Yang Liehao, Kong Jiao, Xing Yunlong, Pan Lingfeng, Li Caihong, Wu Zhuoxia, Li Mingxi, Zhang Lianbo
Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China.
J Wound Care. 2024 Dec 2;33(12):950-957. doi: 10.12968/jowc.2022.0213.
Negative pressure wound therapy (NPWT) and hyperbaric oxygen therapy (HBOT) have been widely used in the treatment of hard-to-heal (chronic) wounds, but there is still a lack of sufficient evidence for their combined use for the treatment of hard-to-heal wounds. This systematic review aimed to identify the clinical efficacy and safety of adding adjunctive HBOT to NPWT for hard-to-heal wounds.
Embase, PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure and Wanfang were searched from the establishment of the database to March 2022. The literature was screened according to the inclusion criteria and exclusion criteria. We assessed the quality of each included study with the Cochrane Collaboration Risk of Bias tool and Newcastle-Ottawa Scale. A meta-analysis was performed using R programming software version 4.1.0 (R Project for Statistical Computing, US). The PRISMA 2020 guidelines were used to report data from systematic reviews and meta-analysis.
A total of 15 studies were identified, including nine randomised clinical controlled trials and six retrospective studies. Meta-analysis results showed that NPWT combined with HBOT had better outcomes compared with the NPWT alone with regards to: wound healing rate (odds ratio (OR)=6.77; 95% confidence interval (Cl): 3.53-12.98; p<0.0001); bacterial positive rate of wound (OR=0.16; 95% CI: 0.05-0.55; p=0.0037); wound healing time (mean difference (MD)= -3.86; 95% Cl: -5.18 - -2.53; p<0.0001); wound area (standardised mean difference (SMD)=1.50; 95% Cl: 0.35-2.65; p=0.0104); hospitalisation time (MD= -3.14; 95% Cl: -4.93 - -1.36; p=0.005); and hospitalisation cost (OR= -202.64; 95% Cl: -404.53 - -0.75; p=0.0492). There was no significant difference in pain score (MD= -0.43; 95% Cl: -1.15-0.30; p=0.25).
The findings of this study demonstrated that adjunctive HBOT with NPWT is safe and effective in the treatment of hard-to-heal wounds. However, these findings should be interpreted with great caution given the limitations of the studies included.
负压伤口治疗（NPWT）和高压氧治疗（HBOT）已广泛应用于难愈合（慢性）伤口的治疗，但对于它们联合用于治疗难愈合伤口仍缺乏充分证据。本系统评价旨在确定在NPWT基础上加用辅助性HBOT治疗难愈合伤口的临床疗效和安全性。
检索了Embase、PubMed、Cochrane图书馆、Web of Science、中国知网和万方数据库，检索时间从各数据库建库至2022年3月。根据纳入标准和排除标准对文献进行筛选。我们使用Cochrane协作偏倚风险工具和纽卡斯尔-渥太华量表评估每项纳入研究的质量。使用R编程软件版本4.1.0（美国统计计算R项目）进行荟萃分析。采用PRISMA 2020指南报告系统评价和荟萃分析的数据。
共纳入15项研究，包括9项随机临床对照试验和6项回顾性研究。荟萃分析结果显示，与单纯NPWT相比，NPWT联合HBOT在以下方面有更好的结果：伤口愈合率（优势比（OR）=6.77；95%置信区间（Cl）：3.53-12.98；p<0.0001）；伤口细菌阳性率（OR=0.16；95% CI：0.05-0.55；p=0.0037）；伤口愈合时间（平均差（MD）=-3.86；95% Cl：-5.18--2.53；p<0.0001）；伤口面积（标准化平均差（SMD）=1.50；95% Cl：0.35-2.65；p=0.0104）；住院时间（MD=-3.14；95% Cl：-4.93--1.36；p=0.005）；以及住院费用（OR=-202.64；95% Cl：-404.53--0.75；p=0.0492）。疼痛评分无显著差异（MD=-0.43；95% Cl：-1.15-0.30；p=0.25）。
本研究结果表明，NPWT联合辅助性HBOT治疗难愈合伤口是安全有效的。然而，鉴于纳入研究的局限性，对这些结果应谨慎解读。
