Department of Blood Transfusion, Guiqian International General Hospital, Guiyang, Guizhou 550018, China
2.
Department of Blood Transfusion, Southwest Hospital, Army Medical University, Chongqing 400038, China
3.
Department of Blood Transfusion, Changhai Hospital, Naval Medical University, Shanghai 200433, China
4.
Department of Blood Transfusion, Tangdu Hospital, Xi’an, Shaanxi 710038, China
5.
Department of Blood Transfusion, the Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
6.
Department of Blood Transfusion, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
7.
Department of Blood Transfusion, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, China
8.
Department of Blood Transfusion, the Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, China
9.
Department of Blood Transfusion, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
10.
Department of Blood Transfusion, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
11.
Medical and Rehabilitation Center, Sichuan Tianfu Hunt Life Science and Technology Co., Ltd. Chengdu, Sichuan 641400, China
12.
Department of Blood Transfusion, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
13.
Department of Blood Transfusion, Dazu People’s Hospital, Chongqing 402360, China
14.
Department of Blood Transfusion, the First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang 310003, China
15.
Department of Blood Transfusion, the First People’s Hospital of Guiyang, Guiyang, Guizhou 550002, China
16.
Department of Blood Transfusion, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
17.
Department of Blood Transfusion, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
18.
Department of Blood Transfusion, Xi’an International Medical Center Hospital, Xi’an, Shaanxi 710100, China
19.
Department of Blood Transfusion, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
20.
Department of Blood Transfusion, Jingdong Zhongmei Hospital, Langfang, Hebei 065200, China
21.
Department of Blood Transfusion, the Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
22.
Department of Blood Transfusion, Shandong Provincial Hospital of Shandong First Medical University, Jinan, Shandong 250021, China
23.
Department of Blood Transfusion, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
24.
Department of Blood Transfusion, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
25.
Department of Blood Transfusion, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
26.
Department of Blood Transfusion, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China
27.
Department of Blood Transfusion, the Second Hospital of Harbin Medical University, Harbin, Heilongjiang 150081, China
28.
Blood Transfusion Department, First Hospital of Jilin University, Changchun, Jilin 130021, China
29.
Department of Blood Transfusion, Jilin Central General Hospital, Jilin, Jilin 132001, China
30.
Working Party on Blood Transfusion Equipment Technology, Chinese Association of Medical Equipment, Beijing 100071, China
Shuming Zhao, Department of Blood Transfusion, Guiqian International General Hospital, 1 Dongfeng Avenue, Guiyang, Guizhou 550018, China. E-mail: shumingzhao123@qq.com
Autologous ozonized blood transfusion (AOBT), an autologous blood transfusion treatment that mixes anticoagulant blood with a certain concentration and volume of medical ozone in vitro, is widely used in clinical medicine. However, there is a lack of country-wide guidelines or other special procedures to follow. The objective of this paper is to provide a general guideline on standard operating procedures for autologous ozonized blood transfusion.
Ozone, also known as an allotrope of oxygen, is composed of three oxygen atoms, one oxygen atom carried by an oxygen molecule. Ozone is an unstable gas with a pungent and characteristic smell that quickly gives up a nascent oxygen molecule to form oxygen gas. It is formed through electrical discharges on the oxygen molecule, which breaks down, releasing atoms that bind to the other two molecules, and generating O3. At high concentrations in air, it turns blue, while at low concentrations it is a colorless gas, lighter than air. Due to this property, it has been used in human medicine historically to kill bacteria and fungi, to inactivate viruses, and to control hemorrhages. Besides these, research shows ozone has many therapeutic effects. Until today, ozone therapy has been utilized and heavily studied for more than a century. With proven effects like consistent, safe, and preventable side effects, medical ozone is used to disinfect and treat disease. Autologous ozonized blood transfusion (AOBT), also known as ozonated auto-hemotherapy (O3-AHT) or major ozonated autohemotherapy or major auto-hemotherapy, is a medical treatment of combined ozone therapy with autologous blood transfusion[1–4]. To standardize its procedures, Chinese blood transfusion experts have reached a consensus on standard operating procedures (SOP) for AOBT.
