Hyperbaric Oxygen Therapy For Spinal Cord Injury:a Meta-analysis Of Treatment Effectiveness

Objective:Meta-analysis was used to evaluate the randomized controlled trials of hyperbaric oxygen in the treatment of spinal cord injury,providing evidence-based medical evidence for the treatment of hyperbaric oxygen.Methods:Pubmed,The Cochrane Library,Embase,China National Knowledge Infrastructure,China Science and Technology Journal,and Wanfang database were systematically searched by computer to select clinical randomized controlled trials between database initiations and January 2019.The experimental group was hyperbaric oxygen therapy combined with conventional treatment group,while the control group was conventional treatment group.Literature was extracted strictly according to inclusion criteria and exclusion criteria,and methodological quality evaluation and bias risk assessment were carried out.Then the extracted data were analyzed by Revman 5.3 software and Stata 12.0 software.Results:17 randomized controlled trails of 1268 patients from online databases were included.There are 655 patients in the experimental group and 613 patients in the control group.Compared with the control group,ASIAimprovement rate[RR=1.24,95%CI(1.13,1.37),P<0.00001],ASIA motor function score[MD=10.38,95%CI(7.66,13.10),P<0.00001],ASIA sensory function score[MD=37.71,95%CI(19.94,55.48),P<0.0001],ASIA light touch score[MD=11.89,95%CI(6.80,16.98),P<0.00001],ASIA pinprick score[MD=12.36,95%CI(6.85,17.87),P<0.0001],Modified Barthel Index score[MD=15.67,95%CI(13.16,18.18),P<0.00001],Function Independent Measure score[MD=14.17,95%CI(3.79,24.55),P=0.007] of the experimental group increased and all the difference were significant.Compared with the control group,Hamilton Depression Scale[MD=-3.74,95%CI(-5.82,-1.65),P=0.0005],Hamilton Anxiety Scale[MD=-2.37,95%CI(-2.72,-2.02),P<0.00001]of the experimental group decreased and all the difference were significant.Sensitivity analysis showed that the results were stable.Funnel plot and Egger's test results(t=2.72,P=0.022)suggest that there may be publication bias.Conclusion:1.Current evidence shows that hyperbaric oxygen therapy combined with conventional therapy can improve neurological function and promote the recovery of sensory and motor function in patients with spinal cord injury.2.Hyperbaric oxygen therapy combined with conventional therapy can improve patients' activities of daily living.3.Hyperbaric oxygen therapy combined with conventional therapy can alleviate mental anxiety and depressive symptoms of patients.4.The overall qualities of the included literature were not high and there are risks of publication bias.Therefore,more high-quality,large-sample,multi-center clinical randomized controlled trials are needed to confirm the above conclusions.