术中吸氧浓度对行脑血管再通术患者术后神经功能和并发症的影响

Effect of intraoperative oxygen concentration on postoperative neurological function and complications in patients undergoing cerebrovascular recanalization

目的探讨术中常压高氧(normobaric hyperoxia,NBO)作为辅助神经保护策略联合血管内再通术治疗缺血性脑血管病(ischemic cerebrovascular disease,ICVD)患者的安全性和有效性。方法本研究为单中心回顾性队列研究,共纳入2016年1月至2021年9月就诊于首都医科大学附属北京天坛医院,全身麻醉(以下简称全麻)下行血管内再通治疗、年龄≥60岁及手术时长≥2 h的ICVD患者351例,依据术中吸氧浓度不同,分为H组(100%O_(2),109例)和L组(50%O_(2),242例),采用美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分评估患者神经功能缺损程度,改良Rankin评分量表(modified Rankin Scale,mRS)评分评估患者神经功能恢复状况。比较术后和出院时两组患者NIHSS评分及mRS评分的差异和相关术后并发症(肺炎、再卒中、脑出血)发生情况,利用Spearman相关分析探讨与术后NIHSS评分相关的因素。结果术后和出院时,两组患者NIHSS评分、mRS评分及术后并发症发生率比较,差异均无统计学意义(P>0.05);与H组比较,L组住院时间明显缩短(P<0.05)。术后与NIHSS评分相关的因素为氧浓度、急/平诊、术前狭窄率、狭窄长度、高血脂、术前NIHSS评分、术前mRS评分。结论虽然常压高氧作为ICVD患者血管再通治疗基础上的辅助神经保护策略作用有限,对患者近期神经功能恢复无显著影响,但也未增加术后并发症的发生率。

Objective To investigate the safety and efficacy of intraoperative normobaric hyperoxia as an auxiliary neuroprotective strategy combined with endovascular recanalization in the treatment of patients with ischemic cerebrovascular disease(ICVD).Methods This is a single-center retrospective cohort study,including patients aged 60 and older with ICVD and operation duration≥2 h in Beijing Tiantan Hospital,Capital Medical University from January 2016 to September 2021 and received endovascular recanalization under general anesthesia.A total of 351 patients were divided into H group(100%O_(2),109 cases)and L group(50%O_(2),242 cases)according to the intraoperative inhaled oxygen concentration.The National Institute of Health Stroke Scale(NIHSS)score was used to evaluate the degree of neurological deficit in stroke patients.Modified Rankin Scale(mRS)score was applied to evaluated the recovery status of neurological function in patients after stroke.We also compared the differences of NIHSS score and mRS score after operation and discharge,and postoperative complications(pneumonia,re-stroke,cerebral hemorrhage)between the two groups.Spearman correlation analysis was used to explore the correlation factors with NIHSS score.Results There was no significant difference in the postoperative and discharge NIHSS score,mRS score and postoperative complication rate between the two groups(P>0.05).Compared to H group,the hospital stay in L group was significantly shorter(P<0.05).The relevant factor for postoperative NIHSS score were oxygen concentration,emergency,preoperative stenosis rate,stenosis length,hyperlipidemia,preoperative NIHSS score and preoperative mRS score.Conclusion Although normobaric hyperoxia has limited effect as an adjuvant neuroprotective strategy based on vascular recanalization in patients with ICVD,it has no significant effect on the recent neurological recovery of patients,but it does not increase the incidence of postoperative complications.