2.
MECHANISM OF AOBT
The mechanism of AOBT lies mainly in four aspects: enhancement to antimicrobial activity, activation of the metabolism and immune system, regulation of oxidative stress balance, and acceleration of wound healing[5].
2.1
Antimicrobial activity
Ozone can kill microorganisms by destroying the viruses' envelope, and reacting with bacterial phospholipids and lipoprotein. In addition, ozone forms intramolecular or intermolecular disulfide bonds by oxidizing sulfhydryl groups on the active fraction of proteins and enzymes, resulting in a loss of enzyme activity, making it difficult for viruses to enter host cells and preventing virus replication.
2.2
Immunomodulation
Ozone can (1) reduce immunoglobulin E (IgE) production by its interplay with immune cells and improve lung function; (2) increase the production of IFN-γ, TNF-α, and IL-2, and enhance inflammatory response ability; (3) regulate M1 macrophages (secreting proinflamma-tory cytokines), IL-12, and inflammatory responses, or M2 macrophages, IL-10, and anti-inflammatory responses.
2.3
Balance regulation of oxidation and antioxidant enzymes
Ozone can (1) form reactive oxygen species (ROS) and lipid oxidation products (LOPs) on contact with blood which accelerates cell metabolism and stimulates tissue repair; (2) induce the increased activity of antioxidant enzymes to prevent metabolic, inflammatory, and infectious diseases; (3) reduce O2 dosage, increase the Nrf2 antioxidant pathway, and reduce the activity of nuclear factor-kB (NF-kB) for beneficial effects; (4) regulate H2O2 production, resulting in the production of cyclooxygenase-2 (COX-2), prostaglandin E2 (PGE2), and cytokine, thus causing toxic effects.
ROS can also increase adenosine triphosphate which causes a right shift oxygen dissociation curve, reduce the affinity of oxygen molecule, and promote blood oxygen supply in red blood cells. In leukocytes and endotheliocytes, it can induce the production of interferon, interleukin, nitrogen oxides, and transforming growth factor (TGF). In addition, ROS can stimulate the release of growth factors in platelets. LOPs produced by ozone reaction can increase the release of NO, relax blood vessels, and improve blood circulation when acting on endothelial cells. LOPs can promote the release of stem cells and erythropoiesis by acting on bone marrow, enhance antioxidant enzyme activity, and accelerate the ability to scavenge oxygen radicals. To sum up, ozone therapy can improve blood circulation and substance metabolism, activate the antioxidant enzyme system, remove free radicals, and regulate antioxidant capacity.
2.4
Acceleration of wound healing
Active oxygen molecules produced by ozone can stimulate platelet aggregation and release growth factors, thus accelerating wound healing. The production of H2O2 leads to the enhancement of O2 effects and increases the release of endogenous growth factors such as vascular endothelial growth factor (VEGF), transforming growth factor (TGF-β), fibroblast growth factor (FGF), and platelet-derived growth factor (PDGF). FGF2 can activate the vascular regeneration related pathways of fibroblasts and promote the production of fibroblasts and collagen, to treat multiple skin diseases, diabetic foot, psoriatic dermatitis, etc. Ozone can inhibit the synthesis and release of partial prostaglandins, bradykinin and various polysaccharide molecules. Meanwhile, it increases the release of proinflammatory cytokine antagonists, relieves partial inflammatory responses and pain. In addition, ozone helps stimulate the body to release more endorphins to achieve central analgesic effects.
3.
