不同供氧方式高压氧治疗对手术治疗后卒中患者经皮氧分压影响的研究

doi:10.3969/j.issn.1673-5765.2024.10.007

摘要/Abstract

摘要： 目的评估不同供氧方式的高压氧治疗下，发病30 d内卒中术后患者经皮氧分压（transcutaneous oximetry，TcPO2）的变化。
方法回顾性纳入2023年1月1日—2024年6月20日在高压氧科接受治疗的发病30 d内卒中术后患者，根据气道情况分为正常气道面罩加储气囊供氧（面罩组）和人工气道头罩供氧（头罩组）。高压氧治疗期间实时监测TcPO2，比较两种供氧方式下TcPO2变化。
结果本研究共入选26例患者，面罩组和头罩组各13例。面罩组升压开始时TcPO₂为（55.92±9.58）mmHg
（1 mmHg=0.133 kPa），稳压吸氧阶段TcPO₂平均值和最大值分别为（679.30±186.80）mmHg和（881.40±208.20）mmHg，减压结束TcPO₂为（83.71±21.54）mmHg。头罩组升压开始时TcPO₂为（62.92±14.84）mmHg，稳压吸氧阶段TcPO₂平均值和最大值分别为（369.50±163.00）mmHg和（487.90±212.10）mmHg，减压结束TcPO₂为（84.25±19.95）mmHg。面罩组稳压吸氧阶段TcPO₂的平均值和最大值高于头罩组相应指标，差异有统计学意义（P<0.01）。面罩组和头罩组稳压吸氧10 min TcPO₂开始升高，面罩组吸氧30 min TcPO₂达到饱和，头罩组随吸氧时间延长TcPO₂动态上升直至吸氧结束。
结论高压氧治疗期间，面罩供氧和头罩供氧均能提升卒中术后患者的TcPO₂水平，面罩吸氧效果应该优于头罩。

文章导读： 高压氧治疗期间TcPO₂监测能实时准确评估高压氧治疗效果，指导个体化治疗。

关键词: 高压氧; 经皮氧分压; 卒中; 面罩吸氧; 头罩吸氧

Abstract: Objective To evaluate the changes in transcutaneous oximetry (TcPO₂) within 30 days of stroke onset in post-surgery patients under hyperbaric oxygen therapy with different oxygen supply methods.
Methods Post-surgery stroke patients who received treatment in the hyperbaric oxygen department within 30 days of onset from January 1, 2023 to June 20, 2024 were included in this retrospective analysis. According to the airway condition, normal airway patients were supplied with a mask and reservoir bag (the mask group) and artificial airway patients with ventilator weaning were supplied with a head hood (the head hood group). The TcPO₂ was monitored in real time during hyperbaric oxygen therapy and compared the changes of TcPO₂ between the two oxygen supply methods.
Results A total of 26 patients were included in this study, including 13 patients in the mask group and 13 patients in the head hood group. In the mask group, TcPO₂ was (55.92±9.58) mmHg (1 mmHg=0.133 kPa) before compression, and the mean and maximum TcPO₂ during oxygen inhalation stage were (679.30±186.80) mmHg and (881.40±208.20) mmHg, respectively. After decompression, TcPO₂ was (83.71±21.54) mmHg. In the head hood group, TcPO₂ was (62.92±14.84) mmHg before compression, the mean and maximum TcPO₂ during oxygen inhalation stage were (369.50±163.00) mmHg and (487.90±212.10) mmHg, respectively. After decompression, TcPO₂ was (84.25±19.95) mmHg. The mean and maximum of TcPO₂ during oxygen inhalation stage in the mask group were higher than those in the head hood group, and the differences were statistically significant (P<0.01). The TcPO₂ of the mask group and the head hood group began to increase after oxygen inhalation for 10 minutes. In the mask group, TcPO₂ reached the saturation at 30 minutes, while in the hood group, TcPO₂ increased dynamically with the extension of oxygen inhalation time until the end of oxygen inhalation.
Conclusions During hyperbaric oxygen therapy, both mask oxygen supply and head hood oxygen supply increased the TcPO₂ level of post-surgery stroke patients, and the oxygen inhalation effect of mask should be better than that of head hood.

Key words: Hyperbaric oxygen; Transcutaneous oximetry; Stroke; Mask oxygen inhalation; Head hood oxygen inhalation

中图分类号:

任梓齐, 王勤芳, 刘亚玲, 王丛, 于秋红. 不同供氧方式高压氧治疗对手术治疗后卒中患者经皮氧分压影响的研究[J]. 中国卒中杂志, 2024, 19(10): 1148-1154.

REN Ziqi, WANG Qinfang, LIU Yaling, WANG Cong, YU Qiuhong. Effects of Different Oxygen Supply Methods during Hyperbaric Oxygen Therapy on the Transcutaneous Oximetry of Post-Surgery Stroke Patients[J]. Chinese Journal of Stroke, 2024, 19(10): 1148-1154.

