Yangısal hastalıklarda hiperbarik oksijen tedavisi

Year 2024, , 11 - 21, 31.01.2024

Serdar Yalçın , Mustafa Edremitlioğlu

https://doi.org/10.55665/troiamedj.1326387

Abstract

Hiperbarik Oksijen Tedavisi, basınç odası adı verilen kapalı bir sızdırmaz kabin içerisinde, artırılmış atmosferik basınç altında, %100 oranında oksijenin, hastalara maske, başlık ya da entübasyon tüpü vasıtasıyla solutulması prensibine dayanan bir tedavi yöntemidir. Hiperbarik Oksijen Tedavisi’nin uygulandığı kabinler, tek kişilik olabildiği gibi, aynı anda birden fazla hastanın tedavi edilebildiği çok kişilik basınç odaları da bulunmaktadır. Tedavi edici oksijen basıncının, çevre basıncının üzerinde bir basınçta uygulanması gerekmektedir. Tedavi süreleri de, her seans için ortalama 90 dakika veya vakanın tıbbi durumuna göre daha uzundur. 1955 yılından beri tıp pratiğinde aktif olarak kullanılmakta olan Hiperbarik Oksijen Tedavisi, temelde iki fizyolojik mekanizma ile etki göstermektedir. Bunlar, yüksek basıncın doğrudan fiziksel etkisi ve parsiyel oksijen basıncının yükselmesi ile oluşan fizyolojik etkilerdir. Bu temel etki mekanizmaları aracılığıyla, dolaşım sisteminde ve dokularda patolojik olarak oluşan gaz kabarcıklarının hacmini azaltır, doku oksijenasyonunu artırır, yara iyileşmesini hızlandırır, iyileşmeyen yaralarda bakteriyel enfeksiyon riskini azaltır, anjiogenezi uyarır ve immün yanıtı düzenler. Hiperbarik oksijen tedavisi bu etkileri sayesinde, dekompresyon hastalığı, karbon monoksit zehirlenmesi, hava ve gaz embolisi, gazlı gangren, crush yaralanması, kompartman sendromu, retinal arter oklüzyonu, diabetik ayak gibi iyileşmeyen yaralar, yumuşak dokunun nekrotizan enfeksiyonları, ani işitme kaybı ve kronik osteomiyelit gibi birçok tıbbi durumda endikedir. Bunlara ek olarak, son yıllarda yapılan deneysel ve klinik çalışmalarda, yangısal ve sistemik hastalıklar, maligniteler, COVID-19 enfeksiyonu, erektil disfonksiyon, yaşlanma, iskemik kalp ve beyin hastalıkları gibi durumlarda da etkinliği araştırılmaktadır. Bu derlemenin amacı, Hiperbarik Oksijen Tedavisi’nin etki mekanizmalarını, yangı üzerine etkilerini ve son yıllarda yapılan birçok yeni çalışmaya konu olan yangısal hastalıklar üzerindeki etkinliğini gözden geçirmektir.

Keywords

Hiperbarik Oksijen Tedavisi, İnflamasyon, İmmünomodülasyon, Sitokinler, Sepsis, Kas Atrofisi

Hyperbaric oxygen therapy in inflammatory diseases

Abstract

Hyperbaric Oxygen Therapy is a treatment method based on the principle of inhaling 100% oxygen under increa-sed atmospheric pressure in a closed sealed cabin called a pressure chamber, through a mask, hood or intubation tube. Hyperbaric Oxygen Therapy cabins can be monoplace or multiplace chambers where more than one patient can be treated at the same time. The therapeutic oxygen pressure must be applied at a pressure above the ambient pressure. Treatment times average 90 minutes per session, or longer depending on the medical condition of the case. Hyperbaric Oxygen Therapy, which has been actively used in medical practice since 1955, works mainly through two physiological mechanisms. These are the direct physical effects of high pressure and the physiologi-cal effects caused by the increase in partial oxygen pressure. Through these basic mechanisms of action, it redu-ces the volume of pathologically formed gas bubbles in the circulatory system and tissues, increases tissue oxy-genation, accelerates wound healing, reduces the risk of bacterial infection in non-healing wounds, stimulates angiogenesis and regulates the immune response. Thanks to these effects, hyperbaric oxygen therapy is indicated in many medical conditions such as decompression sickness, carbon monoxide poisoning, air and gas embolism, gas gangrene, crush injury, compartment syndrome, retinal artery occlusion, non-healing wounds such as diabetic foot, necrotizing infections of soft tissue, sudden hearing loss and chronic osteomyelitis. In addition, recent experimental and clinical trials are investigating its efficacy in inflammatory and systemic diseases, malignancies, COVID-19 infection, erectile dysfunction, aging, ischemic heart and brain diseases. The aim of this review is to review the mechanisms of action of Hyperbaric Oxygen Therapy, its effects on inflammation and its efficacy on inflammatory diseases, which have been the subject of many new studies in recent years.

Keywords

Hyperbaric Oxygen Therapy, Inflammation, Immunomodulation, Cytokines, Sepsis, Muscular Atrophy

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