1. Taw qhia
Mob ntshav qab zib mellitus yog qhov tshwm sim ntau thiab muaj teeb meem loj ntawm cov ntshav qab zib mellitus, feem ntau cuam tshuam nrog kev kho mob qeeb, kev rov ua haujlwm siab, thiab muaj kev pheej hmoo ntawm kev txiav tawm yog tias tsis tswj kom tsim nyog. Kev kho tsis zoo ntawm cov kab mob ntshav qab zib tau txuas nrog ntau yam, suav nrog kab mob peripheral arterial, peripheral neuropathy, cuam tshuam lub cev tsis muaj zog, thiab tsis txaus cov ntaub so ntswg oxygenation. Hyperbaric Oxygen Therapy (HBOT) xa los ntawm hyperbaric chambers tau lees paub tias yog kev cuam tshuam tseem ceeb hauv kev tswj cov kab mob ntshav qab zib, leveraging physiological teebmeem ntawm hyperbaric oxygen los txhawb txoj kev kho qhov txhab. Phau ntawv qhia no qhia txog lub luag haujlwm ntawm HBOT lub luag haujlwm hauv kev saib xyuas qhov txhab mob ntshav qab zib, suav nrog nws cov txheej txheem ntawm kev ua haujlwm, kev siv tshuaj kho mob, cov txheej txheem siv, kev txiav txim siab txog kev nyab xeeb, thiab cov ntaub ntawv pov thawj tam sim no.
2. Mechanisms of Action of HBOT in Supporting Diabetic Wound Healing
Lub hauv paus ntsiab lus kho mob ntawm HBOT suav nrog kev xa tawm ze li ntawm 100% oxygen (tsawg kawg 95%) ntawm qhov siab siab tshaj atmospheric siab (feem ntau yog 1.5-3.0 atmospheres absolute, ATA). Cov txheej txheem no ua rau muaj kev nce siab ib nrab ntawm cov pa oxygen hauv cov ntshav thiab cov ntaub so ntswg, hais txog cov teeb meem tseem ceeb hauv kev kho mob ntshav qab zib qhov txhab los ntawm ntau txoj hauv kev:
2.1 Txhim kho cov ntaub so ntswg Oxygenation
Cov neeg mob ntshav qab zib feem ntau ntsib qhov tsis txaus ntawm cov hlab ntsha peripheral, ua rau txo cov ntshav ntws thiab cov pa oxygen tsis txaus rau qhov chaw mob. Nyob rau hauv hyperbaric tej yam kev mob, solubility ntawm oxygen nyob rau hauv cov ntshav plasma nce ntau (yooj yim ntawm hemoglobin khi), ua kom oxygen mus rau diffuse ntev nyob rau hauv cov ntaub so ntswg. Qhov no yuav pab txo cov ntaub so ntswg hypoxia, ib qho mob uas tuaj yeem cuam tshuam kev loj hlob ntawm fibroblasts, endothelial cells, thiab keratinocytes-txhua yam tseem ceeb rau kev kho qhov txhab.
2.2 Txhim kho Angiogenesis
txaus angiogenesis (kev tsim cov hlab ntsha tshiab) yog qhov tseem ceeb rau kev kho cov ntshav mus rau cov qhov txhab mob. Hyperbaric oxygen tuaj yeem txhawb kev nthuav tawm ntawm vascular endothelial growth factor (VEGF) thiab lwm yam pro-angiogenic yam, txhawb kev loj hlob thiab kev tsiv teb tsaws ntawm cov hlwb endothelial. Qhov no tuaj yeem ua kom nrawm tsim cov hlab ntsha tshiab, yog li txhim kho ntev - cov ntaub so ntswg perfusion thiab ua kom lub qhov txhab zoo.
2.3 Txhawb kev tiv thaiv kab mob
Cov kab mob ntshav qab zib ntev ntev feem ntau cuam tshuam los ntawm cov kab mob, ib feem ntawm lub cev tsis muaj zog uas txo cov leukocytes muaj peev xwm tshem tawm cov kab mob. Oxygen yog ib qho tsim nyog substrate rau neutrophils (ib hom leukocyte) los rhuav tshem cov kab mob los ntawm oxidative tawg mechanism. HBOT tuaj yeem txhim kho cov kab mob bactericidal ntawm neutrophils thiab inhibit qhov kev loj hlob ntawm cov kab mob anaerobic (uas vam meej nyob rau hauv ib puag ncig hypoxic), pab tswj kev kis kab mob.
