高压氧治疗时的禁忌症及副作用

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CONTRAINDICATIONStoHyperbaricOxygenTherapyTe-ChunHsiaHyperbaricOxygenTherapyCenterChinaMedicalCollegeHospital AbsolutecontraindicationsUntreatedpneumothoraxthevolumechangesthattakeplaceinthepleuralspace,theairdoublingortriplinginvolumeasnormalatmosphericpressureisapproachedberelievedsurgicallybeforedecompressionorchesttubeismadeready AbsolutecontraindicationsConcomitantadministrationofdoxorubicinorcisplatinaschemotherapeuticagentsforcancer.HBOanddoxorubicingiventogetherhascauseddeathinrats(probablyfromcardiactoxicity),andcisplatinwithHBOweakensthetensilestrengthofhealingwoundsinmice. AbsolutecontraindicationsDisulfiramblockstheproductionofsuperoxidedismutase(aprotectiveantioxidant) PrematureinfantsRetrolentalfibroplasiaFull-termbabiesmaybesafelytreatedwithHBOBabiesmayrequirepapooserestraints,andyoungchildrenmayneedmildsedation. PrematureinfantsHBOtreatmentofpregnantwomenmightstimulateprematureclosureofthepatentductusinthefetushavebeenmitigatedbyresearchintheSovietUnioninwhichwomeninallstagesofpregnancy,whentreatedwithHBO,producednormalchildrenOverridingneedtotreatapregnantpatient;eg,incarbonmonoxidepoisoning(wherethefetussuffersmuchmorethanthemother)orgasgangrene RelativecontraindicationsHistoryofspontaneouspneumothoraxPreviousthoracicsurgerySevereemphysemawithCO2intoxication,removalofthehypoxicdrivemaycauserespiratoryarrest.Upperrespiratoryinfectionsmaymakeitdifficultforthepatienttoequalizepressureintheearsandsinuses;decongestantsareindicated RelativecontraindicationsHistoryofmiddleearsurgeryforotosclerosis,awireorplasticstrutmightbedisplacedifpatientcannotequalizepressureintheears;tympanostomytubesneeded.SeizuredisordersmayincreasesusceptibilitytoO2seizures,andadditionalpremedication(eg,withdiazepam)maybeadvisable.UncontrolledhighfevermaypredisposetoO2seizuresandshouldbereducedbeforeplacingpatientinthechamber RelativecontraindicationsRespiratoryviralinfectionsmaytendtoworsenwithHBOcongenitalspherocytosis,RBCsarefragile,andhighO2partialpressuresmaycauseseverehemolysis.EricKindwallstatesthatsperocytosisdoesnotpreventsuchapatientreceivingHBOT(non-diving)butshouldalerttheoperatortothepossibilityofhaemolysis RelativecontraindicationsOpticneuritis,evenifnotactive,sometimesassociatedwithblindnessfollowingHBOtreatmentrare,treatmentshouldbehaltedimmediatelyifthepatientcomplainsofasuddenchangeinvision. SideEffectsO2seizuresmorethan2.4atmospheresabsolute(ATA).SomepatientsareidiosyncraticallysusceptibletohighO2partialpressuresTreatmentisdiscontinuanceoftheO2incidenceofseizureislow,beingreportedat1.3/10,000treatments. SideEffectsPulmonaryO2toxicitysubsternalchestpain,cough,andpatchyatelectasisFingernumbnessAfter20or30treatments,somecomplainofnumbfingers,usuallyintheulnardistribution;butthissensationdisappearswithin4to6wkaftertherapy. SideEffectsSerousotitisminorproblem;treatmentisdecongestants.LensrefractivechangesMyopiaworsensPresbyopiaimprovessuggested,butnotproved,thatpreexistingcataractsmaturemorerapidlywithHBO