INDICATIONS AND CONTRAINDICATIONS
3.1
Indications
Indications mainly include metabolic diseases, infectious diseases (including COVID-19)[6-8], ischemic and hypoxic diseases, immune diseases, pain diseases, ulcers and refractory wounds, and adjuvant therapy for cancer. These diseases are characterized by: hypertension, hyperglycemia, hyperlipidemia, gout, chronic hepatitis, COVID-19, rheumatoid diseases, asthma, age-related macular degeneration (atrophy), chronic fatigue syndrome, postherpetic neuralgia, insomnia, headache, multiple sclerosis, cerebral infarction, sudden deafness, ischemia in the lower extremities, chronic ischemic heart disease, adjuvant therapy, etc.
3.2
Contraindications
Contraindications mainly include hyperthyroidism, hypotension, hypocalcemia, hypoglycemia, ozone allergy, gravida, coagulopathy (hemophilia patients), acute myocardial infarction, visceral hemorrhage, thrombocytopenia, sodium citrate allergy, glucose-6-phosphate dehydrogenase deficiency (G-6-PD deficiency), peptic ulcer patients with a history of active bleeding, patients with severe liver, kidney and multiple organ failure, acute alcoholism (excessive intake more than 1000 mL), etc.
4.
STANDARD OPERATING PROCEDURES
Due to various manufacturers of medical ozone therapeutic apparatus, operation processes and ozone therapy concentrations are formulated according to the equipment recommendation and the patient's disease. The main procedures are as follows.
4.1
Overall processes
4.1.1
Pre-treatment assessment
4.1.1.1 Hospital qualification. It is recommended that AOBT therapy be carried out in departments with the ability and qualification of autotransfusion in second-class comprehensive hospitals and upwards. Standard operation procedures and management for AOBT should be in accordance with the autotransfusion information management system.
4.1.1.2 Test indicators. Test indicators include blood routine examination, coagulation function index, biochemical examination (liver function, renal function, electrolyte, etc.), thyroid function, indexes of blood transfusion related infectious diseases (HIV, syphilis, hepatitis C, hepatitis B), electrocardiogram (ECG), etc.
4.1.1.3 Indication assessment. Indications and contraindications should be strictly controlled, as well as pathogenetic conditions to determine the blood collection volume, ozone concentration, and input volume. Treatment records should be established.
4.1.1.4 Informed consent for therapy. Patients and their families should be informed of the condition and treatment procedures, and sign "informed consent for AOBT"[9].
4.1.1.5 Medication effects. Oral vitamins or antioxidants, not recommended during therapy, can be taken before and after treatment. Angiotensin-converting enzyme inhibitor (ACEI) may decrease patients' blood pressure. In addition, it is not recommended for patients to take anticoagulants during treatment.
4.1.2
AOBT application form
The clinician or blood transfusion physician issues the "AOBT application form" from the physician workstation of the hospital information system. The blood collection barcode and patient information (including name, gender, age, identity card number, department, and clinical diagnosis) are printed after confirmation. The label should indicate "autologous blood for personal use only".
4.1.3
Treatment protocols
4.1.3.1 AOBT frequency. The frequency of AOBT relies on the severity of underlying diseases, desired effects, and actual therapeutic effects. The individualized treatment protocol should be formulated. In general, the AOBT frequency is 1 time/day, or 1–3 times/week, and 10–15 times for each course (2 courses or more per year). For populations such as the sub-health group, the frequency can be 2 times/week (3 weeks in a row), 1 time/week (2 weeks in a row), 1 time in half a month (2 times in a row), once a month continuously, or 1–2 times/week for several weeks.
4.1.3.2 Blood collection volume. The blood volume should be 50–250 mL and blood is generally blended with mixed ozone gas in a 1:1 proportion. Ozone concentration of 20–40 μg/mL and a 200 mL (1 Unit) blood bag (containing standard sodium citrate anticoagulant) are recommended. Beginning from a low level, ozone concentration is gradually increased with the increase of treatment times while the maximum safe concentration cannot be over 80 μg/mL.