2.4 Txhawb Collagen Synthesis
Collagen yog cov txheej txheem tseem ceeb ntawm cov kab mob extracellular matrix, tsim "scaffold" rau qhov txhab kho. Fibroblasts xav tau oxygen txaus los tsim collagen. Hyperbaric oxygen tuaj yeem txhim kho kev ua haujlwm fibroblast, nce collagen ntau lawm thiab hla - txuas. Qhov no tuaj yeem txhim kho lub zog thiab kev ncaj ncees ntawm cov ntaub so ntswg granulation, txhawb qhov txhab mob thiab epithelialization.
3. Cov Tshuaj Kho Mob rau HBOT hauv Kev Kho Mob Ntshav Qab Zib
HBOT tsis yog thawj zaug - kho kab mob rau txhua qhov mob ntshav qab zib tab sis yuav raug pom zoo raws li kev kho mob tshwj xeeb rau cov hom mob ntev uas tsis yog- kho cov mob ntshav qab zib uas ua tau raws li cov txheej txheem, raws li cov lus qhia los ntawm cov koom haum xws li Undersea thiab Hyperbaric Medical Society (UHMS). Cov txheej txheem no feem ntau suav nrog:
Diabetic Foot Ulcers (DFUs) nrog cov pov thawj ntawm cov ntaub so ntswg hypoxia uas tsis tau pom tias muaj kev txhim kho txawm tias tsawg kawg 4 lub lis piam ntawm kev saib xyuas tus qauv zoo (xws li kev tshem tawm qhov txhab, kev tiv thaiv kab mob, tshem tawm, kev tswj glycemic, thiab vascular optimization).
DFUs nyuaj los ntawm osteomyelitis (mob pob txha) uas tsis teb rau cov tshuaj tua kab mob thiab kev phais kev phais.
Mob ntshav qab zib qhov txhab cuam tshuam nrog Critical Limb Ischemia (CLI), txhais tau tias yog Pob Tawb -Brachial Index (ABI) < 0.4 lossis ntiv taw siab < 30 mmHg, qhov kev phais revascularization tsis ua tau lossis ua tsis tiav.
Mob ntshav qab zib qhov txhab nrog txwv gangrene (cov ntaub so ntswg necrosis) uas muaj kev pheej hmoo ntawm kev loj hlob mus rau kev txiav tawm loj.
Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias HBOT yuav tsum tau siv ua ke nrog cov txheej txheem kev kho mob thiab tsis tuaj yeem hloov cov kev cuam tshuam tseem ceeb xws li kev tswj glycemic, kev tshem tawm, kev tswj kab mob, thiab kev phais mob.
4. Kev Kho HBOT rau Cov Mob Ntshav Qab Zib
4.1 Pre-Kev Ntsuas Kev Kho Mob
Yuav tsum muaj kev ntsuam xyuas dav dav ntawm tus neeg mob ua ntej pib HBOT kom paub meej tias kev tsim nyog thiab tsis suav nrog contraindications. Cov kev ntsuam xyuas tseem ceeb muaj xws li:
Kev ntsuas qhov txhab: qhov loj me, qhov tob, qib ntawm necrosis, kab mob kis, thiab kev kho kom zoo.
Kev ntsuam xyuas cov hlab ntsha: Kev ntsuam xyuas ntawm cov ntshav peripheral ntawm pob qij txha -Brachial Index (ABI), ntiv taw ntsuas, Doppler ultrasound, lossis angiography.
Kev ntsuas kev ntsuas: glycemic tswj raws li txoj cai (Hemoglobin A1c, HbA1c), lub raum ua haujlwm, pulmonary function, ophthalmic kuaj (los tshuaj xyuas cov ntshav qab zib retinopathy, tus txheeb ze contraindication), thiab keeb kwm kho mob (xws li keeb kwm ntawm pneumothorax, phais pob ntseg, lossis claustrophobia).
4.2 Txoj Cai Kho Mob
Standard HBOT cov txheej txheem rau cov mob ntshav qab zib feem ntau suav nrog cov kev txwv hauv qab no, uas tuaj yeem hloov kho raws li tus neeg mob xav tau:
Siab: 2.0-2.4 atmospheres absolute (ATA).
Oxygen concentration: Ze li 100% (tsawg kawg 95%).
Kev kho lub sij hawm: 90-120 feeb ib zaug (nrog rau compression thiab decompression theem).
Ntau zaus: 5 zaug hauv ib lub lis piam, nrog rau tag nrho cov chav kawm ntawm 20-40 zaug (hloov raws li qhov mob zoo).
