高压氧治疗血管性痴呆随机对照试验的Meta分析

程媛媛++++++张云东

[摘要]目的 系统评价高压氧治疗血管性痴呆的疗效和安全性。方法 分别在英文数据库PubMed、Science Online和Ovid英文数据库以及CNKI和万方中文系统，通过使用计算机以及手工检索文献，全面收集关于高压氧治疗血管性痴呆的随机对照试验（RCT），按Cochrane系统评价的方法进行研究，检索时间为建库至2016年2月。结果 根据Meta分析结果显示，高压氧组治疗血管性痴呆的效果优于对照组[MD=3.40，95%CI（2.75，4.05）]；7个试验依据日常生活能力（ADL）量表对ADL进行评估，高压氧治疗组治疗后的生活能力明显改善[MD=5.45，95%CI（3.72，7.19）]；2个试验依据长谷川痴呆量表（HDS）对神经功能缺损情况进行评估，结果显示，其对神经功能缺损无明显改善[MD=4.81，95%CI（2.95，6.67）]。2个试验报道了相关不良事件，主要为短暂性头晕、心悸、睡眠障碍、腹泻等，均无严重不良事件发生。结论 本系统评价结果提示，高压氧治疗能有效降低HDS评分，提高ADL、MMSE评分，且不良反应较少，未见严重不良反应，但由于纳入研究数量及质量的限制，还需要进一步行大样本、高质量的研究。

[关键词]高压氧；血管性痴呆；Meta分析；系统评价；随机对照试验

[中图分类号] R749.1 [文献标识码] A [文章编号] 1674-4721（2016）10（b）-0016-05

[Abstract]Objective To systematically evaluate the effect and safety about hyperbaric oxygen in treating vascular dementia.Methods Randomized controlled trials （RCT） of hyperbaric oxygen therapy in treating vascular dementia were comprehensive collected by using computer and manual retrieval from English database liked PubMed，Science Online and Ovid，CNKI and wanfang Chinese system.The study was conducted according to Cochrane system evaluation.The search time was up to February 2016 from the database established.Results The results showed from Meta analysis that the hyperbaric oxygen group was better than that the control group in treating vascular dementia [MD=3.40，95%CI （2.75，4.05）]；7 experiments were conducted to evaluate the ability of daily life based on ADL showed that the life quality in hyperbaric oxygen group improved obviously after treatment [MD=5.45，95%CI （3.72，7.19）]；2 experiments were conducted to evaluate the nerve function defect situation based on HDS showed that nerve function defect had no obvious improved [MD=4.81，95%CI （2.95，6.67）].2 of the trials reported the adverse events and were mainly of transient dizziness，palpitation，sleep disorder and diarrhea，and any serious adverse effects happened.Conclusion This system evaluation shows that hyperbaric oxygen can decrease HDS scale score effectively，enhance ADL and MMSE score，with less adverse effects and any serious adverse effects.However，due to the limitations of the quantity and quality of the included studies，further research on the high quality of the large sample is needed.

[Key words]Hyperbaric oxygen；Vascular dementia；Meta analysis；System evaluation；Randomized controlled trial

血管性痴呆是缺血性及出血性脑血管病常见的并发症，脑组织由于循环障碍长时间处于缺血缺氧、低灌注，故导致脑局部神经元坏死[1]，患者逐步出现各种临床痴呆，主要表现为智能及认知功能障碍。其在痴呆亚型中的发病率仅次于阿尔茨海默病（Alzheimer disease，AD）。在发展中国家65岁以上的老年人中，血管性痴呆的患病率为0.6%～2.1%[2]。血管性痴呆不是一个单独的疾病，而是一组脑血管疾病导致的临床综合征，目前的治疗方法尚不能取得明显效果[3]。……