Abstract：
BACKGROUND: The use of both edaravone (EDA) and hyperbaric oxygen therapy (HBOT) is increasingly prevalent in the treatment of delayed encephalopathy after carbon monoxide poisoning (DEACMP). This meta-analysis aims to evaluate the efficacy of using EDA and HBOT in combination with HBOT alone in the treatment of DEACMP.
METHODS: We searched and included all randomized controlled trials (RCTs) published before November 6, 2023, from 12 Chinese and English databases and clinical trial centers in China and the United States. The main outcome indicator was the total effective rate. The secondary outcome indicators included the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Hasegawa Dementia Scale (HDS), Fugl-Meyer Assessment (FMA), Superoxide Dismutase (SOD), and Malondialdehyde (MDA). Statistical measures utilized include risk ratios (RR), weighted mean difference (WMD), and 95 % confidence intervals (95 % CI).
RESULTS: Thirty studies involving a combined total of 2075 participants were ultimately incorporated. It was observed that the combination of EDA with HBOT for the treatment of DEACMP demonstrated an improvement in the total effective rate (RR: 1.25; 95 % CI: 1.20-1.31; P < 0.01), MMSE (WMD: 3.67; 95 % CI: 2.59-4.76; P < 0.01), MoCA (WMD: 4.38; 95 % CI: 4.00-4.76; P < 0.01), BI (WMD: 10.94; 95 % CI: 5.23-16.66; P < 0.01), HDS (WMD: 6.80; 95 % CI: 4.05-9.55; P < 0.01), FMA (WMD: 8.91; 95 % CI: 7.22-10.60; P < 0.01), SOD (WMD: 18.45; 95 % CI: 16.93-19.98; P < 0.01); and a reduction in NIHSS (WMD: -4.12; 95 % CI: -4.93 to -3.30; P < 0.01) and MDA (WMD: -3.05; 95 % CI: -3.43 to -2.68; P < 0.01).
CONCLUSIONS: Low-quality evidence suggests that for DEACMP, compared to using HBOT alone, the combined use of EDA and HBOT may be associated with better cognition and activity of daily living. In the future, conducting more meticulously designed multicenter and large-sample RCTs to substantiate our conclusions is essential.
METHODS: We searched and included all randomized controlled trials (RCTs) published before November 6, 2023, from 12 Chinese and English databases and clinical trial centers in China and the United States. The main outcome indicator was the total effective rate. The secondary outcome indicators included the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Hasegawa Dementia Scale (HDS), Fugl-Meyer Assessment (FMA), Superoxide Dismutase (SOD), and Malondialdehyde (MDA). Statistical measures utilized include risk ratios (RR), weighted mean difference (WMD), and 95 % confidence intervals (95 % CI).
RESULTS: Thirty studies involving a combined total of 2075 participants were ultimately incorporated. It was observed that the combination of EDA with HBOT for the treatment of DEACMP demonstrated an improvement in the total effective rate (RR: 1.25; 95 % CI: 1.20-1.31; P < 0.01), MMSE (WMD: 3.67; 95 % CI: 2.59-4.76; P < 0.01), MoCA (WMD: 4.38; 95 % CI: 4.00-4.76; P < 0.01), BI (WMD: 10.94; 95 % CI: 5.23-16.66; P < 0.01), HDS (WMD: 6.80; 95 % CI: 4.05-9.55; P < 0.01), FMA (WMD: 8.91; 95 % CI: 7.22-10.60; P < 0.01), SOD (WMD: 18.45; 95 % CI: 16.93-19.98; P < 0.01); and a reduction in NIHSS (WMD: -4.12; 95 % CI: -4.93 to -3.30; P < 0.01) and MDA (WMD: -3.05; 95 % CI: -3.43 to -2.68; P < 0.01).
CONCLUSIONS: Low-quality evidence suggests that for DEACMP, compared to using HBOT alone, the combined use of EDA and HBOT may be associated with better cognition and activity of daily living. In the future, conducting more meticulously designed multicenter and large-sample RCTs to substantiate our conclusions is essential.
