Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.
Hyperbaar Geneeskundig Centrum, Rijswijk, The Netherlands.
J Vasc Surg. 2020 Feb;71(2):682-692.e1. doi: 10.1016/j.jvs.2019.07.082.
Diabetic foot ulcers (DFUs) are frequently associated with peripheral arterial occlusive disease (PAOD) and may ultimately lead to amputations of the lower extremity. Adjuvant hyperbaric oxygen treatment (HBOT) might foster better wound healing and lower amputation rates in patients with DFU and PAOD. A systematic review was conducted to assess the effects of HBOT as an adjunctive therapy to standard treatment for patients with DFUs with PAOD.
Systematic review using the MEDLINE, EMBASE, and Cochrane CENTRAL databases (from inception to October 2018). All original, comparative studies on the effect of HBOT on DFUs with PAOD were eligible. The primary outcome measures were amputation rate, amputation-free survival, complete ulcer healing, and mortality.
Eleven studies, totaling 729 patients, were included for analysis, including 7 randomized clinical trials, 2 controlled clinical trials, and 2 retrospective cohorts. Four were used for quantitative synthesis. Meta-analysis showed a significantly fewer major amputations in the HBOT group (10.7% vs 26.0%; risk difference, -15%; 95% confidence interval [CI], -25 to -6; P = .002; number needed to treat, 7; 95% CI, 4-20). No difference was found for minor amputations (risk difference, 8%; 95% CI, -13 to 30; P = .46). Three studies reporting on complete wound healing showed contrasting results. No significant difference was found for mortality or amputation-free survival.
Current evidence shows that adjuvant HBOT improves major amputation rate, but not wound healing, in patients with DFUs and PAOD. Given the wide range of patients included in the trials, better patient selection may help define which patients with DFUs and PAOD benefit most from HBOT as standard adjunctive treatment.
糖尿病足溃疡（DFU）常伴有外周动脉闭塞性疾病（PAOD），最终可能导致下肢截肢。辅助高压氧治疗（HBOT）可能会促进 DFU 和 PAOD 患者更好地愈合伤口，降低截肢率。进行了系统评价，以评估 HBOT 作为 DFU 和 PAOD 患者标准治疗的辅助治疗的效果。
使用 MEDLINE、EMBASE 和 Cochrane CENTRAL 数据库进行系统评价（从创建到 2018 年 10 月）。所有关于 HBOT 对 DFU 和 PAOD 影响的原始、对照研究均符合条件。主要结局指标为截肢率、无截肢生存率、完全溃疡愈合和死亡率。
共纳入 11 项研究，共 729 例患者，包括 7 项随机临床试验、2 项对照临床试验和 2 项回顾性队列研究。其中 4 项用于定量综合分析。荟萃分析显示，HBOT 组的主要截肢率明显较低（10.7% vs. 26.0%；风险差异，-15%；95%置信区间[CI]，-25 至-6；P =.002；需要治疗的人数，7；95%CI，4-20）。而次要截肢率无差异（风险差异，8%；95%CI，-13 至 30；P =.46）。3 项报告完全伤口愈合的研究结果相反。死亡率或无截肢生存率无显著差异。
目前的证据表明，辅助 HBOT 可降低 DFU 和 PAOD 患者的主要截肢率，但不能改善伤口愈合。鉴于纳入试验的患者范围广泛，更好的患者选择可能有助于确定哪些 DFU 和 PAOD 患者最受益于 HBOT 作为标准辅助治疗。
