背景:为了确定高压氧疗法(HBO)治疗坏死性软组织感染(NSTI)的疗效,我们对现有证据进行了荟萃分析.
方法:数据源是PubMed,Embase,WebofScience,科克伦图书馆,和参考列表。该研究包括观察性试验,比较HBO与非HBO,或标准护理。主要结果是死亡率。次要结果是清创次数,截肢率及并发症发生率。计算二分和连续结局的相对风险或95%置信区间的标准化平均差。分别。
结果:共纳入回顾性队列和病例对照研究,包括49,152名患者,1448人接受HBO和47,704人接受对照。HBO组的死亡率明显低于非HBO组[RR=0.522,95%CI(0.403,0.677),p<0.05]。然而,HBO组清创次数高于非HBO组[SMD=0.611,95%CI(0.012,1.211),p<0.05]。两组截肢率无显著差异[RR=0.836,95%CI(0.619,1.129),p>0.05]。在并发症方面,HBO组MODS发生率低于非HBO组[RR=0.205,95%CI(0.164,0.256),p<0.05]。其他并发症的发生率无显著差异,比如败血症,震惊,心肌梗塞,肺栓塞,还有肺炎,两组之间(p>0.05)。
结论:目前的证据表明,使用HBO治疗NSTI可以显着降低死亡率和并发症的发生率。然而,由于研究的回顾性性质,证据不足,需要进一步的研究来确定其功效。同样重要的是要注意,并非所有医院都可以使用HBO,其使用应根据患者的个人情况仔细考虑。此外,仍然值得强调及时评估手术风险以防止错过最佳治疗时间的重要性。
To determine the efficacy of hyperbaric oxygen therapy (HBO) in the treatment of necrotizing soft tissue infections (NSTI), we conducted a meta-analysis of the available evidence.
Data sources were PubMed, Embase, Web of Science, Cochrane Library, and reference lists. The study included observational trials that compared HBO with non-HBO, or standard care. The primary outcome was the mortality rate. Secondary outcomes were the number of debridement, amputation rate and complication rate. Relative risks or standardized mean differences with 95% confidence intervals were calculated for dichotomous and continuous outcomes, respectively.
A total of retrospective cohort and case-control studies were included, including 49,152 patients, 1448 who received HBO and 47,704 in control. The mortality rate in the HBO group was significantly lower than that in the non-HBO group [RR = 0.522, 95% CI (0.403, 0.677), p < 0.05]. However, the number of debridements performed in the HBO group was higher than in the non-HBO group [SMD = 0.611, 95% CI (0.012, 1.211), p < 0.05]. There was no significant difference in amputation rates between the two groups [RR = 0.836, 95% CI (0.619, 1.129), p > 0.05]. In terms of complications, the incidence of MODS was lower in the HBO group than in the non-HBO group [RR = 0.205, 95% CI (0.164, 0.256), p < 0.05]. There was no significant difference in the incidence of other complications, such as sepsis, shock, myocardial infarction, pulmonary embolism, and pneumonia, between the two groups (p > 0.05).
The current evidence suggests that the use of HBO in the treatment of NSTI can significantly reduce the mortality rates and the incidence rates of complications. However, due to the retrospective nature of the studies, the evidence is weak, and further research is needed to establish its efficacy. It is also important to note that HBO is not available in all hospitals, and its use should be carefully considered based on the patient\'s individual circumstances. Additionally, it is still worthwhile to stress the significance of promptly evaluating surgical risks to prevent missing the optimal treatment time.