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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 blood gas analysis of continuous use of high flow oxygen at one atmosphere in patients with severe ischemic stroke. Methods According to our previously studied methodology, 16 patients with severe ischemic stroke within 48 h were collected from August 2005 to February 2007; patients were randomly assigned to use a mask set either by 2: 1 (mask vs. cannula) or Casing group, each using 10d. The inclusion criteria were patients with a National Institutes of Health Stroke Scale (NIHSS) score ≥17 and a infarct size greater than two-thirds of the middle cerebral artery (MCA) distribution. Blood samples were collected from the patients at the beginning of admission, on the next day of enrollment and at 6 am on the 11th day. RESULTS: Of the 57 consecutive patients who developed infarction in the MCA perfusion field in 18 consecutive months, 16 met the inclusion and exclusion criteria, 11 were randomized to the Oxygen Nasal Mask group and 5 were Assigned to oxygen nasal tube group. Arterial blood gas analysis and APACHE II scores were not statistically different between the first and second day after enrollment in the two groups; NIHSS scores were initially 22 and were 16 at discharge. However, studies have found that interfering factors such as skull removal and intubation hyperventilation may have implications for patient survival analysis. Conclusions The main purpose of this small-scale study was to explore the continuous use of oxygen with no effect on patient safety and survival outcomes and to complement the deficiencies of previous studies that did not make oximetry. There was essentially no statistical difference between front-to-back mask analysis and nasal oxygen administration with respect to patient survival, which may be related to the influence of interfering factors, requiring larger clinical studies to validate those data that are not fully collected.