Roeckl-Wiedmann I, Bennett M, Kranke P
Department of Anaesthesiology and Intensive Care Medicine, Rotkreuz-Krankenhaus, Munich, Germany.
Br J Surg. 2005 Jan;92(1):24-32. doi: 10.1002/bjs.4863.
Many therapeutic options exist for chronic wounds. Hyperbaric oxygen therapy (HBOT) is one such option. It may be used for diabetic, venous, arterial and pressure ulcers.
Following a systematic search of the literature, pooled analyses of predetermined clinical outcomes of randomized controlled trials involving the use of HBOT for chronic wounds were performed. Relative risks (RR) and number needed to treat (NNT) with 95 per cent confidence intervals (c.i.) were calculated.
Six studies met the inclusion criteria. No appropriate trials were located for arterial and pressure ulcers. Pooled data from five trials on diabetic ulcers (118 patients) suggested a significant reduction in the risk of major amputation with HBOT (RR: 0.31; c.i. 0.13 to 0.71) with a NNT of 4 (c.i. 3 to 11). Sensitivity analyses did not alter the results. Ulcer healing and the rate of minor amputation were not influenced by HBOT. Data from one trial on venous ulcers suggested significant wound size reduction at the end of the treatment, but not at follow-up.
There is evidence that HBOT reduces the risk of major amputation in diabetic patients. For venous, arterial or pressure ulcers there is a lack of data. Further trials may be warranted.
慢性伤口有多种治疗选择。高压氧疗法（HBOT）就是其中之一。它可用于治疗糖尿病性溃疡、静脉性溃疡、动脉性溃疡和压疮。
在对文献进行系统检索后，对涉及使用HBOT治疗慢性伤口的随机对照试验的预定临床结果进行了汇总分析。计算了相对风险（RR）和需要治疗的人数（NNT）以及95%置信区间（c.i.）。
六项研究符合纳入标准。未找到关于动脉性溃疡和压疮的合适试验。五项关于糖尿病性溃疡的试验（118例患者）的汇总数据表明，HBOT可显著降低大截肢风险（RR：0.31；c.i. 0.13至0.71），NNT为4（c.i. 3至11）。敏感性分析未改变结果。溃疡愈合情况和小截肢率不受HBOT影响。一项关于静脉性溃疡的试验数据表明，治疗结束时伤口大小显著减小，但随访时未减小。
有证据表明，HBOT可降低糖尿病患者大截肢的风险。对于静脉性、动脉性或压疮，缺乏相关数据。可能需要进一步开展试验。
