高压氧治疗时的禁忌症及副作用

CONTRAINDICATIONStoHyperbaricOxygenTherapyTe-ChunHsiaHyperbaricOxygenTherapyCenterChinaMedicalCollegeHospitalAbsolutecontraindicationsUntreatedpneumothoraxthevolumechangesthattakeplaceinthepleuralspace,theairdoublingortriplinginvolumeasnormalatmosphericpressureisapproachedberelievedsurgicallybeforedecompressionorchesttubeismadereadyAbsolutecontraindicationsConcomitantadministrationofdoxorubicinorcisplatinaschemotherapeuticagentsforcancer.HBOanddoxorubicingiventogetherhascauseddeathinrats(probablyfromcardiactoxicity),andcisplatinwithHBOweakensthetensilestrengthofhealingwoundsinmice.AbsolutecontraindicationsDisulfiramblockstheproductionofsuperoxidedismutase(aprotectiveantioxidant)PrematureinfantsRetrolentalfibroplasiaFull-termbabiesmaybesafelytreatedwithHBOBabiesmayrequirepapooserestraints,andyoungchildrenmayneedmildsedation.PrematureinfantsHBOtreatmentofpregnantwomenmightstimulateprematureclosureofthepatentductusinthefetushavebeenmitigatedbyresearchintheSovietUnioninwhichwomeninallstagesofpregnancy,whentreatedwithHBO,producednormalchildrenOverridingneedtotreatapregnantpatient;eg,incarbonmonoxidepoisoning(wherethefetussuffersmuchmorethanthemother)orgasgangreneRelativecontraindicationsHistoryofspontaneouspneumothoraxPreviousthoracicsurgerySevereemphysemawithCO2intoxication,removalofthehypoxicdrivemaycauserespiratoryarrest.Upperrespiratoryinfectionsmaymakeitdifficultforthepatienttoequalizepressureintheearsandsinuses;decongestantsareindicatedRelativecontraindicationsHistoryofmiddleearsurgeryforotosclerosis,awireorplasticstrutmightbedisplacedifpatientcannotequalizepressureintheears;tympanostomytubesneeded.SeizuredisordersmayincreasesusceptibilitytoO2seizures,andadditionalpremedication(eg,withdiazepam)maybeadvisable.UncontrolledhighfevermaypredisposetoO2seizuresandshouldbereducedbeforeplacingpatientinthechamberRelativecontraindicationsRespiratoryviralinfectionsmaytendtoworsenwithHBOcongenitalspherocytosis,RBCsarefragile,andhighO2partialpressuresmaycauseseverehemolysis.EricKindwallstatesthatsperocytosisdoesnotpreventsuchapatientreceivingHBOT(non-diving)butshouldalerttheoperatortothepossibilityofhaemolysisRelativecontraindicationsOpticneuritis,evenifnotactive,sometimesassociatedwithblindnessfollowingHBOtreatmentrare,treatmentshouldbehaltedimmediatelyifthepatientcomplainsofasuddenchangeinvision.SideEffectsO2seizuresmorethan2.4atmospheresabsolute(ATA).SomepatientsareidiosyncraticallysusceptibletohighO2partialpressuresTreatmentisdiscontinuanceoftheO2incidenceofseizureislow,beingreportedat1.3/10,000treatments.SideEffectsPulmonaryO2toxicitysubsternalchestpain,cough,andpatchyatelectasisFingernumbnessAfter20or30treatments,somecomplainofnumbfingers,usuallyintheulnardistribution;butthissensationdisappearswithin4to6wkaftertherapy.SideEffectsSerousotitisminorproblem;treatmentisdecongestants.LensrefractivechangesMyopiaworsensPresbyopiaimprovessuggested,butnotproved,thatpreexistingcataractsmaturemorerapidlywithHBO