中文摘要：

目的 探讨高压氧（HBO）对中国人下肢创伤后小腿部慢性创面愈合的影响,以及创面愈合与外周循环中CD34＋内皮干细胞（EPCs）的相关性.方法 选择119例下肢创伤后小腿部慢性创面病程＞3个月的患者,进行一个随机、单中心和对照的临床研究.其中97例接受HBO治疗,22例接受相同高气压非氧气治疗作为压力效应对照的安慰剂治疗组.每天治疗90 min（总过程120min）,每周5d连续4周,观察患者在HBO治疗前、后小腿慢性创面愈合率,流式细胞仪检测其外周循环中CD34＋ EPCs细胞平均计数和设门选定的细胞群中CD34 ＋/Scal-1＋,CD34 ＋/CXCR4细胞的百分比,并统计分析CD34＋ EPCs细胞水平与下肢慢性创面愈合速率的相关性.结果 在接受HBO治疗第4周,在HBO治疗和对照组患者下肢创面愈合率差异有统计学意义（62.7％±22.3％vs34.4％±20.6％,P＜ 0.05）.经过10次HBO治疗,外周循环中CD34＋ EPCs细胞平均计数由HBO治疗前的（0.24±0.03）％升高到（1.32±0.05）％；而经过20次HBO治疗,患者外周循环中CD34＋EPCs细胞平均计数为（1.75±0.17）％,较治疗之前差异有统计学意义（P＜0.05）.在设门细胞中,HBO治疗20次后CD34 ＋/Scal-1＋,CD34 ＋/CXCR4细胞百分比分别是HBO治疗前的5.8倍和5.2倍.在压力效应的对照组中,外周循环中CD34＋ EPCs细胞没有增加.在经过10次HBO处理后,患者外周循环中CD34＋ EPCs细胞数目和下肢创面愈合的相关性之间存在一个显著地正相关性（r2=0.84；P＜ 0.01）.结论 HBO治疗可以通过动员外周循环中EPCs促进下肢创伤后慢性创面的愈合.

英文摘要：

Objective To evaluate the effects of hyperbaric oxygen（HBO）therapy in the management of chronic wound and observe the correlation between wound healing and CD34 ＋ endothelial progenitor cells（EPCs）.Methods A total of 119 patients with chronic wound in lower extremities lasting 〉3 months were recruited for this randomized,single-center,placebo-controlled clinical trial.The changes of CD34 ＋ average count before and after HBO therapy were detected by flow cytometry（FACS）.There were 97 patients on long-term HBO therapy and in 22 patients on hyperbaric air therapy as control group.The CD34/Scal-1 ＋ and CD34/CXCR4 dual-positive populations of gated cell were determined respectively by FACs.The outcomes of two groups were compared.Treatment was administered within a single-place hyperbaric chamber for 90-main daily（session duration 120 main）for 5 days a week for 4 weeks （20 treatment sessions）.Results The wound size decreased at the4-week end point（62.7% ＋22.3% in the HBO group vs 34.4% ＋20.6% in the control group,P 〈0.05）.Mter 10 episodes of HBO therapies for chronic non-healing wound,the peripheral CD34 ＋ EPCs average count rose from 0.24% ＋ 0.03% at pretreatment to 1.32% ±0.05% while the number was 1.75% ＋ 0.17% after 20 episodes of HBO（P 〈 0.05）Both were significantly different from that of the patients at pre-treatment.However the overall circulating white cell count was not significantly elevated.The CD34/Scal-1 ＋ and CD34/CXCR4 dual-positive populations of gated cell in HBO group were 5.8 and 5.2 folds than those at pre-treatment respectively.The number of EPCs was positively correlated with wound healing in lower extremities（correlation coefficient 0.84 ; P 〈 0.01）.Conclusion Adjunctive treatment of HBO facilitates the healing of chronic non-healing wound in selected patients through the mobilization of EPCs.