Department of Neurology and Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Munson Medical Center, Traverse City, MI, USA; Department of Neurosurgery, Munson Healthcare, Traverse City, MI, USA.
J Neurol Sci. 2022 Oct 15;441:120350. doi: 10.1016/j.jns.2022.120350. Epub 2022 Jul 25.
Recent studies suggest only a third of posterior circulation stroke patients have a good functional outcome with a high mortality after mechanical thrombectomy. To mitigate mortality rates and increase functional outcomes, we investigated the safety and efficacy of high-flow, normobaric oxygen (NBO) after endovascular recanalization in posterior 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.
While we assessed 122 patients for eligibility, 87 patients were randomly assigned (44 patients to the NBO group). Post operatively there was no significant difference in distribution of global disability scores on the mRS at 90 days or functional independence between the two groups. We did observe a trend suggesting reduced mortality at 90 days with reduced infarct volume in the NBO group, however this was not statistically significant. No significant differences were seen in the rate of sICH, pneumonia or urinary infection between the two groups. When comparing our results with the BASICS and BEST study, our study did reveal a significantly better prognosis after endovascular therapy.
Our results indicate that high-flow adjuvant NBO therapy was safe. However, the current study does not provide evidence for a significant neuroprotection effect in posterior circulation stroke patients after endovascular recanalization.
最近的研究表明，在后循环卒中患者中，仅有三分之一的患者在机械取栓后具有良好的功能预后，且死亡率较高。为了降低死亡率并提高功能预后，我们研究了血管内再通后高流量、常压氧（NBO）在后循环卒中患者中的安全性和有效性。
这是一项前瞻性随机对照研究。将符合条件的患者随机分为接受经文丘里面罩（FiO 50%，流量 15 L/min）给予高流量 NBO 组，或在血管再通后 6 小时内通过鼻导管（流量 3 L/min）给予常规低流量氧补充组。评估患者的人口统计学、程序指标、并发症、功能结局、症状性颅内出血（sICH）和梗死体积。
我们评估了 122 例符合条件的患者，87 例患者被随机分配（44 例患者分入 NBO 组）。术后 90 天时，两组患者的 mRS 全球残疾评分分布或功能独立性无显著差异。我们观察到一种趋势，即 NBO 组的死亡率降低，梗死体积减小，但这没有统计学意义。两组患者 sICH、肺炎或尿路感染的发生率无显著差异。与 BASICS 和 BEST 研究相比，我们的研究确实揭示了血管内治疗后预后明显改善。
我们的结果表明，高流量辅助 NBO 治疗是安全的。然而，目前的研究并未在后循环卒中患者血管内再通后提供 NBO 治疗具有显著神经保护作用的证据。