参考文献

[1] LI X Z，LU L，MIN Y，et al. Efficacy and safety of hyperbaric oxygen therapy in acute ischaemic stroke：a systematic review and meta-analysis[J/OL]. BMC Neurol，2024，24（1）：55[2024-06-08]. https://doi.org/10.1186/s12883-024-03555-w.
[2] CATALOGNA M，HADANNY A，PARAG Y，et al. Functional MRI evaluation of hyperbaric oxygen therapy effect on hand motor recovery in a chronic post-stroke patient：a case report and physiological discussion
[J/OL]. Front Neurol，2023，14：1233841[2024-06-06].
https://doi.org/10.3389/fneur.2023.1233841.
[3] BENNETT M H，WEIBEL S，WASIAK J，et al. Hyperbaric oxygen therapy for acute ischaemic stroke[J/OL]. Cochrane Database Syst Rev，2014，2014（11）：CD004954[2024-06-06]. https://doi.org/10.1002/14651858.CD004954.pub3.
[4] RUSYNIAK D E，KIRK M A，MAY J D，et al. Hyperbaric oxygen therapy in acute ischemic stroke：results of the hyperbaric oxygen in acute ischemic stroke trial pilot study[J]. Stroke，2003，34（2）：571-574.
[5] ZHAI W W，SUN L，YU Z Q，et al. Hyperbaric oxygen therapy in experimental and clinical stroke[J]. Med Gas Res，2016，6（2）：111-118.
[6] KOT J，MATHIEU D. Controversial issues in hyperbaric oxygen therapy：a European Committee for Hyperbaric Medicine Workshop[J]. Diving Hyperb Med，2011，41（2）：101-104.
[7] DOOLEY J，KING G，SLADE B. Establishment of reference pressure of transcutaneous oxygen for the comparative evaluation of problem wounds[J]. Undersea Hyperb Med，1997，24（4）：235-244.
[8] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性卒中诊治指南2023[J]. 中华神经科杂志，2024，57（6）：523-559.
Chinese Society of Neurology，Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2023[J]. Chin J Neurol，2024，57（6）：523-559.
[9] World Health Organization. International Classification of Diseases（ICD）Tenth Revision Code，ICD 10[M]. Geneva：WHO，1994.
[10] LU K M，WANG H R，GE X X，et al. Hyperbaric oxygen protects against cerebral damage in permanent middle cerebral artery occlusion rats and inhibits autophagy activity[J]. Neurocrit Care，2019，30（1）：98-105.
[11] CHEN C Y，WU R W，TSAI N W，et al. Increased circulating endothelial progenitor cells and improved short-term outcomes in acute non-cardioembolic stroke after hyperbaric oxygen therapy[J/OL]. J Transl Med，2018，16（1）：255[2024-06-08]. https://doi.org/10.1186/s12967-018-1629-x.
[12] XUE L B，YU Q H，ZHANG H X，et al. Effect of large dose hyperbaric oxygenation therapy on prognosis and oxidative stress of acute permanent cerebral ischemic stroke in rats[J]. Neurol Res，2008，30（4）：389-393.
[13] 任梓齐，王丛，薛连璧. 缺血性卒中高压氧治疗的研究现状及展望[J]. 中国卒中杂志，2020，15（8）：823-828.
REN Z Q，WANG C，XUE L B. The research status and prospect of hyperbaric oxygen therapy for ischemic stroke[J]. Chin J Stroke，2020，15（8）：823-828.
[14] 于秋红，李婕，刘亚玲，等. 高压氧治疗对局灶性脑梗死大鼠的神经保护作用[J]. 中国卒中杂志，2020，15（8）：830-835.
YU Q H，LI J，LIU Y L，et al. The neuroprotective effect of hyperbaric oxygen after cerebral infarction in rats[J]. Chin J Stroke，2020，15（8）：830-835.
[15] MCCORMICK J G，HOULE T T，SALTZMAN H A，et al. Treatment of acute stroke with hyperbaric oxygen：time window for efficacy[J]. Undersea Hyperb Med，2011，38（5）：321-334.
[16] BEPPU T，KAMADA K，YOSHIDA Y，et al. Change of oxygen pressure in glioblastoma tissue under various conditions[J]. J Neurooncol，2002，58（1）：47-52.
[17] YAMAMOTO N，TAKADA R，MAEDA T，et al. Microcirculation and tissue oxygenation in the head and limbs during hyperbaric oxygen treatment[J]. Diving Hyperb Med，2021，51（4）：338-344.
[18] HEYBOER M，BYRNE J，PONS P，et al. Use of in-chamber transcutaneous oxygen measurement to determine optimal treatment pressure in patients undergoing hyperbaric oxygen therapy[J]. Undersea Hyperb Med，2018，45（4）：389-394.
[19] FIFE C E，BUYUKCAKIR C，OTTO G H，et al. The predictive value of transcutaneous oxygen tension measurement in diabetic lower extremity ulcers treated with hyperbaric oxygen therapy：a retrospective analysis of 1144 patients[J]. Wound Repair Regen，2002，10（4）：198-207.
[20] SACK R A，PIKKEL Y Y，SHEMY O L，et al. Transcutaneous oximetry values in chronic ulcer patients during hyperbaric treatment at 1.4 ATA compared to 2 ATA[J]. Undersea Hyperb Med，2024，51（1）：1-5.
[21] YANG C，WENG H，CHEN L C，et al. Transcutaneous oxygen pressure measurement in diabetic foot ulcers：mean values and cut-point for wound healing[J]. J Wound Ostomy Continence Nurs，2013，40（6）：585-589.
[22] 高光凯，吴镝，杨鹰，等. 高压舱内经皮氧分压监测的临床应用[J]. 中华航海医学与高气压医学杂志，2014，21（4）：260-262.
GAO G K，WU D，YANG Y，et al. Clinical application of transcutaneous partial oxygen tension detection in the hyperbaric chamber[J]. Chin J Naut Med & Hyperbar Med，2014，21（4）：260-262.