高压氧治疗可以提高糖尿病人的心肌舒张功能

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Tohoku J Exp Med. 2008 Mar;214(3):281-9. Links
Hyperbaric oxygen therapy improves myocardial diastolic function in diabetic patients.Aparci M, Kardesoglu E, Suleymanoglu S, Uzun G, Onem Y, Uz O, Kucukardali Y, Ozkan S.
Department of Cardiology, Gulhane Military Medical Academy, Haydarpasa Teaching Hospital.

Myocardial diastolic dysfunction is the relaxation abnormality of ventricles that limits the diastolic filling and generally precedes diastolic heart failure. Diastolic dysfunction is a common finding in diabetes. Diabetic patients receive hyperbaric oxygen (HBO) therapy for non-healing lower extremity ulcers, and exposure to HBO therapy is known to influence cardiovascular functions. This study was designed to evaluate the effect of HBO therapy on myocardial diastolic function in diabetic patients. Thirty diabetic patients (18 male and 12 female, 59.9 +/- 10 years old), who were planning to undergo HBO therapy, were consecutively enrolled. Myocardial diastolic function was evaluated by pulsed wave Doppler echocardiography and tissue Doppler echocardiography before the first HBO therapy and after the tenth HBO therapy session. HBO therapy improved the relaxation capability of left ventricular myocardium, which was reflected by reduction in E wave deceleration time of mitral valve inflow (286.1 +/- 65.8 msec vs 214.3 +/- 32.1 msec, p < 0.05). HBO therapy also affected favorably the diastolic filling dynamics of right ventricle, which was partially reflected by the changes in E wave peak velocity of tricuspid valve inflow (0.48 +/- 0.07 m/sec vs 0.46 +/- 0.09 m/sec, p < 0.05). Tissue Doppler parameters of mitral lateral annulus, which are better correlated with ventricular relaxation, tended to be improved after HBO therapy, but the degree of improvement was not statistically significant. In conclusion, we suggest that HBO therapy may improve the myocardial diastolic function of diabetic patients when applied repetitively.
心肌舒张功能不良就是心室舒张功能障碍，即心室舒张充盈受限，这通常发生在心力衰竭之前。舒张功能障碍在糖尿病病人身上很常见。糖尿病患者接受高压氧治疗，可以治疗肢体末端不易愈合的溃疡，改善心肌功能。这个研究设计了怎样评估高压氧对糖尿病患者治疗后心肌舒张功能改善的效果。30个本来也计划接受高压氧治疗的糖尿病患者（18个男性患者，12个女性患者，年龄59.9 +/- 10）入选这个研究。在高压氧治疗前和治疗10次后，分别通过进行脉冲波多普勒超声心动检查和组织多普勒超声心动检查评估心肌舒张功能。观察到经过高压氧治疗后，左室心肌舒张功能改善，这是通过观察到高压氧治疗后图像二尖瓣瓣膜流入的E波减速时间的减少得出的结论（286.1 +/- 65.8 msec vs 214.3 +/- 32.1 msec, p < 0.05）。高压氧治疗也帮助改善右室的舒张期充盈状况，这可以部分的通过观察到的三尖瓣瓣膜流入的E波高峰速度的改变得出(0.48 +/- 0.07 m/sec vs 0.46 +/- 0.09 m/sec, p < 0.05)。二尖瓣外侧环的组织多普勒参数是与心室舒张功能更相关的一个参数，这个参数在高压氧治疗后能够观察到改善，不过改善的程度没有统计学意义。因此，我们的结论是多次重复高压氧治疗可能有助于改善糖尿病患者的心肌舒张功能。


高压氧治疗糖尿病皮肤损伤效果是公认，本研究发现高压氧能提高糖尿病患者心功能，是比较有新意的发现。也是值得关注的，现在关于高压氧的新作用的发现越来越多，临床工作者不能不重视这一个新的趋势。希望大家关注，这个文献对做临床研究很有启发。我们一定要放开思路，不能把眼光停留在过去的疾病方面，在治疗其他疾病的同时，观察一些新的指标，也许有重要发现