重症缺血性卒中患者以氧气面罩供应高流量氧气的血氧分析研究

Blood Gas Analysis of Venturi Mask Adjuvant Oxygen Therapy in Severe lschemic Stroke Patients-A Pilot, Randomized Case-control Study

目的调查在严重的缺血性卒中患者中,一个大气压下连续使用高流量氧气的安全性和血气分析情况。方法根据我们先前研究的方法学,从2005年8月到2007年2月收集48h内16例严重的缺血性卒中患者;通过2:1(面罩对套管)随机化分配成使用面罩组或者套管组,各使用10d。入组标准为美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)得分≥17分且梗死面积超过大脑中动脉(middle cerebral artery,MCA)分布区2/3的患者。分别在入院初、入组的隔天及第11天上午6点采集患者的动脉血进行血气分析研究。结果在连续18个月中有57例严重的MCA灌流域梗塞形成的患者,其中16例符合纳入与排除的入组标准,有11例患者被随机分配到氧气口鼻面罩组,5位患者被分配到氧气鼻管组。两组存活患者动脉血气体分析和APACHE Ⅱ得分在入组最初、入组后隔天及第11天没有统计上的差别;NIHSS得分最初都是22分,出院时均为16分。但研究发现干扰因子如颅骨移除术和插管过度换气,可能对于患者的存活分析有影响。结论这次小规模研究主要目的是探讨氧气的连续性使用,对于患者安全与存活结果有无影响,并补足先前研究未做血氧分析的缺陷。面罩式给氧与鼻管给氧的前后气体分析与患者存活基本上无统计的差别,可能和干扰因子的影响有关,需要通过更大型的临床研究来验证那些不完全收集的数据。

Objective To investigate the safety and gas analysis after continuous usage of hyperoxygenation in severe ischemic stroke patients. Methods According to the methodology of our prior study, we included 16 severe ischemic stroke patients within 48 hours of onset from August, 2005 to February, 2007; by means of 2：1 （Mask to cannula） randomization. Both groups were allocated to use mask or cannula for 10 days at one atmosphere. Inclusion criteria were changed to National Institute of Health Stroke Scale（NIHSS） score 17 and more than two-third of middle cerebral artery（MCA） territory infarction.. Overall arterial blood gases were recorded at six o＇clock a.m. in the initial, day 1 and day 10 after patients registered. Concomitant treatments were as clinical practice. Results During 18 months, 16 severe infarction patients were enrolled in 57 MCA infarctions There were 11 patients allocated to the venturi mask and 5 to the cannula group randomly. They were basically equal. There were no statistical difference at both artery blood gas analysis and APACHE II scores in survival patients in the initial, day I and day 10; NIHSS scores were 22 initially and 16 at discharge in both groups. However, confounding factors such as craniectomy and hyperventilation might contribute to the survival outcomes. Conclusion This pilot study sought to find if gas profiles contribute to the survival outcomes. No statistical difference in gas analysis, APACHE II and survival outcomes. Incomplete data collections and confounders might contribute to the survival outcomes which need to be clarified in tbe future large sample size study.