Application of HBO (Hyperbaric Oxygen Therapy) in the gastrointestinal perioperative period

Author: Yu Qingzhong, Hyperbaric Oxygen Department, Chaoyang Second Hospital, Liaoning Province

The perioperative period :  Refering to the period before the operation (5-7 days), during the operation and after the operation (7-12 days), which is a whole process of the perioperative period.

Common complications after gastrointestinal surgery

 Mr.Bi , a well-known oncologist in my country, terminated his life because of intestinal obstruction after gastric cancer surgery and anastomotic leakage after intestinal obstruction surgery. In the event of serious postoperative complications, in addition to endangering the patient's life, it will also involve medical disputes and medical compensation. It is the beginning of a nightmare for the doctors involved. How to reduce postoperative complications is an important assessment indicator to test the skills of doctors in each operating department and the success of the operation.
1. Anastomotic leakage is a serious complication, with an incidence rate of 2.4%-15.9%, and a fatality rate of 16%. Many anastomotic leakages require reoperation, which may even affect the long-term survival of patients.
2. Gastrointestinal dysfunction: including nausea, vomiting, poor exhaustion, flatulence, intestinal obstruction, intestinal adhesions, etc., the incidence rate is between 10% and 50%, and the reason is the stimulation of surgical traction, followed by anesthesia Drug damage to gastrointestinal function.
3. Complications after general anesthesia: first reflux and aspiration, second airway obstruction, third hypoventilation, fourth hypoxemia, fifth hypotension or hypertension, sixth arrhythmia, seventh hyperthermia .
4. Various postoperative infections, including abdominal infection, incision infection, etc.

Mechanism of HBO in the treatment of gastrointestinal perioperative period

1. HBO can rapidly increase blood oxygen content, increase physical dissolved oxygen, rapidly improve the systemic oxygen supply of postoperative patients, and at the same time improve systemic blood circulation and promote the establishment of microcirculation.
2. Gastrointestinal vasoconstriction in the HBO environment reduces vascular exudation and reduces intestinal edema.
3. HBO treatment can promote gastrointestinal peristalsis, restore normal intestinal peristalsis function of patients as soon as possible, and reduce postoperative gastroparesis and intestinal obstruction.
4. HBO treatment itself has a strong anti-inflammatory effect, and HBO can prevent and control secondary infection after surgery.
5. HBO can inhibit the growth and reproduction of intestinal pathogenic bacteria and restore normal gastrointestinal flora growth.
6. HBO can improve the functional recovery of important organs such as the heart, brain, liver, and kidney, and reduce the poisoning effect of drugs on important organs.
7. HBO enhances the aerobic metabolism of the patient's body, corrects the metabolic disorder, and helps restore the patient's ion and electrolyte balance.
8. HBO can reduce the volume of intestinal gas and reduce the pressure. Under the pressure of 2.0ATA, it can reduce the volume of intestinal gas by 50%, the diameter of the intestinal lumen by 29%, and reduce the reflux of gastric juice and intestinal juice.
9. HBO can improve the body's immunity and promote postoperative recovery.
10. HBO can regulate the excitatory-inhibitory function of the cerebral cortex, improve the mood and sleep of patients.

Application of HBO in the treatment of gastrointestinal perioperative period

In 2020 and 2021, our hospital completed 100 patients with more than 2 times of HBO treatment in the perioperative period of gastrointestinal surgery, including 55 patients who received 2-5 times, 21 patients who received 5-10 times, 24 patients who received more than 10 times, and the longest Did it 29 times.

Disease distribution: 25 patients with colon cancer and rectal cancer after surgery, 14 patients with gastric cancer after surgery, 7 patients with intestinal obstruction with acute peritonitis, 10 patients with upper gastrointestinal perforation, 15 patients with acute appendicitis with suppuration, and 8 patients with small intestinal necrosis with diffuse peritonitis 1 case, 1 case of cholangiocarcinoma after operation, 1 case of severe pancreatitis, other 19 cases including abdominal trauma, abdominal infection, abdominal wall hernia, etc.;

Age distribution: 25 people under 50 years old, 25 people between 50 and 60 years old, 31 people between 60 and 70 years old, and 19 people over 70 years old, with an average age of 59 years old.

HBO treatment status: HBO treatment for the perioperative period includes:
1. Preoperative HBO pretreatment of patients;
2. Postoperative HBO preventive treatment to prevent surgical complications;
3.HBO treatment of postoperative complications.
Treatment plan: 2.0 ATA, oxygen inhalation for 20 minutes*3, rest for 5 minutes*2.

Significance of HBO in the treatment of gastrointestinal perioperative period

 We counted those who started HBO on the 2nd day after surgery and were treated for more than 2 times, and no postoperative complications occurred. At the same time, many of the patients' original underlying diseases were not aggravated by major surgery, and after HBO treatment There are varying degrees of improvement. All patients who completed more than 2 HBO treatments recovered better than those who did not do HBO in the same period. Most of the patients were significantly relieved after 5 treatments, especially those with side effects of anesthetics recovered faster, which significantly shortened the recovery time and hospitalization of the patients. Time, a few due to their old age and complex disease, after multiple surgeries, the recovery is slow, and the HBO treatment time is long, but they still achieve satisfactory results and reach the index of recovery and discharge. According to statistics, since HBO intervention in our hospital has been used for perioperative treatment of gastrointestinal surgery in the past 2 years, the incidence of postoperative complications has been significantly reduced, and the incidence of postoperative intestinal obstruction and anastomotic leakage has been zero.

Experience of HBO in the Treatment of Gastrointestinal Perioperative Period

1. After gastrointestinal surgery, almost all patients carry various drainage tubes or analgesic pumps, such as gastrointestinal drainage tubes. After abdominal surgery, the drainage tube HBO is closed during pressurization and opened during decompression. The analgesic pump can generally be used for 48 hours after surgery. Removal, patients entering the HBO cabin for treatment only involve 1-2 times entering the cabin with a pump. Each time, it is necessary to observe the amount of the pain relief pump to meet the time required to complete the HBO treatment. In the past 2 years of work, no drainage tube has occurred. And the complications caused by the pain pump, so we think it's safe.
2. The patient fasted in the early postoperative period and wore a gastrointestinal decompression tube. After abdominal surgery, the force of the chest and abdomen was limited, and he could not completely hold his breath to perform the nose-pinch and air-inflating movements. The pressure-boosting process was difficult, so the pressure-boosting should be increased appropriately Due to the gastrointestinal decompression tube, you can also drink a small amount of water for swallowing, which will not increase the burden on the gastrointestinal tract.
3. The patient's body is weak and the condition is serious. Under the premise of ensuring safety, the first-level oxygen supply is preferred. When choosing the second-level oxygen inhalation, it is often difficult to inhale oxygen initially. Our experience is that the patient can inhale as long as he can, and adapt to 1-2 Oxygen can be inhaled normally as the condition improves.
4. Some patients can take HBO treatment on the second day after the operation, partly due to the side effects of anesthesia, and they are not fully awake, or there are anxiety, irritability, emotional instability, etc., medical care needs to do a good job of education, psychological counseling, and try to get the patient or family member's information. Cooperate with understanding.
5. Before entering the cabin, the doctor should understand the patient's condition in detail and make an assessment, inform the purpose of HBO treatment, and try to accompany the medical staff in the cabin as much as possible, especially the initial treatment and critically ill patients