Department of Neurology and Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing, 101149, China.
China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
Neurotherapeutics. 2021 Apr;18(2):1188-1197. doi: 10.1007/s13311-020-00979-3. Epub 2021 Jan 6.
Adjuvant neuroprotective therapies for acute ischemic stroke (AIS) have demonstrated benefit in animal studies, albeit without human translation. We investigated the safety and efficacy of high-flow normobaric oxygen (NBO) after endovascular recanalization in anterior circulation stroke. This is a prospective randomized controlled study. Eligible patients were randomized to receive high-flow NBO by a Venturi mask (FiO 50%, flow 15 L/min) or routine low-flow oxygen supplementation by nasal cannula (flow 3 L/min) after vessel recanalization for 6 h. Patient demographics, procedural metrics, complications, functional outcomes, symptomatic intracranial hemorrhage (sICH), and infarct volume were assessed. A total of 91 patients were treated with high-flow NBO. NBO treatment revealed a common odds ratio of 2.2 (95% CI, 1.26 to 3.87) favoring the distribution of global disability scores on the mRS at 90 days. The mortality at 90 days was significantly lower in the NBO group than in the control group, with an absolute difference of 13.86% (rate ratio, 0.35; 95% CI, 0.13-0.93). A significant reduction of infarct volume as determined by MRI was noted in the NBO group. The median infarct volume was 9.4 ml versus 20.5 ml in the control group (beta coefficient, - 20.24; 95% CI, - 35.93 to - 4.55). No significant differences were seen in the rate of sICH, pneumonia, urinary infection, and seizures between the 2 groups. This study suggests that high-flow NBO therapy after endovascular recanalization is safe and effective in improving functional outcomes, decreasing mortality, and reducing infarct volumes in anterior circulation stroke patients within 6 h from stroke onset.
血管内再通后高流量常压氧（NBO）治疗急性缺血性脑卒中（AIS）的辅助神经保护疗法在动物研究中显示出获益，但尚未在人类中得到转化。我们研究了血管内再通后在前循环脑卒中患者中使用高流量 NBO 的安全性和有效性。这是一项前瞻性随机对照研究。符合条件的患者被随机分为两组，一组在血管再通后 6 小时内通过文丘里面罩（FiO50%，流量 15L/min）接受高流量 NBO，另一组通过鼻导管（流量 3L/min）接受常规低流量氧补充。评估了患者的人口统计学、程序指标、并发症、功能结局、症状性颅内出血（sICH）和梗死体积。共有 91 例患者接受了高流量 NBO 治疗。NBO 治疗的优势比为 2.2（95%CI，1.26-3.87），有利于 90 天 mRS 分布的总体残疾评分。90 天的死亡率在 NBO 组明显低于对照组，绝对差异为 13.86%（率比，0.35；95%CI，0.13-0.93）。NBO 组的梗死体积也显著减少。NBO 组的中位数梗死体积为 9.4ml，而对照组为 20.5ml（β系数，-20.24；95%CI，-35.93 至-4.55）。两组之间 sICH、肺炎、尿路感染和癫痫发作的发生率没有显著差异。这项研究表明，血管内再通后高流量 NBO 治疗在前循环脑卒中患者中是安全有效的，可改善功能结局，降低死亡率，并减少发病后 6 小时内的梗死体积。
