- 期刊
A Narrative Review of the Uses and Dangers of Hydrogen Peroxide
文獻探討過氧化氫的應用與危險
摘要
Background: The use of hydrogen peroxide (H_2O_2) is widespread. In various surgical subspecialties, it is popularly used as a wound antiseptic solution and hemostasis agent. Anecdotally, many surgeons use H_2O_2 and swear by its efficacy, but the risks of using H_2O_2 has not been weighed against its supposed benefits. Aim and Objectives: We would like to review the current available literature and give an evidence base recommendation regarding the use of H_2O_2, particularly for parts relevant to plastic surgery. Materials and Methods: PubMed database was used, and we used the keywords ＂H_2O_2＂, ＂hydrogen peroxide＂ in varying combinations with the keywords ＂complications＂, ＂surgery＂, ＂toxicity＂, and selected all relevant articles for assessment and summary. We were limited to articles written in English and Chinese, and case reports that had a well written English abstract were also included. Results: A total of 92 journal articles were considered for review. The majority were case reports. (43) and written by orthopedic (15) and neurosurgeons (16). Our findings are summarized in three main sections: 1) H_2O_2 pharmacology and applications in surgery 2) Complications of H_2O_2 relevant to plastic surgery and 3) Recommendations for H_2O_2 use. There is enough published experience in the literature that shows H_2O_2 is a weak antiseptic solution, and is an effective hemostatic agent for mainly superficial wounds. The major concern is the effect of H_2O_2 on wound healing, risk of gaseous emboli, central nervous system and cardiovascular collapse. The risk for these complications are very small especially in plastic surgical contexts, but still considered potentially fatal, and thus we recommend well selected use of H_2O_2 with extreme caution. Conclusion: The role of H_2O_2 is not irreplaceable, making the small risk of potential fatality from H_2O_2 unnecessary. We conclude that thorough re-education is required in the surgical community on the potential dangers of H_2O_2. We strongly advise against using H_2O_2 except in very well selected situations for hemostasis, and only after consultation with the anaesthetic staff.
並列摘要
背景：過氧化氫（雙氧水）被廣泛用於許多次專科，多半用於殺菌、止血。依醫師個人習慣，有些覺得過氧化氫非常好用。但是是使用過氧化氫的好處並未跟其風險及可能性副作用做過完整的比較。目的及目標：我們希望進行較全面的文獻搜尋以整理現有的證據，特別是在整形外科的運用上做一較有實證醫學為根基的過氧化氫應用推薦。材料及方法：使用PubMed資料庫搜尋“H2O2＂、“過氧化氫”、“併發症”、“手術”等等像關鍵詞，並選擇了所有相關文章進行評估和總結。發表日期不受限制，但我們僅限於英文和中文撰寫的文章。結果：我們評估和總結了92篇期刊文章。其中大多數（43篇）是病例報告，尤其骨科（15篇）和神經外科（16篇）文獻居多。我們根據現有證據整理出三個部分：1）過氧化氫的藥理學與外科應用，2）過氧化氫的併發症，3）建議使用方式。目前有足夠的研究顯示過氧化氫只有偏弱的殺菌作用，也僅有很容易被取代的止血效果。使用過氧化氫的風險包括皮下氣腫、氣腦、空氣栓塞。這些併發症在整形外科常見的手術風險極小術，但還是有可能致命。因此我們建議嚴格評估過之後才能小心使用。結論：統合整理後文獻中有足夠的經驗顯示過氧化氫的功用並非無可取代，因此它潛在死亡的風險其實是不必要的。如果不能完全避免使用，也必須限制在少數的特殊情況下。我們的結論是，整形外科界需要對過氧化氫的潛在危險有更多的了解。我們也強烈建議不要使用過氧化氫，除非在特例情況下為了止血，並且必須在告知麻醉人員之後才能使用。