高压氧治疗急性缺血性脑卒中近期疗效的系统评价

 目的评价高压氧(HBO)治疗急性缺血性脑卒中的近期疗效及安全性.方法使用国际Cochrane协作网的系统评价方法对全世界关于HBO治疗急性缺血性脑卒中的随机/半随机对照试验进行系统评价.结果至2001年12月,共收集到国内外23个已完成的RCTs,其中18个(共包括2 040例患者)试验,符合本研究的纳入标准.早期病死率降低(0 vs11.11%;OR 0.12;95%CI0.02～0.90;P<0.05),提示用HBO每治疗9人可避免约1人早期死亡;HBO治疗的副作用明显高于对照组(2.82%vs0;OR 5.54;95%CI 2.09～14.68;P<0.01);HBO治疗期末神经功能缺损改善的人数显著增加(94.88%vs79.18%:OR4.37;95%CI 3.30～5.77;P<0.01).结论HBO治疗急性缺血性脑卒中是一种有前途的治疗方法,但由于存在发表偏倚及RCTs普遍质量较低尚不能对HBO的疗效作出明确的结论,潜在的疗效及安全性有待于更多的设计严格的RCTs予以进一步证实.

Hyperbaric oxygen for acute ischemic stroke:a systematic review of randomized controlled trials

Objectives To assess the efficacy and safely of hyperbaric oxygen (HBO) in treatment of acute ischemic stroke(AIS). Methods A systematic review of world - wide literature on randomized controlled trials (RCTs) of HBO in treatment of AIS was performed by using Cochrane collaboration network, All unconfounded truly randomized trials or quasi-randomized trials (CCTs) completed before the end of 2001 were included. Results Twenty-three completed RCTs or CCTs were retrieved, of which 18 trials (including 2 040 patients) met the inclusion criteria. HBO was associated with a significant reduction in early deaths (0 vs 11%; odds ratio 0.12; 95% contidential interval 0.02 - 0.90; P = 0.04) .suggesting that treatment 1 of 9 patients would avoid early death. The adverse effects were significantly more in the HBO group than in the control group (2.82% vs0; OR5.54; 95% CI2.09- 14.68; P =0.0006). There were more patients in the HBO group who had neurologic defects improved at the end of treatment (94.88% vs 79.18%; OR4.37; 95% CI 3.30-5.77; P <0.001) .Conclusion HBO is a promising therapy for treatment of AIS. But as the trials included in the review were of poor methodological quality, we could not draw reliable conclusions from the present data. Rigorously designed, randomised, and controlled trials are required.