pts. with a history of asthma, COPD, emphysema are at risk for tension pneumo. CXR pre HBO is mandatory Optic neuritis - 25% incidence in MS pts who receive I-EBO - ? explanation Acute viral infection - potentiates viral infection CONTRAINDICATIONS TO HBO THERAPY URI - HBO should be delayed until subsides - congestion makes pressure equilibrium of sinuses and middle ear difficult CONGENITAL SPHEROCYTOSIS: condition where there are abnormal proteins that cause loss of RBC membrane following hemolysis of cells (glucose deprivation) - HBO exacerbates hemolysis in these pts. CONTRAINDICATIONS TO HBO THERAPY PREGNANCY: ? only in theory - large study of 700 pregnant woman in Russia who received HBO de