Department of Emergency and Internal Medicine.
Section of Clinical Physiology, Clinical Sciences Lund, Skåne University Hospital, Lund University.
Eur J Emerg Med. 2018 Apr;25(2):78-84. doi: 10.1097/MEJ.0000000000000431.
Recent studies suggest that administration of O2 in patients with acute myocardial infarction may have negative effects. With the use of cardiac MRI (CMR), we evaluated the effects of supplemental O2 in patients with ST elevation myocardial infarction (STEMI) accepted for acute percutaneous coronary intervention (PCI).
This study was a randomized-controlled trial conducted at two university hospitals in Sweden. Normoxic STEMI patients were randomized in the ambulance to either supplemental O2 (10 l/min) or room air until the conclusion of the PCI. CMR was performed 2-6 days after the inclusion. The primary endpoint was the myocardial salvage index assessed by CMR. The secondary endpoints included infarct size and myocardium at risk.
At inclusion, the O2 (n=46) and air (n=49) patient groups had similar patient characteristics. There were no significant differences in myocardial salvage index [53.9±25.1 vs. 49.3±24.0%; 95% confidence interval (CI): -5.4 to 14.6], myocardium at risk (31.9±10.0% of the left ventricle in the O2 group vs. 30.0±11.8% in the air group; 95% CI: -2.6 to 6.3), or infarct size (15.6±10.4% of the left ventricle vs. 16.0±11.0%; 95% CI: -4.7 to 4.1).
In STEMI patients undergoing acute PCI, we found no effect of high-flow oxygen compared with room air on the size of ischemia before PCI, myocardial salvage, or the resulting infarct size. These results support the safety of withholding supplemental oxygen in normoxic STEMI patients.
最近的研究表明，给急性心肌梗死患者输氧可能会产生负面效果。我们使用心脏磁共振成像（CMR）来评估给接受急性经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者补充氧气的效果。
这是在瑞典两家大学医院进行的一项随机对照试验。将接受氧合的 STEMI 患者在救护车上随机分为补充氧气（10L/min）组或空气组，直到 PCI 结束。纳入后 2-6 天进行 CMR。主要终点是 CMR 评估的心肌挽救指数。次要终点包括梗死面积和危险心肌。
纳入时，补充氧气（n=46）和空气（n=49）患者组的患者特征相似。心肌挽救指数无显著差异[53.9±25.1 比 49.3±24.0%；95%置信区间（CI）：-5.4 至 14.6]，危险心肌（左心室的 31.9±10.0%在补充氧气组，30.0±11.8%在空气组；95%CI：-2.6 至 6.3）或梗死面积（左心室的 15.6±10.4%在补充氧气组，16.0±11.0%在空气组；95%CI：-4.7 至 4.1）也无显著差异。
在接受急性 PCI 的 STEMI 患者中，与空气相比，高流量氧气对 PCI 前缺血面积、心肌挽救或由此产生的梗死面积没有影响。这些结果支持对氧合正常的 STEMI 患者不补充氧气的安全性。