4.1.3.3 Solution. A 0.9% NaCl solution is used to maintain venous access.
4.1.4
Preparation and verification of medical items[10–11]
4.1.4.1 Specialized items. These items include a therapeutic medical ozone generator, a sterile tube connecting machine, disposable connecting tubes, disposable blood collection and transfusion devices, disposable plastic blood bags (check their models, validity, appearance of blood bags with no damage or leakage), and blood collection scales/microcomputer liquid collection controllers.
4.1.4.2 Related items. These necessary items for autologous blood collection include puncture needles (if necessary), sterile treatment towels, tourniquets/disposable medical dressings or elastic pulse bands, sterile items such as saline, iodophor and cotton swabs, disposable sterile gloves, medical waste cans (bags), sharps containers, and emergency drugs and consumables such as dexamethasone and adrenaline.
4.1.4.3 Safety monitoring items. These items include routine ECG monitoring and oxyhemoglobin saturation monitoring machines.
4.2.1 Consumable assembly for ozone therapy. Under sterile conditions, such as laminar flow purification rooms or clean benches, a "disposable autologous ozonized blood transfusion pipeline" is assembled by sterilely connecting a disposable connecting tube, a disposable blood collection and transfusion device, and a disposable plastic blood bag (special antioxidant blood bag), then connecting an injection plastic bottle of 0.9% sodium chloride, and emptying the air inside. A special "disposable autologous ozonized blood transfusion pipeline" kit can also be used (Fig. 1). The printed blood collection barcode and patient information label (including patient name, blood group, medical record number, and other unique identification such as information, collection time, as well as warning information marked "for autologous personal infusion only") should be pasted on the blood bag (referring to WS/T796-2022: Guideline for perioperative patient blood management).
Figure
1.
Structure diagram for disposable autologous ozonized blood transfusion set (with automatic blocking and exhaust function)
(Note: diagram of unpublished patent application by Jianjun Wu, et al.)
4.2.2 Preparation of general medical consumables. The operator should prepare the treatment kits, disinfection items, medical waste bags, sharps containers, etc.
4.2.3 Patient preparation. The operator should verify patient name, gender, age, department, bed number, and ID number; inform the patient of the treatment purpose; assess patient consciousness, degree of cooperation, vascular access status, and measurement and record of vital signs; check whether the punctured skin has been injured, or has inflammation, rash, dermatomycosis, or scar, as well as blood pressure, pulse, and oxyhemoglobin saturation.
4.2.4 Equipment preparation. The operator should connect the medical oxygen with the therapeutic medical ozone generator and adjust the parameters; prepare and check operation status according to the equipment SOP. Emergency facilities and medicine must be ready for use[9–11]. Beginning from a low level for the first time of treatment, the concentration of ozone is recommended to be 20–40 μg/mL, and the maximum cannot be over 80 μg/mL. The blood collection volume and ozone concentration are applied according to the recommendation in treatment principles.
4.2.5 Blood collection. Firstly, the nurse should place a sterile treatment towel on the hospital bed, instruct the patient to take a sitting, semi-sitting or supine position, and then open the treatment kit, wear sterile gloves, and disinfect. Large veins such as the median cubital vein or basilic vein are preferred for puncture. The insertion of a central catheter can be performed if necessary. A dedicated AOBT bag with an appropriate patient label must be verified for blood collection (including name, age, gentle, patient or specimen ID, etc.). Secondly, the nurse should keep the puncture needle's access to the disposable plastic blood bag unobstructed, and collect blood (a professional blood collection scale is recommended for automatic collection after confirming the volume and setting up the collection parameters). Thirdly, the recommended collection volume for an adult is 200 mL (1 Unit); for a younger or elder and/or very thin individual, the volume can be calculated at 1.5–2.0 mL/kg, but no more than 200 mL. Anticoagulants and blood are mixed at a ratio of 1:4. In addition, the collection pathway is maintained with a 0.9% sodium chloride injection.
