Garcia-Covarrubias Lisardo, McSwain Norman E, Van Meter Keith, Bell Richard M
Department of Surgery, Tulane University School of Medicine and Charity Hospital, New Orleans, Louisiana 70112, USA.
Am Surg. 2005 Feb;71(2):144-51.
Hyperbaric oxygen therapy (HBO) has been recommended as an adjunct treatment in acute traumatic ischemia and crush injury. Several animal models have shown better outcomes when HBO is used in crush injury and compartment syndrome. Animal and in vitro models have suggested that these beneficial effects may be mediated by attenuation of ischemia-reperfusion injury. We did a systematic review of the literature using the Eastern Association for the Surgery of Trauma (EAST) recommendations for evidence-based reviews. An electronic search using Medline, OVID technologies, and the Cochrane database was performed. Only clinical papers published between 1966 and December 2003 with at least five patients that included enough information to evaluate were selected. A group of trauma experts reviewed the selected articles and scored them applying the instrument developed by the EAST practice management guidelines committee. Nine documents fulfilled the inclusion criteria for a total of approximately 150 patients. Most documents were retrospective, uncontrolled, and case series lacking a standardized methodology (class III). There was one prospective controlled randomized trial with some limitations on its design. We determined that eight of nine studies showed a beneficial effect from HBO with only one major complication. We concluded that adjunctive HBO is not likely to be harmful and could be beneficial if administered early. Well designed clinical studies are warranted.
高压氧疗法（HBO）已被推荐作为急性创伤性缺血和挤压伤的辅助治疗方法。一些动物模型显示，在挤压伤和骨筋膜室综合征中使用HBO时效果更好。动物和体外模型表明，这些有益作用可能是通过减轻缺血再灌注损伤来介导的。我们使用东部创伤外科学会（EAST）循证医学综述的建议对文献进行了系统评价。通过使用Medline、OVID技术和Cochrane数据库进行了电子检索。仅选择了1966年至2003年12月期间发表的、至少有5名患者且包含足够信息以进行评估的临床论文。一组创伤专家对所选文章进行了评审，并应用EAST实践管理指南委员会开发的工具对其进行评分。9份文件符合纳入标准，共涉及约150名患者。大多数文件为回顾性、非对照性病例系列研究，缺乏标准化方法（III级）。有一项前瞻性对照随机试验，其设计存在一些局限性。我们确定，9项研究中有8项显示HBO有有益作用，且只有1例主要并发症。我们得出结论，辅助性HBO不太可能有害，如果早期应用可能有益。需要开展设计良好的临床研究。
