Holland N Julian, Bernstein Jonathan M, Hamilton John W
ENT Department, St Michael’s Hospital, Bristol, UK.
Cochrane Database Syst Rev. 2012 Feb 15;2012(2):CD007288. doi: 10.1002/14651858.CD007288.pub2.
Bell's palsy is an idiopathic, acute unilateral facial weakness that evolves rapidly and is maximal within two days. Moderate ear discomfort, sensitivity to sound and reduced tearing may occur.
To assess the effects of hyperbaric oxygen therapy on recovery of facial function in adults with moderate to severe Bell's palsy.
We searched the Cochrane Neuromuscular Disease Group Specialized Register (January 2012), CENTRAL (2011, Issue 4), MEDLINE (January 1966 to January 2012), EMBASE (January 1980 to January 2012), CINAHL (1937 to January 2012), AMED (1985 to January 2012), LILACS (January 1982 to January 2012). In addition we made a systematic search for relevant controlled trials in specific hyperbaric literature sources.
Randomised controlled trials or quasi-randomised controlled trials of adults (over 16 years of age) undergoing hyperbaric oxygen therapy for moderate to severe Bell's palsy. We considered studies to be of sufficient quality for inclusion in the review only if there was blinding in the assessment of the facial palsy grade. We planned to include studies of HBOT used as adjuvant therapy, or in addition to routine medical therapy (including corticosteroids or antivirals, or both). Both treatment and control groups were to receive the same baseline therapy. HBOT had to be delivered at concentrations greater than or equal to 1.2 ATA in a hyperbaric oxygen chamber as a series of dives of 30 to 120 minutes.
Two reviewers independently assessed eligibility and study quality and extracted data. We contacted study authors for additional information.
Our searches found no randomised controlled trials or quasi-randomised controlled trials that met the eligibility criteria for this review.There is very low quality evidence from one randomised trial involving 79 participants with acute Bell's palsy, but this study was excluded as the outcome assessor was not blinded to treatment allocation and thus did not meet pre-defined eligibility criteria. The trial compared 42 people who received hyperbaric oxygen therapy (2.8 atmospheres for 60 minutes twice daily, five days per week until the facial palsy resolved; maximum 30 'dives') and placebo tablets with 37 people who received placebo hyperbaric oxygen therapy (achieving only a normal partial pressure of oxygen) and prednisone (40 mg twice daily, reducing over eight days). Facial function recovered in more participants treated with hyperbaric oxygen therapy than with prednisone (hyperbaric oxygen therapy, 40/42 (95%); prednisone, 28/37 (76%); risk ratio 1.26, 95% CI 1.04 to 1.53). There were no reported major complications and all participants completed the trial.
AUTHORS' CONCLUSIONS: Very low quality evidence from one trial suggests that hyperbaric oxygen therapy may be an effective treatment for moderate to severe Bell's palsy, but this study was excluded as the outcome assessor was not blinded to treatment allocation. Further randomised controlled trials are needed.
贝尔氏面瘫是一种特发性急性单侧面部无力，发展迅速，在两天内达到最严重程度。可能会出现中度耳部不适、对声音敏感和流泪减少的症状。
评估高压氧疗法对中重度贝尔氏面瘫成年患者面部功能恢复的影响。
我们检索了Cochrane神经肌肉疾病组专业注册库（2012年1月）、Cochrane系统评价数据库（2011年第4期）、医学期刊数据库（1966年1月至2012年1月）、荷兰医学文摘数据库（1980年1月至2012年1月）、护理学与健康照护数据库（1937年至2012年1月）、澳大利亚和新西兰医学文摘数据库（1985年至2012年1月）、拉丁美洲和加勒比地区健康科学数据库（1982年1月至2012年1月）。此外，我们还在特定的高压氧文献来源中系统检索了相关对照试验。
针对中重度贝尔氏面瘫成年患者（16岁以上）进行高压氧疗法的随机对照试验或半随机对照试验。只有在对面瘫分级评估采用盲法的情况下，我们才认为这些研究质量足以纳入综述。我们计划纳入将高压氧疗法用作辅助治疗或作为常规药物治疗（包括皮质类固醇或抗病毒药物，或两者兼有）补充的研究。治疗组和对照组均接受相同的基线治疗。高压氧疗法必须在高压氧舱中以大于或等于1.2 ATA的浓度进行一系列30至120分钟的潜水治疗。
两名评价员独立评估研究的合格性和质量并提取数据。我们与研究作者联系以获取更多信息。
我们的检索未发现符合本综述合格标准的随机对照试验或半随机对照试验。一项涉及79名急性贝尔氏面瘫患者的随机试验提供了质量极低的证据，但该研究被排除，因为结局评估者未对治疗分配设盲，因此不符合预先确定的合格标准。该试验将42名接受高压氧疗法（2.8个大气压，每天两次，每次60分钟，每周五天，直至面瘫缓解；最多30次“潜水”）和安慰剂片的患者与37名接受安慰剂高压氧疗法（仅达到正常氧分压）和泼尼松（每日两次，每次40毫克，持续八天减量）的患者进行了比较。接受高压氧疗法治疗的患者面部功能恢复的比例高于接受泼尼松治疗的患者（高压氧疗法组，40/42（95%）；泼尼松组，28/37（76%）；风险比1.26，95%可信区间1.04至1.53）。未报告重大并发症，所有参与者均完成了试验。
一项试验提供的质量极低的证据表明，高压氧疗法可能是治疗中重度贝尔氏面瘫的有效方法，但该研究被排除因为结局评估者未对治疗分配设盲。需要进一步的随机对照试验。