4.2.6 Preparation of ozonized blood. In the first place, the operator should aseptically connect the disposable blood bag and outlet (sterile interface), start the ozone generator, and blend the ozone mixed gas with blood in proportion (generally 1:1); then, mix and shake the blood bag slowly and evenly (avoiding violent oscillation) for 5−8 minutes (the automatic blood collection scale can be used). To avoid bacterial contamination, mixing ozone autologous blood by using syringes to inject ozone into the blood bag several times is not recommended. Finally, the prepared ozonized blood contained in the blood bag, is placed into the ozone autologous whole blood container and recorded in the "blood bank or blood management system" according to autologous blood management instructions, as part of the autotransfusion.
4.2.7 Transfusion of ozonized blood. The nurse should close the 0.9% sodium chloride injection pathway and open the blood transfusion pathway to transfuse ozonized blood at a speed of 75−150 drops/minute (5−10 mL/minute). The recommended time for the transfusion of 200 mL ozonized blood is 20−40 minutes, and the transfusion rate can be accelerated according to the status of each patient. The patient's vital signs must be closely observed (relevant monitoring indexes should be observed according to the allogeneic blood transfusion process) during the transfusion process.
4.2.8 Post-transfusion. The nurse should flush the tube with sodium chloride injection after transfusion. The patient should press the puncture position for more than 5 minutes after removing the puncture needle, and observe for about 15 minutes. In the end, the puncture part must be bound up by using disposable medical dressings or an elastic pulse bandage.
4.2.9 Waste disposal. After transfusion, it is suggested that the blood bag be sealed by a heat sealer and then kept at 4 ℃ for more than 24 hours as a trace source in the event of bacterial contamination where the treatment is suspected. Medical waste must be discarded in the medical waste can, and edge tools such as blood needles must be disposed of in the sharps container.
4.2.10 Information input. The operator should complete treatment execution and treatment record forms (electronic forms) in two copies. One copy is for the medical record and the other is for the blood transfusion department. The record form includes consumables (name, batch number, amount, handover amount of medical waste, etc.), treatment parameters such as blood volume, ozone concentration, cycle indexes of ozone therapy, billing, changes in patient condition, and treatment conditions. The nurse should fill in the "execution form of blood treatment" (including monitoring of vital signs, treatment start and end times, treatment dose, etc.), and the blood transfusion physician should fill in the "blood treatment record form" (including the whole blood collection volume, ozone concentration, cycle indexes of ozone therapy, etc.).
5.
COMPLICATIONS AND MANAGE-MENT
During therapy, the physician must closely observe the patient (measuring blood pressure, heart rate, respiration, and pulse every 30 minutes), ask the patient whether they are experiencing any adverse reactions such as dizziness, lip numbness, palpitations, or dyspnea, and take any corresponding treatment actions as necessary. To ensure safety, it is recommended that ECG monitoring is adopted for the whole treatment process for medium and high-risk patients.
5.1
Anaphylaxis and allergy
Patients who are allergic to ozone or sodium citrate, usually present with rash, pruritus, chills, fear of cold, fever and, and anaphylactic shock in severe cases. Once these symptoms occur, AOBT should be stopped immediately; antianaphylactic treatment should be given to patients; anaphylactic shock should be treated according to the shock rescue process.
5.2
Hypotension
Hypotension may result from excessive blood collection speeds or may occur during the ozonized blood transfusion process. The incidence of hypotension may increase especially in patients orally taking angiotensin converting enzyme inhibitors. Therefore, blood pressure must be kept under close supervision so that the treatment can be suspended as soon as patients present with hypotension.
5.3
Hemolysis
If patients present with hemolysis, treatment must be stopped immediately, and corresponding treatments must be applied if any causes are identified.
5.4
Bacteremia
Bacteremia is mainly triggered by blood contamination which should be avoided by aseptic operation during treatment.