Thaum kho, cov neeg mob tau muab tso rau hauv ib qho chaw hyperbaric chamber (monoplace chambers rau ib tus neeg siv lossis multiplace chambers rau ntau tus neeg mob). Cov kws kho mob saib xyuas cov cim tseem ceeb, cov pa oxygen saturation, thiab kev nplij siab ntawm tus neeg mob thoob plaws qhov kev sib kho kom muaj kev nyab xeeb. Nws yuav tsum tau muab sau tseg tias hyperbaric chambers raug cais raws li Class IIb cov cuab yeej kho mob raws li European Union's Medical Devices Regulation (MDR) thiab yuav tsum ua raws li cov qauv kev nyab xeeb nruj.
4.3 Tom qab-Kev Kho Mob
Tom qab txhua qhov kev sib tham HBOT, lub qhov txhab yuav tsum tau rov- soj ntsuam thiab hnav khaub ncaws zoo. Kev ua raws li cov txheej txheem kev saib xyuas lub qhov txhab (xws li kev tshem tawm, kev tiv thaiv kab mob, thiab kev tswj glycemic) yog qhov tseem ceeb. Kev ntsuas tsis tu ncua ntawm qhov txhab loj, tsim cov ntaub so ntswg granulation, thiab qib mob tau ua los saib xyuas cov lus teb kho mob. Yog tias tsis pom muaj kev txhim kho tseem ceeb tom qab 10-15 zaug, txoj kev npaj kho mob yuav tsum tau rov qab- soj ntsuam los ntawm tus kws kho mob.
5. Kev txiav txim siab txog kev nyab xeeb thiab contraindications
5.1 Tsis muaj contraindications
HBOT yog nruj me ntsis txwv tsis pub rau cov neeg mob uas muaj cov mob hauv qab no vim muaj kev pheej hmoo ntawm cov xwm txheej tsis zoo:
Tsis kho pneumothorax (nce siab tuaj yeem ua rau lub ntsws loj dua).
Intracranial cua embolism (hyperbaric oxygen tuaj yeem nthuav dav cua npuas, uas ua rau muaj kev puas tsuaj rau lub paj hlwb).
Oxygen toxicity qaug dab peg (keeb kwm ntawm cov pa oxygen tsis daws teeb meem - ntxias qaug dab peg).
Qee qhov xwm txheej ntawm congenital spherocytosis (kev pheej hmoo ntawm hemolysis nyob rau hauv cov mob hyperbaric).
5.2 Cov txheeb ze Contraindications
Rau cov neeg mob uas muaj cov xwm txheej hauv qab no, HBOT tuaj yeem raug txiav txim siab tsuas yog tom qab muaj kev pheej hmoo txaus ntshai - kev soj ntsuam cov txiaj ntsig thiab kev siv cov kev cuam tshuam tsim nyog:
Proliferative mob ntshav qab zib retinopathy (kev pheej hmoo ntawm kev ua tsis zoo ntawm neovascularization; kev sib tham ophthalmic yog pom zoo ua ntej kho).
Kab Mob Hlwb Obstructive Pulmonary Disease (COPD) nrog cov pa roj carbon dioxide retention (kev pheej hmoo ntawm cov pa oxygen-induced hypoventilation; yuav tsum tau saib xyuas cov roj ntshav kom ze).
Lub raum tsis txaus (muaj peev xwm ua rau muaj kev pheej hmoo ntawm cov pa oxygen-vim oxidative kev nyuaj siab cuam tshuam rau lub raum ua haujlwm).
Claustrophobia (tej zaum yuav tswj tau nrog kev kho mob me me lossis kev siv ntau qhov chaw nrog tus khub).
Cev xeeb tub (tshwj xeeb tshaj yog thawj peb lub hlis twg; tsuas yog siv yog tias qhov txiaj ntsig zoo tshaj qhov kev pheej hmoo rau tus menyuam hauv plab).
5.3 Cov xwm txheej tsis zoo thiab cov tswv yim txo qis
Cov xwm txheej tsis zoo uas cuam tshuam nrog HBOT suav nrog pob ntseg barotrauma (mob lossis tympanic membrane rupture vim kev hloov siab), sinus barotrauma, thiab myopia ib ntus (ua rau oxygenation ntawm lub lens). Cov no tuaj yeem txo qis los ntawm kev qhia cov neeg mob kom ua cov txheej txheem sib npaug sib npaug (piv txwv li, nqos, yawning) thaum compression thiab kho tus nqi compression. Cov xwm txheej tsis tshua muaj tshwm sim tab sis loj heev (xws li oxygen toxicity thiab air embolism) tuaj yeem tiv thaiv tau los ntawm kev ua raws li cov txheej txheem kho mob thiab kev saib xyuas tas li los ntawm cov neeg ua haujlwm kho mob uas tsim nyog.
