Department of Neurology with Clinic, V.A. Almazov National Medical Research Center, Saint-Petersburg, Russia.
Department of Ultrasound and Functional Diagnostics, Altai State Medical University, Barnaul, Russia.
Neurol Res. 2024 Aug;46(8):695-705. doi: 10.1080/01616412.2024.2343510. Epub 2024 Apr 21.
Experimental studies on animals have demonstrated a higher neuroprotective efficacy of hypercapnic hypoxia compared to normocapnic hypoxia. Respiratory training with hypercapnic hypoxia has shown a positive impact on the functional state of the nervous system in children with cerebral palsy (CP). It can be presumed that the combined effect of moderate hypercapnia and hypoxia will be promising for clinical application within the context of early rehabilitation after ischemic stroke.
A randomized triple-blind placebo-controlled study was conducted on 102 patients with ischemic stroke, aged 63.07 ± 12.1 years. All patients were diagnosed with ischemic stroke based on neuroimaging criteria and/or clinical criteria within the 48-72 hour timeframe. The experimental group ( = 50) underwent daily respiratory training with hypercapnic hypoxia (FetCO2 5-6%, FetO2 15-16%) using the 'Carbonic' device for 7-11 sessions of 20 minutes each day during the treatment process. The control group (placebo, = 52) underwent training on a similar device modified for breathing atmospheric air. Neurological examinations were conducted on all patients before the study and on the day after completing the training course.
The standard treatment demonstrated effectiveness in terms of neurological status scales in both groups. Intermittent exposure to hypercapnic hypoxia proved more effective in improving neurological function indicators in patients compared to the placebo group: NIHSS scale scores were 40% lower than in the placebo group ( < 0.001); mRS scale scores were 35% lower ( < 0.001); B-ADL-I and RMI indices were higher by 26% ( < 0.01) and 36% ( < 0.001), respectively; MoCA scale results were 13% higher ( < 0.05); HADS and BDI-II scale scores were lower by 35% ( < 0.05) and 25% ( < 0.05), respectively. The increase in MMSE scale scores in the intervention group was 54% higher ( < 0.001), and MoCA scale scores increased by 25% ( < 0.001).
Respiratory training with hypercapnic hypoxia improves the functional state of the nervous system in patients with ischemic stroke. After conducting further clarifying studies, hypercapnic hypoxia can be considered as an effective method of neurorehabilitation, which can be used as early as 48-72 hours after the onset of stroke.
动物实验研究表明，高碳酸低氧血症比正常碳酸低氧血症具有更高的神经保护作用。高碳酸低氧呼吸训练已显示出对脑瘫（CP）儿童神经系统功能状态的积极影响。可以推测，适度高碳酸血症和低氧血症的联合作用将有望在缺血性中风后的早期康复治疗中得到临床应用。
对 102 名年龄在 63.07±12.1 岁的缺血性中风患者进行了随机、三盲、安慰剂对照研究。所有患者均根据神经影像学标准和/或临床标准在 48-72 小时内被诊断为缺血性中风。实验组（n=50）在治疗过程中每天使用“Carbonic”设备进行 7-11 次 20 分钟的高碳酸低氧呼吸训练（FetCO2 5-6%，FetO2 15-16%）。对照组（n=52）在类似的设备上进行呼吸空气的训练。所有患者在研究前和完成训练课程后的第二天进行神经学检查。
标准治疗在两组的神经状态量表中均显示出有效性。间歇性暴露于高碳酸低氧血症在改善患者的神经功能指标方面比安慰剂组更有效：NIHSS 量表评分降低了 40%（p<0.001）；mRS 量表评分降低了 35%（p<0.001）；B-ADL-I 和 RMI 指数分别升高了 26%（p<0.01）和 36%（p<0.001）；MoCA 量表评分升高了 13%（p<0.05）；HADS 和 BDI-II 量表评分分别降低了 35%（p<0.05）和 25%（p<0.05）。干预组 MMSE 量表评分升高了 54%（p<0.001），MoCA 量表评分升高了 25%（p<0.001）。
高碳酸低氧呼吸训练可改善缺血性中风患者的神经系统功能状态。在进行进一步澄清研究后，可以考虑高碳酸低氧血症作为一种有效的神经康复方法，可在中风发病后 48-72 小时内尽早使用。