5.5
Bleeding or thrombosis
A shortage of anticoagulants can lead to thrombosis, while excessive anticoagulants can result in coagulation dysfunction. Therefore, the ratio of anticoagulant to blood volume must be strictly controlled to avoid such reactions.
5.6
Air embolism
Air embolisms happen when gas enters the blood vessel due to improper administration. The physician should exhaust all air in the pipeline before treatment, and closely observe the pipeline during treatment to avoid air entering the blood vessel which is potentially life-threatening. If an air embolism is suspected, the patient should immediately be placed in the left lateral position with head low and feet high, and be treated with supportive therapy such as hyperbaric oxygen by the relevant department.
5.7
Heart failure
For the elderly or patients with cardiac insufficiency, heart failure may be induced by excessive blood collection or transfusion. Therefore, the speed of collection and transfusion should be formulated according to each patient's parameter, and be adjusted in a timely manner based on the patient's symptoms, such as dizziness, fatigue, palpitations, wheezing, and shortness of breath. If necessary, treatment such as cardiac diuretic therapy should be applied.
6.1
Monitoring of ozone concentration and related indexes
An ozone concentration monitor is recommended for monitoring ozone concentration four times per month. Generally, the concentration of O3 in oxygen-ozone mixed gas produced by therapeutic medical ozone generators is 5–80 μg/mL, with an error of about ±10%. Hospitals can regularly check blood gas indexes of ozonized blood, such as oxyhemoglobin saturation, and adjust monitoring frequency based on the number of sample cases. If the number of cases is small (for example less than 10 cases per month), it is suggested that at least 4 cases be checked for quality control purposes (referring to the quality control standards for blood products by blood bank system); the frequency can be appropriately increased if the number of cases is large.
6.2
Environmental management for therapeutic departments
The total number of bacterial colonies in the air of the therapeutic room should be ≤4 cfu/5 minutes in a 9 cm plate, and be ≤10 cfu/cm2 on the surface of objects. The treatment room must be well-ventilated, clean, and quiet. Smoking, naked flames, and flammable and explosive gases, such as ether and ethylene oxide, are prohibited in the room. In addition, peracetic acid spray cannot be used for air disinfection. After ozone extraction, the ozone generator should be closed in time, and the remaining gas should be recovered and converted through the apparatus to prevent gas from leaking into the air. If gas leakage occurs when using the ozone concentration monitor, the operator should close the therapeutic medical ozone generator first, evacuate indoor staff expediently, and increase ventilation until the gas concentration is reduced to a safe range.
6.3
Hospital infection management for therapeutic departments
Before and after treatment, a medical plasma air disinfector should be used for 1 hour. Air culture should be carried out once a month, and the number of bacterial colonies should be ≤4 cfu/5 minutes in a 9 cm plate; a culture from the surface of the ozone therapeutic generator should be carried out, and the number of bacterial colonies should be ≤5 cfu/5 minutes in a 9 cm plate. In addition, the bacteria colony number found on hands should be ≤10 cfu/cm2.
6.4
Equipment maintenance
All equipment should be kept clean. When contaminated with blood or dirt, equipment must be cleaned and disinfected promptly. The air intake of the therapeutic medical ozone generator should be protected and be connected with an air filter when not in use to keep dust out. Liquids such as iodine tincture and iodophor are strictly prohibited for disinfection, while dry alcohol wipes (not dripping alcohol) can be used to wipe the equipment's air intake. All equipment must be maintained regularly, once per day for departments, once per quarter for the equipment department, and half yearly for equipment manufacturers.
6.5
Material inspection
Blood bags used must be legal, with medical device registration certificates and delivery inspection reports, and be used within their period of validity. There should be independent storage space for all materials, as well as fire and moisture-proof measures.
6.6
Operation personnel requirements
Ozone therapy medical staff should be trained, and pass related assessments before undertaking the procedure. Further education and training is necessary every two years. The training should include operational guidance, common maintenance and equipment troubleshooting, observation and treatment of adverse reactions, etc.
