Department of Clinical Sciences, Lund University, Lund S-221 85, Sweden.
Med Clin North Am. 2013 Sep;97(5):957-80. doi: 10.1016/j.mcna.2013.04.004. Epub 2013 Jul 6.
The widespread use of HBO as an adjunctive treatment of diabetic foot ulcers has been founded on weak scientific evidence, but the consistency in positive outcomes in trials evaluating HBO on ulcer healing is noteworthy, not least as these results are in concert with data from in vitro and physiologic studies supporting the theoretical framework of HBO reversing hypoxia-induced abnormality. The long-term ulcer-healing rates of the nonrandomized controlled studies before the recent study by Margolis and colleagues, 77% with HBO versus 25% with standard treatment, are in concert with 1-year follow-up data from the 2 double-blind RCTs, 54% versus 25%. These 2 trials have put the use of HBO on firmer ground, but several issues, including health economics, developing robust selection criteria for treatment, optimizing treatment protocols, and identifying standards for when to start and stop treatment, remain to be elucidated. Not least, outcomes from further high-quality studies are needed. At present, HBO may be used as an adjunctive therapy in a select group of patients with diabetic foot ulcers that are difficult to heal.
高压氧（HBO）被广泛用作治疗糖尿病足溃疡的辅助疗法，其依据是薄弱的科学证据，但在评估 HBO 对溃疡愈合的疗效的试验中，其结果始终一致，这值得注意，尤其是因为这些结果与支持 HBO 逆转缺氧诱导的异常的体外和生理研究数据一致。在马戈利斯（Margolis）及其同事最近的研究之前，非随机对照研究中，HBO 组的长期溃疡愈合率为 77%，而标准治疗组为 25%，这与 2 项双盲 RCT 的 1 年随访数据一致，分别为 54%和 25%。这两项试验使 HBO 的应用更加可靠，但仍有一些问题需要解决，包括卫生经济学、为治疗制定更严格的选择标准、优化治疗方案，以及确定何时开始和停止治疗的标准。此外，还需要进一步的高质量研究结果。目前，HBO 可作为一组难以愈合的糖尿病足溃疡的选择性辅助治疗方法。
