Counterpoint: Hyperbaric oxygen for diabetic foot wounds is not effective
Counterpoint: Hyperbaric oxygen for diabetic foot wounds is not effective
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DOI：
10.1086/505223
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发表时间：
2006-07-15
影响因子：
11.8
通讯作者：
Berendt, A. R.
中科院分区：
文献类型：
--
作者：
Berendt, A. R.
背景。糖尿病足溃疡很常见，每年影响 1.0% - 4.1% 的糖尿病患者，一生中高达 25%。糖尿病足溃疡的起源是多因素的，许多愈合缓慢和/或因感染而复杂化，常常导致截肢。高压氧疗法已被建议用于多种适应症，资助机构也认可其用于少数适应症，包括糖尿病足部伤口。我回顾了有关高压氧治疗的历史和实践以及与疗效、有效性和成本效益相关的关键问题的文献。结果。尽管得到医疗保险和主要保险公司的报销认可，高压氧治疗糖尿病足护理的证据基础仍然薄弱。 Cochrane 协作组织的系统评价得出的结论是，高压氧疗法可能对治疗糖尿病伤口有价值，但所有评价的研究都存在方法学上的弱点，并且在包括假治疗组的单项随机评价试验中没有看到治疗的积极效果。高压氧治疗消耗大量资源，并且有可能消耗更多资源，这些资源可以更好地用于管理或预防糖尿病足溃疡的其他方面。结论。在大规模、充分盲法、对照和有力的随机研究明确证明高压氧治疗在治愈溃疡和预防大截肢方面的功效和成本效益之前，不应对糖尿病足部伤口进行高压氧治疗。
Background. Diabetic foot ulceration is common, affecting 1.0% - 4.1% of diabetic persons per year and up to 25% in a lifetime. Diabetic foot ulcers are multifactorial in origin, and many are slow to heal and/or are complicated by infection, frequently leading to amputation. Hyperbaric oxygen therapy has been suggested for numerous indications, and it is recognized by funding agencies for a smaller number including diabetic foot wounds.Methods. I reviewed the literature about the history and practice of hyperbaric oxygen therapy and key issues relevant to efficacy, effectiveness, and cost-effectiveness.Results. Although recognized for reimbursement by Medicare and major insurers, the evidence base for hyperbaric oxygen therapy for diabetic foot care remains weak. A systematic review for the Cochrane Collaboration concluded that hyperbaric oxygen therapy may have value in treating diabetic wounds, but the studies reviewed all had methodological weaknesses, and the positive effect of treatment was not seen in the single reviewed randomized trial to include a sham treatment arm. Hyperbaric oxygen therapy consumes very substantial resources - and has the potential to consume far more - that could be better spent on other aspects of management or prevention of diabetic foot ulceration.Conclusions. Hyperbaric oxygen therapy should not be offered for diabetic foot wounds until large-scale, adequately blinded, controlled, and powered randomized studies have clearly demonstrated efficacy and cost effectiveness in the healing of ulcers and the prevention of major amputation.