高压氧辅助治疗糖尿病足溃疡的系统评价  

Hyperbaric Oxygen Therapy as Adjunctive Treatment for Diabetic Foot Ulcers:A Systematic Review

作　　者：何继东[1] 伍晓华[1] 刘莉[1] 兰直良 

机构地区：[1]四川省雅安市第二人民医院内分泌科,四川雅安625000

出　　处：《中国循证医学杂志》2014年第12期1476-1481,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价高压氧辅助治疗糖尿病足溃疡的临床疗效和安全性。方法计算机检索h e Cochrane Library(2014年第1期)、Pub Med、EMbase、CBM、VIP、CNKI和Wan Fang Data数据库,纳入关于高压氧辅助治疗糖尿病足溃疡的随机对照试验(RCT),检索时限均截至2014年1月。由2位研究者独立按照纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量后,采用Rev Man 5.2软件进行Meta分析。结果共纳入14个RCT,合计910例患者。Meta分析结果显示:高压氧联合常规治疗在糖尿病足溃疡愈合率[RR=2.16,95%CI(1.43,3.26),P=0.000 3]、大截肢发生率[RR=0.20,95%CI(0.10,0.38),P<0.000 01]、溃疡面积减少[MD=1.73,95%CI(1.34,2.11),P<0.000 01]和经皮氧分压改善情况[MD=14.75,95%CI(2.01,27.48),P=0.02]等方面均优于常规治疗,但在小截肢发生率方面不优于常规治疗[RR=0.70,95%CI(0.24,2.11),P=0.53]。此外,高压氧联合常规治疗无严重治疗相关副作用及并发症发生。结论当前证据表明,高压氧辅助治疗糖尿病足溃疡可能促进溃疡愈合和减少大截肢发生率。Objective To systematically review the clinical efficacy and safety of hyperbaric oxygen therapy as adjunctive treatment for diabetic foot ulcers. Methods Such databases as the Cochrane Library（Issue 1,2014）,Pub Med,EMbase,CBM,VIP,CNKI and Wan Fang Data were searched up to January 2014 for randomized controlled trials（RCTs） about hyperbaric oxygen therapy as adjunctive treatment for diabetic foot ulcers. According to the inclusion and exclusion criteria,two reviewers independently screened literature,extracted data,and assessed methodological quality of included studies. Then,meta-analysis was performed using Rev Man 5.2 sot ware. Results Fourteen RCTs involving 910 patients were included. The results of metaanalysis showed that,hyperbaric oxygen therapy combined with routine therapy was superior to routine therapy alone regarding ulcer healing rates（RR=2.16,95%CI 1.43 to 3.26,P=0.000 3）,incidence of major amputation（RR=0.20,95%CI 0.10 to 0.38,P〈0.000 01）,reduction of ulcer area（MD=1.73,95%CI 1.34 to 2.11,P〈0.000 01）,and improvement of transcutaneous oxygen tension（MD=14.75,95%CI 2.01 to 27.48,P=0.02）. However,no significant dif erence was found between the two group in minor amputation rates（RR=0.70,95%CI 0.24 to 2.11,P=0.53）. In addition,neither relevant serious adverse reaction nor complications were reported when using hyperbaric oxygen therapy as adjunctive treatment. Conclusion Current evidence shows that hyperbaric oxygen therapy as adjunctive treatment could improve ulcer healing and reduce incidence of major amputation.

关 键 词：高压氧治疗 糖尿病 糖尿病足溃疡 系统评价 META分析 随机对照试验 

分 类 号：R587.2[医药卫生—内分泌]