Adjunctive hyperbaric oxygen therapy for post-stroke cognitive impairment: a systematic review and meta-analysis of randomized controlled trials.

IF 3.3 3区医学 Q2 CLINICAL NEUROLOGY

Frontiers in Neurology Pub Date : 2026-10-13 eCollection Date: 2026-01-01 DOI:10.3389/fneur.2026.1982226

Xiaosai Hu, Shurong Zhao, Dandan Zhang, Xianguo Meng

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引用次数: 0

Abstract

Objective: To evaluate the effects of adjunctive hyperbaric oxygen therapy (HBOT) on cognitive, neurological, and functional outcomes in patients with post-stroke cognitive impairment (PSCI), and explore potential sources of heterogeneity.

Methods: Eight databases were searched from inception to July 15, 2026. Randomized controlled trials (RCTs) evaluating adjunctive HBOT in patients with PSCI were included. The primary outcome was the Montreal Cognitive Assessment (MoCA); secondary outcomes included the Mini-Mental State Examination (MMSE), National Institutes of Health Stroke Scale (NIHSS), Modified Barthel Index (MBI), and Barthel Index (BI). Random-effects meta-analyses, prespecified subgroup analyses, and meta-regression were performed. Sensitivity analyses, funnel plots, Egger's tests, and GRADE assessments were conducted.

Results: Thirty-five RCTs involving 3,036 participants, all conducted in China, were included. Adjunctive HBOT was associated with higher MoCA scores (MD = 2.90, 95% CI: 2.47-3.33; p < 0.00001; I ² = 84%) and MMSE scores (MD = 2.68, 95% CI: 2.20-3.16; p < 0.00001; I ² = 83%). Improvements were also observed in NIHSS (MD = -2.61, 95% CI: -3.34 to -1.89; p < 0.00001; I ² = 93%), MBI (MD = 6.64, 95% CI: 3.76-9.52; p < 0.00001; I ² = 82%), and BI (MD = 8.77, 95% CI: 4.72-12.82;p < 0.00001; I ² = 82%). No statistically significant subgroup differences were observed for MoCA (p = 0.10) or MMSE (p = 0.43). Higher baseline MoCA scores tended to be associated with smaller treatment effects in meta-regression (β = -0.1411, p = 0.0637; R ² = 15.42%). Substantial heterogeneity remained largely unexplained. Evidence certainty was low for MoCA, MMSE, and MBI and very low for NIHSS and BI.

Conclusion: Adjunctive HBOT may provide cognitive and functional benefits in patients with PSCI. However, substantial unexplained heterogeneity, low-to-very-low certainty of evidence, and the exclusively Chinese evidence base warrant cautious interpretation and limit generalizability. Further well-designed RCTs involving diverse populations are needed.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261473579, PROSPERO, CRD420261473579.

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辅助高压氧治疗脑卒中后认知障碍：随机对照试验的系统回顾和荟萃分析。

目的：评估辅助高压氧治疗（HBOT）对脑卒中后认知功能障碍（PSCI）患者认知、神经和功能预后的影响，并探讨异质性的潜在来源。方法：检索自建库至2026年7月15日的8个数据库。纳入评估PSCI患者辅助HBOT的随机对照试验（RCTs）。主要结果为蒙特利尔认知评估（MoCA）；次要结果包括简易精神状态检查（MMSE）、美国国立卫生研究院卒中量表（NIHSS）、修正Barthel指数（MBI）和Barthel指数（BI）。进行随机效应荟萃分析、预先指定的亚组分析和荟萃回归。进行敏感性分析、漏斗图、Egger检验和GRADE评估。结果：纳入35项随机对照试验，涉及3036名受试者，均在中国进行。辅助HBOT MoCA分数更大(MD = 2.90,95%置信区间CI: 2.47 - -3.33; p 我2 = 84%)和MMSE评分(MD = 2.68,95%置信区间CI: 2.20 - -3.16; p 我2 = 83%)。改进也观察到署(MD = -2.61,95%置信区间CI: -3.34 - -1.89; p 我2 = 93%),MBI (MD = 6.64,95%置信区间CI: 3.76 - -9.52; p 我2 = 82%),和BI (MD = 8.77,95%置信区间CI: 4.72 - -12.82; p 我2 = 82%)。MoCA （p = 0.10）或MMSE （p = 0.43）的亚组差异无统计学意义。在meta回归中，较高的基线MoCA评分往往与较小的治疗效果相关（β = -0.1411,p = 0.0637;r2 = 15.42%）。实质性的异质性在很大程度上仍无法解释。MoCA、MMSE和MBI的证据确定性较低，NIHSS和BI的证据确定性非常低。结论：辅助HBOT可改善PSCI患者的认知和功能。然而，大量无法解释的异质性，低至极低的证据确定性，以及完全中国的证据基础，需要谨慎解释和限制推广。需要进一步设计良好、涉及不同人群的随机对照试验。系统评价注册：https://www.crd.york.ac.uk/PROSPERO/view/CRD420261473579， PROSPERO, CRD420261473579。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Neurology CLINICAL NEUROLOGYNEUROSCIENCES -NEUROSCIENCES

CiteScore

4.90

自引率

8.80%

发文量

2792

审稿时长

14 weeks

期刊介绍： The section Stroke aims to quickly and accurately publish important experimental, translational and clinical studies, and reviews that contribute to the knowledge of stroke, its causes, manifestations, diagnosis, and management.