Bennett Michael H, Weibel Stephanie, Wasiak Jason, Schnabel Alexander, French Christopher, Kranke Peter
Cochrane Database Syst Rev. 2014 Nov 12;2014(11):CD004954. doi: 10.1002/14651858.CD004954.pub3.
Background Most cases of stroke are caused by impairment of blood flow to the brain (ischaemia), which results in a reduction in available oxygen and subsequent cell death. It has been postulated that hyperbaric oxygen therapy (HBOT) may reduce the volume of brain that will die by greatly increasing available oxygen, and it may further improve outcomes by reducing brain swelling. Some centres are using HBOT routinely to treat people with stroke. This is an update of a Cochrane Review first published in 2005.Objectives To assess the effectiveness and safety of adjunctive HBOT in the treatment of people with acute ischaemic stroke.Search methods We searched the Cochrane Stroke Group Trials Register (last searched April 2014), the Cochrane Central Register of Controlled Trials(CENTRAL) (April 2014), MEDLINE (1966 to April 2014), EMBASE (1980 to April 2014), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to April 2014), the Database of Randomised Controlled Trials in Hyperbaric Medicine(DORCTIHM) (searched April 2014) and the reference lists of articles.We handsearched relevant publications and contacted researchers to identify additional published and unpublished studies.Selection criteria Randomised controlled trials (RCTs) that compared the effects of adjunctive HBOT versus those of no HBOT (no treatment or sham).Data collection and analysis Three review authors independently extracted data, assessed each trial for internal validity and resolved differences by discussion.Main results We included 11 RCTs involving 705 participants. The methodological quality of the trials varied. We could pool data only for case fatalities. No significant differences were noted in the case fatality rate at six months in those receiving HBOT compared with the control group (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.34 to 2.75, P value 0.96). Four of 14 scale measures of disability and functional performance indicated improvement following HBOT, for example, the mean Trouillas Disability Scale score was lower with HBOT (mean difference (MD) 2.2 point reduction with HBOT, 95% CI 0.15 to 4.3, P value 0.04), and the mean Orgogozo Scale score was higher (MD 27.9 points, 95% CI 4.0 to 51.8, P value 0.02).Authors' conclusions We found no good evidence to show that HBOT improves clinical outcomes when applied during acute presentation of ischaemic stroke. Although evidence from the 11 RCTs is insufficient to provide clear guidelines for practice, the possibility of clinical benefit has not been excluded. Further research is required to better define the role of HBOT in this condition.
大多数中风病例是由脑部血流受损（缺血）引起的，这会导致可用氧气减少并随后导致细胞死亡。据推测，高压氧疗法（HBOT）可能通过大幅增加可用氧气来减少将死亡的脑体积，并且可能通过减轻脑肿胀进一步改善预后。一些中心正在常规使用HBOT治疗中风患者。这是2005年首次发表的Cochrane系统评价的更新版。
评估辅助性HBOT治疗急性缺血性中风患者的有效性和安全性。
我们检索了Cochrane中风小组试验注册库（最后检索时间为2014年4月）、Cochrane对照试验中央注册库（CENTRAL）（2014年4月）、MEDLINE（1966年至2014年4月）、EMBASE（1980年至2014年4月）、护理及相关健康文献累积索引（CINAHL）（1982年至2014年4月）、高压氧医学随机对照试验数据库（DORCTIHM）（2014年4月检索）以及文章的参考文献列表。我们手工检索了相关出版物并联系研究人员以识别其他已发表和未发表的研究。
比较辅助性HBOT与不进行HBOT（不治疗或假治疗）效果的随机对照试验（RCT）。
三位综述作者独立提取数据，评估每个试验的内部有效性，并通过讨论解决分歧。
我们纳入了11项RCT，涉及705名参与者。试验的方法学质量各不相同。我们仅能汇总病例死亡率的数据。与对照组相比，接受HBOT的患者在6个月时的病例死亡率未发现显著差异（风险比（RR）0.97，95%置信区间（CI）0.34至2.75，P值0.96）。14项残疾和功能表现量表测量中有4项表明HBOT后有所改善，例如，HBOT组的Trouillas残疾量表平均得分较低（HBOT组平均降低2.2分，95%CI 0.15至4.3，P值0.04），而Orgogozo量表平均得分较高（平均差（MD）27.9分，95%CI 4.0至51.8，P值0.02）。
我们没有找到充分的证据表明在缺血性中风急性发作时应用HBOT能改善临床预后。尽管11项RCT的证据不足以提供明确的实践指南，但临床获益的可能性并未被排除。需要进一步研究以更好地界定HBOT在这种情况下的作用。