6. Cov pov thawj kho mob thiab cov txiaj ntsig kho mob
Ntau qhov kev tshawb fawb soj ntsuam thiab meta- cov kev tshuaj ntsuam tau tshawb xyuas lub luag haujlwm ntawm HBOT hauv kev txhim kho tus nqi kho mob ntawm cov mob ntshav qab zib ntev ntev thiab txo qis kev pheej hmoo ntawm kev txiav tawm. Piv txwv li, 2022 meta- kev tshuaj ntsuam luam tawm nyob rau hauv Phau Tsom Faj Txog Kev Kho Mob suav nrog 15 randomized tswj kev sim (RCTs) thiab pom tias HBOT tau cuam tshuam nrog kev kho mob siab dua ntawm cov kab mob ntshav qab zib ko taw piv rau kev saib xyuas tus qauv ib leeg (tus txheeb ze pheej hmoo RR=1.56, 95% kev ntseeg siab lub sijhawm 3-1.9). Tsis tas li ntawd, qee qhov kev tshawb fawb qhia tias HBOT tuaj yeem pab txo qis kev txiav txim siab loj los ntawm 30–50% hauv cov neeg mob uas tsis yog - kho qhov txhab thiab qhov mob caj dab tseem ceeb.
Nws yuav tsum tau hais qhia tias cov txiaj ntsig kev kho mob yuav txawv ntawm cov tib neeg. Cov yam ntxwv xws li lub sijhawm lub qhov txhab, qhov hnyav ntawm cov hlab ntsha tsis zoo, kev tswj glycemic, thiab kev ua raws li tus neeg mob ua raws li kev saib xyuas tus qauv tuaj yeem cuam tshuam rau kev ua haujlwm ntawm HBOT. Yog li ntawd, cov kev kho mob yuav tsum yog tus kheej raws li tus neeg mob qhov chaw kho mob tshwj xeeb thiab tsim los ntawm tus kws kho mob uas tsim nyog.
7. Cov lus xaus thiab cov lus qhia yav tom ntej
Raws li kev kho mob ntxiv rau cov mob ntshav qab zib ntev ntev, HBOT xa los ntawm cov chav tsev hyperbaric tuaj yeem txhawb kev kho qhov txhab los ntawm kev txhim kho cov ntaub so ntswg oxygenation, txhim kho angiogenesis, txhawb kev tiv thaiv kab mob, thiab txhawb kev sib txuas ntawm collagen. Thaum siv ua ke nrog cov txheej txheem kev saib xyuas lub qhov txhab, nws tuaj yeem pab txhim kho kev kho mob ntawm cov qhov txhab mob ntshav qab zib refractory thiab txo qhov kev pheej hmoo ntawm amputation. Txawm li cas los xij, kev ua raws li kev soj ntsuam nruj me ntsis, kev ntsuas ua ntej - kev kho mob, thiab kev saib xyuas kev nyab xeeb yog qhov tseem ceeb los xyuas kom muaj kev nyab xeeb kev kho mob zoo thiab ua tau zoo.
Cov lus qhia kev tshawb fawb yav tom ntej suav nrog kev ua kom zoo HBOT cov txheej txheem (xws li, kho lub siab, lub sijhawm, thiab zaus), tshawb nrhiav kev sib xyaw ua ke (piv txwv li, HBOT ua ke nrog cov qia cell therapy lossis kev kho mob loj hlob), thiab txhim kho cov khoom siv tau yooj yim thiab siv tau hyperbaric. Cov kev nce qib no tuaj yeem pab nthuav kev nkag mus rau HBOT rau cov neeg mob ntshav qab zib qhov txhab, tshwj xeeb hauv cov peev txheej - txwv tsis pub.
Disclaimer: Phau ntawv qhia no yog rau cov ntaub ntawv xov xwm nkaus xwb thiab tsis yog cov lus qhia kho mob. HBOT yuav tsum tsuas yog ua raws li kev saib xyuas ntawm cov kws kho mob uas tsim nyog raws li cov lus qhia thiab cov kev cai siv. Hyperbaric Chambers yog cov khoom siv kho mob uas yuav tsum ua raws li cov qauv kev nyab xeeb uas cuam tshuam.