Hyperbare Sauerstofftherapie bei akuter zerebraler Ischämie

Zusammenfassung

Der hyperbaren Sauerstofftherapie (HBOT) werden günstige Effekte in der Therapie des akuten ischämischen zerebralen Insultes zugesprochen. Ziel dieser systematischen Übersicht war es, die Effektivität und Sicherheit der HBOT für diese Indikation zu überprüfen. Es erfolgte eine systematische Suche nach randomisierten kontrollierten Studien, die den Effekt der HBOT im Vergleich zu einer Sham-Behandlung untersuchten. Zwei Autoren extrahierten unabhängig voneinander die Daten. Jede Studie wurde auf ihre Validität überprüft. Die Datenanalyse erfolgte mit dem Computerprogramm RevMan 4.2. Drei randomisierte kontrollierte Studien erfüllten die Einschlusskriterien. Nach 6 Monaten fanden sich zwischen den Behandlungsgruppen keine signifikanten Unterschiede in der Mortalitätsrate. Zwei aus 15 Beeinträchtigungsbzw. Funktionsskalen zeigten eine Verbesserung ein Jahr nach HBOT: die mittlere Trouillas Disability Scale war nach HBOT niedriger und die mittlere Orgogozo Scale war nach HBOT höher. Diese Verbesserungen konnten in anderen Untersuchungen und unter Verwendung anderer Skalen nicht nachvollzogen werden. Diese systematische Übersichtsarbeit hat keine überzeugenden Belege dafür ergeben, dass der Krankheitsverlauf durch eine HBOT bei einem akuten ischämischen zerebralen Insult verbessert wird. Zwar erlauben die drei eingeschlossenen Studien keine abschließende Empfehlung, klinisch relevante positive Effekte sind jedoch unwahrscheinlich.

Summary

It has been postulated that hyperbaric oxygen therapy (HBOT) may improve outcome in patients following acute stroke. Therefore, the aim of this review was to assess the effectiveness and safety of adjunctive HBOT in the treatment of acute ischaemic stroke. Two authors systematically searched all randomised controlled trials that compared the effect of adjunctive HBOT with no HBOT and they extracted the data independently. Each trial was assessed for validity. Data were extracted and analysed with RevMan 4.2. Three randomised controlled trials satisfied the inclusion criteria. There were no significant differences in mortality rate at six months in those receiving HBOT compared to the control group. 2 of 15 scale measures of disability and functional indicated an improvement following HBOT, both at one year follow up: the mean Trouillas Disability Scale was lower with HBOT and the mean Orgogozo Scale was higher. These improvements were not reflected in other trials or functional scales. This systematic review has not found evidence to show that HBOT improves clinical outcomes when applied during the acute presentation of ischaemic stroke. While evidence from three randomised controlled trials is insufficient to provide clear guidelines for practice, clinical benefit does not seem likely. Hyperbaric oxygen therapy in acute stroke Cochrane Review.

Schlüsselwörter

Akuter zerebraler ischämischer Insult - Hyperbarmedizin - hyperbare Sauerstofftherapie - Evidence-Based Medicine - Metaanalyse

Keywords

Acute ischaemic stroke - hyperbaric medicine - hyperbaric oxygen therapy - evidence-based medicine - metaanalysis

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