三氧治疗(O3X)基本原则
实施三氧处理前必须考虑的三项基本原则如下：
a) 首先不可伤害：做任何治疗之前，不要做任何伤害。
b）错开剂量：始终从低剂量开始，并逐渐增加剂量。14,19
在溃疡或损伤感染情况下例外，应用剂量是反向的。在这种情况下，从高浓度开始，并根据病人病情的改善来减少剂量。详见表1。在同样的治疗方式情况下，与所有药物发生的效果，较高的三氧浓度并不一定更好。
2.1禁忌症
以下情况禁止给予三氧：
1. 葡萄糖-6-磷酸脱氢酶缺乏症（蚕豆病，急性溶血性贫血）*
2. 毒性甲状腺功能亢进症-BasedowGraves综合症
3. 血小板减少低于50000和严重的凝血障碍
4. 严重的不稳定性心血管病
5. 急性酒精中毒
6. 急性心肌梗死
7. 大量和急性出血
8. 抽搐状态
9. 血色素沉着病
10.接受铜或铁剂治疗的患者
*葡萄糖-6-磷酸脱氢酶（G-6-PD）缺乏症的发生率在不同族群中不同，与撒哈拉以南非洲（7.5％）相比，在美洲（3.4％），欧洲（3.9％）和太平洋（2.9%），中东（6.0％）和亚洲（4.7％）21的发生率更低。建议在O3治疗前进行G6PD测试以避免并发症。
2.2 与三氧相互作用的药物
在用三氧治疗期间，可能使用抗氧化物补充剂（例如维生素C和维生素E）。然而，这些化合物以高浓度存在于血液中时，会干扰三氧作为氧化剂的作用及治疗获益。因此，口服维生素或抗氧化剂，不应在治疗期间使用，只能用在三氧治疗之前或之后。抑制的时间取决于每种特定抗氧化剂的生物利用度。建议静脉应用抗氧化治疗，既不在三氧治疗之前使用，也不在三氧治疗中使用，只在三氧治疗后施用，如维生素C或谷胱甘肽。
三氧增加ACE抑制剂（ACEI血管紧张素酶抑制剂）的影响。接受抗凝治疗如香豆素/肝素治疗的患者必须在控制INR下进行三氧治疗。接受铜或铁治疗的患者不能接受三氧治疗。
三氧疗法与其他氧化疗法（紫外线、过氧化氢等）具有协同作用。联合激光治疗、磁疗、针灸、透热疗法、理疗会产生预期互补效应。
2.3 不良反应
大部分的副作用报告与医疗过失相关：如管理技术、给药途径、三氧给药浓度，等等。
根据美国国立卫生研究院（NIH）（2010）常见不良反应事件评价标准对已经报道的不良反应（AE）进行分级判定。22
2.3.1 1级轻度
轻度：无症状或症状轻微；仅为临床或诊断所见；无需治疗。
l 有些患者在接受三氧局部注射后会有短暂的热、微痛感觉。23
l 1名患者在三氧浸润注射部位出现血肿。24
l 在治疗结束时，有4名患者嘴唇和舌头出现瘙痒的感觉，3例患者在三氧化血液回输期间感到反胃和口中有异味，1例患者在治疗期间出现呼吸困难。25,26
l 15例继发于动脉缺血引起的皮肤病变应用三氧治疗患者，使用三氧自体血疗法后出现兴奋。27
2.3.2 2级中度
中度：需要较小、局部或非侵入性治疗；与年龄相当的工具性日常生活活动（ADL）受限。
l 组内两名患者在三氧治疗后腿部的敏感性降低,给予皮质激素类药物两小时内减轻。28
l 报告显示，5例患者在接受三氧注射后，腰部和腿部疼痛自发消除，8例患者在三氧治疗后出现轻度的角膜刺激和可逆的呼吸困难。29
l 根据报告，当采用直肠注入给药方式应用三氧，有患者出现腹胀和便秘。27
2.3.3 3级严重
严重：严重或者医学上有重要意义但不会立即危及生命；导致住院或者延长住院时间；致残；个人日常生活活动受限。
l 椎基底动脉系统卒中30
l 1例急性双侧玻璃体视网膜出血31
l 1例脑膜刺激32
l 3例病毒性肝炎33
2.3.4 4级
4级：危及生命；需要紧急治疗。
l 已报道神经节周围的静脉丛气体栓塞1例，累及椎基底动脉，临床表现为几分钟局部疼痛，几天之后清消。34
l 2.3.5 5级
5级：与AE相关的死亡。
l 4例三氧直接静脉注射治疗致气体栓塞死亡。35-37
l 1例银屑病应用三氧自血疗法治疗后死亡。38
l 1例腰椎间盘突出症患者三氧治疗治疗后死于暴发性败血症。39
2.4 毒性
禁止吸入三氧。由受过训练的专业人员使用适当的临床方案、以适当范围的剂量（表1）使用时，三氧是无毒的。医疗失误可引起死亡病例的结局。（关于三氧毒性的参考，请见附录B）。
2.5 通过直肠灌注方式儿科应用剂量
全身应用方式，仅能用直肠方式。
l 三氧应用浓度取决于患者的氧化应激状态和病理治疗分级（表2A）。
l 三氧体积用量取决于病人的年龄（表2B）。
l 将直肠导管插入肛门括约肌内部（1-2）厘米进行吹入。
表2直肠灌注方式儿童剂量表2A 使用浓度应依据氧化应激
治疗周
O3浓度 (µg/NmL)
氧化应激状态
低
中
重
第一周
20
15
10
第二周
25
20
15
第三周
30
25
20
第四周
35
30
25
表2B. 根据儿童的年龄进行体积管理
儿童患者年龄
体积
28 天-11 月
15-20
1-3 岁
20-35
3-10 岁
40-75
11-15 岁
75-120
每五次改变一次剂量。第一年期间，15-20次为一循环周期，每4-5个月1循环。然后，将对患者进行评估以确定第二年的周期频率。
附录 B.
三氧治疗致突变性、毒性、不良反应
书籍
1. Bocci V. Oxygen-Ozone Therapy. A criticalevaluation' Ed. Kluwer Academic Publishers, Dordrecht,2002.19
2. Bocci V. Ozone: a new medical drug. Ed.Springer, Dordrecht, 2010.42
3. Viebahn - Hänsler R. The use of ozone in medicine. Ed. Odrei Publishers, Iffezheim,2007.94
4.Schwartz A. et al. The Guide for the medical useof ozone. Therapeutic Basis and indications(2011) published by AEPROMO.43
科技期刊论文
毒性、致突变性
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不良反应
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9. Marchetti O., La Monaca G. An unexpected deathduring oxygen-ozone therapy. Am. J. Forensic Med. Pathol. 2000. 21(2):144-147.38
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