6.7
Medical documents
Medical documents recording the treatment process should be written in a standard, timely, and complete manner.
6.8
Adverse reactions
Adverse reactions during the treatment process should be dealt with as per emergency plans.
7.
MANAGEMENT SYSTEM FOR TRANSFUSION INFORMATION
7.1
Maintenance of basic data in transfusion information system
The physician should add therapeutic auto-transfusion to the autotransfusion category in the blood requirements column and add ozone autologous whole blood to the classification of autologous blood.
7.2
Pre-treatment assessment
The physician should check the indicators for the assessment of blood routine and coagulation function tests, and strictly grasp the indications and contraindications.
7.3
Treatment application
The physician should apply the treatment according to conventional autotransfusion procedures, choose therapeutic autotransfusion, then ozone autologous whole blood, blood collection volume, and ozone concentration.
7.4
Blood collection
The nurse should operate the computer system according to autologous blood collection methods, print the label marked "ozone autologous whole blood", affix it to the blood bag, and collect blood from the patient.
7.5
Transfusion during treatment
The nurse should fill in the associated blood transfusion data in the blood transfusion nursing system record.
7.6
Effect evaluation
The physician should evaluate therapeutic effects according to changes in patient condition and related examinations.
The International Scientific Committee of Ozone Therapy. Madrid declaration on ozone therapy: version 3[EB/OL]. [2020-05-14]. http://www.isco3.org/.
[2]
Bocci V. Oxygen-ozone therapy[M]. Beijing: Peking University Medical Press, 2006.
[3]
Chinese Society of Anesthesiology Committee for Pain Medicine, Chinese Association of Anesthesiology, Chinese Medical Association of Minorities Committee for Ozone Medicine. Expert consensus on ozonated autohemotherapy[J]. Transl Med J, 2018, 7(6): 326−328, 345. doi: 10.3969/j.issn.2095-3097.2018.06.002
[4]
Ma YL, Guo L, Dai ZQ, et al. Clinical research progress of medical ozonated autohemotherapy[J]. Electron J Clin lit, 2019, 6(83): 197. doi: 10.16281/j.cnki.jocml.2019.83.147
[5]
Pivotto AP, Banhuk FW, Staffen IV, et al. Clinical uses and molecular aspects of ozone therapy: a review[J]. OnLine J Biol Sci, 2020, 20(1): 37−49. doi: 10.3844/ojbsci.2020.37.49
[6]
Cattel F, Giordano S, Bertiond C, et al. Ozone therapy in COVID-19: a narrative review[J]. Virus Res, 2021, 291: 198207. doi: 10.1016/j.virusres.2020.198207
[7]
Hernández A, Viñals M, Pablos A, et al. Ozone therapy for patients with COVID-19 pneumonia: preliminary report of a prospective case-control study[J]. Int Immunopharmacol, 2021, 90: 107261. doi: 10.1016/j.intimp.2020.107261
[8]
Tascini C, Sermann G, Pagotto A, et al. Blood ozonization in patients with mild to moderate COVID-19 pneumonia: a single centre experience[J]. Intern Emerg Med, 2021, 16(3): 669−675. doi: 10.1007/s11739-020-02542-6
Peng GF, Yu KQ, Li M, et al. Effect comparison of different concentrations of medical ozonated autohemotherapy in the treatment of acute gouty arthritis[J]. Shandong Med J, 2021, 61(5): 79−81. doi: 10.3969/j.issn.1002-266X.2021.05.022
[13]
Feng LF, Chen N, Li XX, et al. Effectiveness and safety of trioxy autotransfusion therapy for gout: a systematic review and meta analysis[J]. Chin J Drug Eval, 2021, 38(5): 425−430.
[14]
Tan YC, Guo JP, Wang CF, et al. Clinical effect of immune ozonated autohemotherapy in the treatment of hyperlipidemia[J]. Women's Health Res, 2019, 0(12): 57−58.
DownLoad:
