Hyperbaric oxygen for treating wounds - A systematic review of the literature
Hyperbaric oxygen for treating wounds - A systematic review of the literature
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DOI：
10.1001/archsurg.138.3.272
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发表时间：
2003-03-01
影响因子：
--
通讯作者：
Lau, J
中科院分区：
文献类型：
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作者：
Wang, CC;Schwaitzberg, S;Lau, J
目的：确定高压氧（HBO）疗法是否是缺氧伤口的有效辅助治疗方法。方法：我们从 HBO 技术评估报告和 1998 年中期至 2001 年 8 月的 MEDLINE 搜索中筛选出研究。我们接受了报告原始数据的随机对照试验（RCT）、队列和病例系列，包括至少 5 名患者，评估了 HBO 在伤口护理中的应用，并报告了临床结果：人口统计学、伤口状况、HBO 方案；从每项研究中提取不良事件和主要临床结局。结果：本次评价纳入了 57 项研究、7 项随机对照试验、16 项非随机研究和涉及 2000 多名患者的 34 个病例系列。所有研究均未使用伤口组织缺氧作为患者纳入标准。研究结果表明，与单独使用标准伤口护理相比，HBO 作为一种辅助疗法可能有益于慢性不愈合糖尿病伤口、受损皮肤移植、放射性骨坏死、软组织放射性坏死和气性坏疽。与 HBO 相关的严重不良事件包括癫痫发作和压力相关的创伤，例如气胸。研究中的一些死亡与这些不良事件有关。结论：总体研究质量较差，大多数研究中对照不足或没有对照。研究表明 HBO 可能对某些伤口有帮助，但没有足够的证据来确定开始治疗的适当时间并建立确定患者是否受益的标准。可能会发生严重的不良事件。评估 HBO 的短期和长期风险和益处的高质量随机对照试验对于更好地为临床决策提供信息是必要的。
Objective: To determine whether hyperbaric oxygen (HBO) therapy is an effective adjunct treatment for hypoxic wounds.Methods: We identified studies from technology assessment reports on HBO and a MEDLINE search from mid-1998 to August 2001. We accepted randomized controlled trials (RCTs), cohorts, and case series that reported original data, included at least 5 patients, evaluated the use of HBO for wound care, and reported clinical outcomes: Demographics, wound conditions, HBO regimen; adverse events, and major clinical outcomes were extracted from each study.Results: Fifty-seven studies, 7 RCTs, 16 nonrandomized studies, and 34 case series involving more than 2000 patients are included in this review. None of the studies used wound tissue hypoxia as a patient inclusion criterion. The study results suggest that HBO may be beneficial as An adjunctive therapy for chronic nonhealing diabetic wounds, compromised skin grafts, osteoradionecrosis, soft tissue radionecrosis, and gas gangrene compared with standard wound care, alone. Serious adverse events associated with HBO include seizures and pressure-related traumas, such as pneumothorax. A few deaths in the studies were associated with these adverse events.Conclusions: The overall study quality is poor, with inadequate or no controls in most studies. The studies suggest that HBO may be helpful for some wounds, but there is insufficient evidence to ascertain the appropriate time to initiate therapy and to establish criteria that determine whether patients Will benefit. Serious adverse events may occur. High-quality RCTs that evaluate the short- and long-term risks and benefits of HBO are necessary to better inform clinical decisions.