Department of Quality Assurance & Process Innovation, Room A3-503, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22700, Amsterdam 1100 DE, The Netherlands.
World J Surg. 2011 Mar;35(3):535-42. doi: 10.1007/s00268-010-0923-4.
Hyperbaric oxygen therapy (HBOT) is used to treat various wound types. However, the possible beneficial and harmful effects of HBOT for acute wounds are unclear.
We undertook a systematic review to evaluate the effectiveness of HBOT compared to other interventions on wound healing and adverse effects in patients with acute wounds. To detect all available randomized controlled trials (RCTs) we searched five relevant databases up to March 2010. Trial selection, quality assessment, data extraction, and data synthesis were conducted by two of the authors independently.
We included five trials, totaling 360 patients. These trials, with some methodologic flaws, included different kinds of wound and focused on different outcome parameters, which prohibited meta-analysis. A French trial (n = 36 patients) reported that significantly more crush wounds healed with HBOT than with sham HBOT [relative risk (RR) 1.70, 95% confidence interval (CI) 1.11-2.61]. Moreover, there were significantly fewer additional surgical procedures required with HBOT (RR 1.60, 95% CI 1.03-2.50), and there was significantly less tissue necrosis (RR 1.70, 95% CI 1.11-2.61). In one of two American trials (n = 141) burn wounds healed significantly quicker with HBOT (P < 0.005) than with routine burn care. A British trial (n = 48) compared HBOT with usual care. HBOT resulted in a significantly higher percentage of healthy graft area in split skin grafts (RR 3.50, 95% CI 1.35-9.11). In a Chinese trial (n = 145) HBOT did not significantly improve flap survival in patients with limb skin defects.
HBOT, if readily available, appears effective for the management of acute, difficult to heal wounds.
高压氧疗法（HBOT）用于治疗各种类型的伤口。然而，HBOT 治疗急性伤口的可能有益和有害影响尚不清楚。
我们进行了系统评价，以评估 HBOT 与其他干预措施相比在治疗急性伤口和不良反应方面的有效性。为了检测所有可用的随机对照试验（RCT），我们检索了五个相关数据库，截止到 2010 年 3 月。两名作者独立进行了试验选择、质量评估、数据提取和数据综合。
我们纳入了五项试验，共计 360 例患者。这些试验存在一些方法学缺陷，包括不同类型的伤口和关注不同的结局参数，因此无法进行荟萃分析。一项法国试验（n = 36 例）报道，与假 HBOT 相比，HBOT 治疗后挤压伤的愈合率显著更高[相对风险（RR）1.70，95%置信区间（CI）1.11-2.61]。此外，HBOT 所需的额外手术程序明显减少（RR 1.60，95% CI 1.03-2.50），组织坏死明显减少（RR 1.70，95% CI 1.11-2.61）。在两项美国试验中的一项（n = 141）中，HBOT 治疗烧伤的愈合速度显著快于常规烧伤护理（P < 0.005）。一项英国试验（n = 48）比较了 HBOT 与常规护理。HBOT 使游离皮片移植中的健康移植物面积百分比显著更高（RR 3.50，95% CI 1.35-9.11）。在中国的一项试验（n = 145）中，HBOT 并未显著提高肢体皮肤缺损患者的皮瓣存活率。
如果 HBOT 易于获得，它似乎对治疗急性、难以愈合的伤口有效。
