Eskes Anne, Vermeulen Hester, Lucas Cees, Ubbink Dirk T
Quality Assurance & Process Innovation, Academic Medical Centre, University of Amsterdam & Amsterdam School of Health Professions, Meibergdreef 9, Amsterdam, Netherlands, 1105AZ.
Cochrane Database Syst Rev. 2013 Dec 16;2013(12):CD008059. doi: 10.1002/14651858.CD008059.pub3.
Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute wounds (such as those arising from surgery and trauma). However, the effects of HBOT on wound healing are unclear.
To determine the effects of HBOT on the healing of acute surgical and traumatic wounds.
We searched the Cochrane Wounds Group Specialised Register (searched 9 August 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12); Ovid MEDLINE (2010 to July Week 5 2013); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, August 08, 2013); Ovid EMBASE (2010 to 2013 Week 31); EBSCO CINAHL (2010 to 8 August 2013).
Randomised controlled trials (RCTs) comparing HBOT with other interventions such as dressings, steroids, or sham HOBT or comparisons between alternative HBOT regimens.
Two review authors conducted selection of trials, risk of bias assessment, data extraction and data synthesis independently. Any disagreements were referred to a third review author.
Four trials involving 229 participants were included. The studies were clinically heterogeneous, which precluded a meta-analysis.One trial (48 participants with burn wounds undergoing split skin grafts) compared HBOT with usual care and reported a significantly higher complete graft survival associated with HBOT (95% healthy graft area risk ratio (RR) 3.50; 95% confidence interval (CI) 1.35 to 9.11). A second trial (10 participants in free flap surgery) reported no significant difference between graft survival (no data available). A third trial (36 participants with crush injuries) reported significantly more wounds healed (RR 1.70; 95% CI 1.11 to 2.61), and significantly less tissue necrosis (RR 0.13; 95% CI 0.02 to 0.90) with HBOT compared to sham HBOT. The fourth trial (135 people undergoing flap grafting) reported no significant differences in complete graft survival with HBOT compared with dexamethasone (RR 1.14; 95% CI 0.95 to 1.38) or heparin (RR 1.21; 95% CI 0.99 to 1.49).Many of the predefined secondary outcomes of the review were not reported. All four trials were at unclear or high risk of bias.
AUTHORS' CONCLUSIONS: There is a lack of high quality, valid research evidence regarding the effects of HBOT on wound healing. Whilst two small trials suggested that HBOT may improve the outcomes of skin grafting and trauma, these trials were at risk of bias. Further evaluation by means of high quality RCTs is needed.
高压氧疗法（HBOT）被用作急性伤口（如手术和创伤引起的伤口）的一种治疗方法。然而，HBOT对伤口愈合的影响尚不清楚。
确定HBOT对急性手术伤口和创伤伤口愈合的影响。
我们检索了Cochrane伤口小组专业注册库（检索日期为2013年8月9日）；Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2012年第12期）；Ovid MEDLINE（2010年至2013年7月第5周）；Ovid MEDLINE（在研及其他未索引引文，2013年8月8日）；Ovid EMBASE（2010年至2013年第31周）；EBSCO CINAHL（2010年至2013年8月8日）。
比较HBOT与其他干预措施（如敷料、类固醇或假HBOT）的随机对照试验（RCT），或不同HBOT方案之间的比较。
两位综述作者独立进行试验选择、偏倚风险评估、数据提取和数据合成。如有分歧，则交由第三位综述作者处理。
纳入了4项涉及229名参与者的试验。这些研究在临床上具有异质性，无法进行荟萃分析。一项试验（48名接受植皮手术的烧伤伤口患者）将HBOT与常规护理进行比较，报告显示与HBOT相关的完全植皮存活显著更高（95%健康植皮面积风险比（RR）3.50；95%置信区间（CI）1.35至9.11）。第二项试验（10名进行游离皮瓣手术的参与者）报告植皮存活方面无显著差异（无可用数据）。第三项试验（36名挤压伤患者）报告与假HBOT相比，HBOT治疗的伤口愈合显著更多（RR 1.70；95% CI 1.11至2.61），组织坏死显著更少（RR 0.13；95% CI 0.02至0.90）。第四项试验（135名接受皮瓣移植的患者）报告与地塞米松（RR 1.14；95% CI 0.95至1.38）或肝素（RR 1.21；95% CI 0.99至1.49）相比，HBOT在完全植皮存活方面无显著差异。该综述许多预先定义的次要结局未报告。所有四项试验的偏倚风险均不明确或较高。
关于HBOT对伤口愈合影响的高质量、有效研究证据不足。虽然两项小型试验表明HBOT可能改善植皮和创伤的结局，但这些试验存在偏倚风险。需要通过高质量的RCT进行进一步评估。