摘要：
背景：在一氧化碳中毒后迟发性脑病（DEACMP）的治疗中，使用依达拉奉（EDA）和高压氧疗法（HBOT）越来越普遍。这项荟萃分析旨在评估使用EDA和HBOT联合单独使用HBOT治疗DEACMP的疗效。
方法：我们从中国和美国的12个中英文数据库和临床试验中心检索并纳入了2023年11月6日之前发表的所有随机对照试验（RCT）。主要结果指标为总有效率。次要结果指标包括迷你精神状态检查（MMSE），蒙特利尔认知评估（MoCA）美国国立卫生研究院卒中量表(NIHSS),Barthel指数（BI），长谷川痴呆量表（HDS），Fugl-Meyer评估（FMA），超氧化物歧化酶(SOD),和丙二醛(MDA)。使用的统计措施包括风险比率(RR)，加权平均差(WMD)，和95%置信区间(95%CI)。
结果：最终纳入了30项涉及2075名参与者的研究。观察到EDA与HBOT联合治疗DEACMP显示总有效率改善（RR：1.25；95％CI：1.20-1.31；P<0.01），MMSE(WMD:3.67;95%CI:2.59-4.76;P<0.01),MoCA(WMD:4.38;95%CI:4.00-4.76;P<0.01),BI（WMD：10.94；95%CI：5.23-16.66；P<0.01），HDS（WMD：6.80；95%CI：4.05-9.55；P<0.01），FMA(WMD:8.91;95%CI:7.22-10.60;P<0.01),SOD（WMD：18.45；95％CI：16.93-19.98；P<0.01）；NIHSS（WMD：-4.12；95％CI：-4.93至-3.30；P<0.01）和MDA（WMD：-3.05；95％CI：-3.43至-2.68；P<0.01）降低。
结论：低质量证据表明，对于DEACMP，与单独使用HBOT相比，结合使用EDA和HBOT可能与更好的认知和日常生活活动有关。在未来,进行更精心设计的多中心和大样本RCT来证实我们的结论是至关重要的。
方法：我们从中国和美国的12个中英文数据库和临床试验中心检索并纳入了2023年11月6日之前发表的所有随机对照试验（RCT）。主要结果指标为总有效率。次要结果指标包括迷你精神状态检查（MMSE），蒙特利尔认知评估（MoCA）美国国立卫生研究院卒中量表(NIHSS),Barthel指数（BI），长谷川痴呆量表（HDS），Fugl-Meyer评估（FMA），超氧化物歧化酶(SOD),和丙二醛(MDA)。使用的统计措施包括风险比率(RR)，加权平均差(WMD)，和95%置信区间(95%CI)。
结果：最终纳入了30项涉及2075名参与者的研究。观察到EDA与HBOT联合治疗DEACMP显示总有效率改善（RR：1.25；95％CI：1.20-1.31；P<0.01），MMSE(WMD:3.67;95%CI:2.59-4.76;P<0.01),MoCA(WMD:4.38;95%CI:4.00-4.76;P<0.01),BI（WMD：10.94；95%CI：5.23-16.66；P<0.01），HDS（WMD：6.80；95%CI：4.05-9.55；P<0.01），FMA(WMD:8.91;95%CI:7.22-10.60;P<0.01),SOD（WMD：18.45；95％CI：16.93-19.98；P<0.01）；NIHSS（WMD：-4.12；95％CI：-4.93至-3.30；P<0.01）和MDA（WMD：-3.05；95％CI：-3.43至-2.68；P<0.01）降低。
结论：低质量证据表明，对于DEACMP，与单独使用HBOT相比，结合使用EDA和HBOT可能与更好的认知和日常生活活动有关。在未来,进行更精心设计的多中心和大样本RCT来证实我们的结论是至关重要的。
