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目的探讨高压氧辅助治疗对尿道下裂(后型)患儿术后促进转移包皮皮瓣存活及预防尿瘘的作用。方法选取2006年1月-2010年12月在本院住院的年龄1~4岁的尿道下裂后型术后(Dukett尿道成型术)患儿,在常规使用相同抗生素治疗基础上,200例尿道下裂术后高压氧治疗患儿为高压氧治疗组。高压氧治疗组术后第2天开始高压氧治疗,疗程5 d,治疗压力2.3绝对压(ATA),加压20 m in,面罩吸入纯氧40 m in(舱内空气氧体积分数<250 mL.L-1),间隔吸入空气10 m in,再吸纯氧40 m in,减压33m in。每天1次,每次治疗143 m in。选取200例术后未行高压氧治疗的患儿作为对照组。术后第2天、第7天行动脉血气分析,同时观察患儿转移包皮皮瓣存活情况及尿瘘发生率。采用指标包括手指末梢血氧分压[pa(O2)]、氧饱和度[Sa(O2)]、转移包皮皮瓣存活情况和尿瘘发生率。结果高压氧治疗组术后第2天、第7天pa(O2)分别为(93.33±2.50)mmHg(1 mmHg=0.133 kPa)、(95.22±1.77)mmHg,Sa(O2)分别为(94.86±1.61)%、(96.08±1.60)%,均高于对照组(Pa<0.05)。高压氧治疗组转移包皮皮瓣显著存活157例(显著有效存活率78.5%),明显高于对照组(显著有效存活136例,存活率为68.0%)(P<0.05);且尿瘘的发生率(14.0%)明显低于对照组(22.5%)(P<0.05)。结论高压氧治疗可增加机体血氧含量、提高pa(O2),明显改善缺血、缺氧组织的血供,增强微循环功能,从而促进尿道下裂术后转移皮瓣的存活,降低尿瘘发生。
Objective To investigate the effects of hyperbaric oxygen therapy on the survival of the circumcised skin flap and the prevention of urinary fistula in children with hypospadias (posterior type). Methods From January 2006 to December 2010 in our hospital, aged 1 to 4 years old post-hypospadias (Dukett urethroplasty) children, routine use of the same antibiotics on the basis of 200 cases of urethra Hypotonic hyperbaric oxygen treatment of children with hyperbaric oxygen treatment group. Hyperbaric oxygen therapy group began hyperbaric oxygen therapy on the second postoperative day, the course of treatment was 5 days, the treatment pressure was 2.3 absolute pressure (ATA), pressure 20 min, mask inhalation of pure oxygen 40 m in (cabin air oxygen content <250 mL .L-1), air inhalation interval 10 min, and then inhaled pure oxygen 40 m in, decompression 33m in. Once daily, 143 mins per treatment. 200 cases were selected without hyperbaric oxygen therapy as a control group. Arterial blood gas analysis was performed on the second day and the seventh day after surgery. The survival of the circumcised skin flap and the incidence of urinary fistula were also observed. Indicators included peripheral blood oxygen partial pressure [pa (O2)], oxygen saturation [Sa (O2)], survival of metastatic foreskin flaps, and incidence of urinary fistula. Results The levels of pa (O2) in the hyperbaric oxygen group were (93.33 ± 2.50) mmHg (1 mmHg = 0.133 kPa) and 95.22 ± 1.77 mmHg on the 2nd and 7th day postoperatively respectively, and the values of Sa (O2) were 94.86 ± 1.61)%, (96.08 ± 1.60)% respectively, all higher than the control group (Pa <0.05). In the hyperbaric oxygen therapy group, 157 cases (markedly effective survival rate 78.5%) had significant survival of the metastatic foreskin flap, which was significantly higher than that of the control group (136 patients were significantly effective and the survival rate was 68.0%) (P <0.05); and the incidence of urinary fistula (14.0%) was significantly lower than the control group (22.5%) (P <0.05). Conclusions Hyperbaric oxygen therapy can increase body oxygen content, increase pa (O2), significantly improve blood supply of ischemic and hypoxic tissues and enhance microcirculation function, thereby promoting the survival of metastatic skin flap after hypospadias operation and reducing the occurrence of urinary fistula .