目的 评价高压氧对脑性瘫痪患儿的疗效及安全性,为临床应用提供指导。方法 检索Pubmed、Embase、Cochrane library、CNKI、CBM、VIP、万方等数据库,筛选高压氧治疗脑瘫患儿的随机对照研究,由两位研究者评价纳入研究的质量、提取数据,采用RevMan 5.2.7软件统计分析。结果 共纳入10项研究,含1 111例患儿。Meta分析结果显示:高压氧治疗并不能改善脑瘫患儿运动功能(MD=-5.64,95%CI:-13.98~2.71,P=0.19)、日常生活功能;能够改善肌张力(RR=3.38,95%CI:2.05~5.58,P<0.05),提高发育商的显效率(RR=1.31,95%CI:1.02~1.69,P=0.04),降低无效率(RR=0.30,95%CI:0.19~0.50,P<0.001),但原始研究质量低,可信度差。同时高压氧治疗过程中存在中耳气压伤、耳痛等不良反应。结论 高压氧治疗对于可提高脑瘫患儿的各项功能状态的证据尚不充分,安全性也有待进一步评估,临床应用需谨慎。需要更多高质量临床研究进一步评价其疗效及安全性。
Abstract
Objective To evaluate the effectiveness and safety of the hyperbaric oxygen (HBO) for cerebral palsy (CP) and provide guidance for clinical applications. Methods From Pubmed,Embase,Cochrane library,CNKI,CBM,VIP,Wanfang databases,the randomized controlled studies of HBO for CP were included.Two individuals assessed the quality and extracted data.Statistical analysis was performed by RevMan5.2.7 software. Results A total of 10 studies with 1 111 patients were included in meta-analysis.Meta-analysis showed:HBO did not improve the motor function of children with CP (MD=-5.64,95%CI:-13.98~2.71,P=0.19),activities of daily living.It could ameliorate the muscle tension (RR=3.38,95%CI:2.05~5.58,P<0.05),and had a positive role in developmental quotient,which could improve the efficiency significantly (RR=1.31,95%CI:1.02~1.69,P=0.04) and reduce the inefficiency (RR=0.30,95%CI:0.19~0.50,P<0.001),but the original studies were poor quality with incredibility.In the process of HBO,middle ear barotraumas and earache were common. Conclusions The evidence that HBO could improve the function of the children with CP is insufficient,security also needed further study.More high quality studies in the future are necessary and needed to objective understanding.
关键词
高压氧 /
脑性瘫痪 /
Meta分析
Key words
hyperbaric oxygen /
cerebral palsy /
meta-analysis
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 杨李,吴德,唐久来.小儿脑瘫病因学的研究进展[J].中国实用儿科杂志,2008,23 (9):710-712.
[2] 张晓杰,郭继东,伊洪波.小儿脑瘫患者的危险因素分析[J].中国妇幼保健,2012,27 (29):4549-4551.
[3] Harch PG,Gottlieb SF,Van Meter KW,et al.HMPAO SPECT brain imaging and low pressure HBOT in the diagnosis and treatment of chronic traumatic,ischemic,hypoxic and anoxic encephalopathies[J].Undersea Hyperb Med,1994,21(S):30-36.
[4] Montgomery D,Goldberg J,Amar M,et al.Effects of hyperbaric oxygen therapy on children with spastic diplegic cerebral palsy:a pilot project[J].Undersea Hyperb Med,1999,26(4):235-242.
[5] Sethi A,Mukherjee A.To see the efficacy of hyperbaric oxygen therapy in gross motor abilities of cerebral palsy children of 2-5 years,given initially as an adjunct to occupational therapy[J].The Indian Journal of Occupational Therapy,2003,25 (1):7-11.
[6] Collet JP,Vanasse M,Marois P,et al.Hyperbaric oxygen for children with cerebral palsy:a randomised multicentre trial.HBO-CP Research Group[J].Lancet,2001,357 (9256):582-586.
[7] Lacey DJ,Stolfi A,Pilati LE.Effects of hyperbaric oxygen on motor function in children with cerebral palsy[J].Annals of Neurology,2012,72(5):695-703.
[8] Sénéchal C,Larivée S,Richard E,et al.Hyperbaric oxygenation therapy in the treatment of cerebral palsy:A review and comparison to currently accepted therapies[J].Journal of American Physicians and Surgeons,2007,12(4):109-115.
[9] McDonagh MS,Morgan D,Carson S,et al.Systematic review of hyperbaric oxygen therapy for cerebral palsy:the state of the evidence[J].Developmental Medicine & Child Neurology,2007,49(12):942-947.
[10] 林庆.小儿脑性瘫痪的定义,诊断条件及分型[J].中华儿科杂志,2005,43(4):262-263.
[11] Nordmark E,Hgglund G,Jarnlo G.Reliability of the gross motor function measure in cerebral palsy[J].Scandinavian Journal of Rehabilitation Medicine,1997,29(1):25-34.
[12] Palisano RJ,Hanna SE,Rosenbaum PL,et al.Validation of a model of gross motor function for children with cerebral palsy[J].Phys Ther,2000,80(10):974-985.
[13] 邱明星,熊国兵,龚百生,等.中医药治疗前列腺炎随机对照试验的系统评价[J].中国循证医学杂志,2010,10(1):56-72.
[14] 李丽,杨兵,赵彩虹,等.早期高压氧综合治疗小儿脑瘫的疗效分析[J].中华航海医学与高气压医学杂志,2013,20(2):83-85.
[15] 李唯,董红琴,王燕,等.高压氧配合功能训练治疗痉挛型脑瘫疗效观察[J].遵义医学院学报,2007,30(3):312-313.
[16] 龙颖,余明,雷学,等.高压氧综合治疗对小儿脑瘫运动功能的影响[J].中华航海医学与高气压医学杂志,2005,12(3):151-151.
[17] 彭升,何洲.高压氧治疗婴幼儿脑瘫的临床观察[J].当代医学,2012,18(2):6-7.
[18] 闫斐,邱萌.高压氧治疗婴幼儿脑瘫的疗效分析[J].临床军医杂志,2011,39(6):1156-1157.
[19] 闫光.神经节苷脂联合高压氧治疗幼儿脑瘫疗效分析[J].中国现代药物应用,2011,5(18):58-59.
[20] 姚静婵,胡国华,曹樟全,等.高压氧治疗婴幼儿脑瘫的临床疗效观察[J].浙江临床医学,2007,9(10):1311-1312.
[21] 周红玲,余亚平,董小丽,等.综合康复训练配合高压氧对脑性瘫痪患儿早期治疗的疗效观察[J].实用中西医结合临床,2004,4(5):28-30.
PDF(533 KB)
