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何种吸氧方案最适于STEMI患者?

2015-01-23 CMT 中国医学论坛报

吸氧方案STEMI患者
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何种吸氧方案最适于STEMI患者? Q高远医师：近期发布的AVOID研究显示，供氧或加剧STEMI患者心肌损伤。吸氧是STEMI患者常规治疗之一，我认为该结果暂时不会改变临床实践，但会引起反思。请问，怎样正确理解该研究? A李为民教授、薛竟宜医师：已有研究证实，“高氧症”可降低心脏病患者冠脉血流量和心肌耗氧量。不合并心源性休克和低氧血症的STEMI患者给予高浓度吸氧同样可以造成冠脉

何种吸氧方案最适于STEMI患者?

Q高远医师：近期发布的AVOID研究显示，供氧或加剧STEMI患者心肌损伤。吸氧是STEMI患者常规治疗之一，我认为该结果暂时不会改变临床实践，但会引起反思。请问，怎样正确理解该研究?

A李为民教授、薛竟宜医师：已有研究证实，“高氧症”可降低心脏病患者冠脉血流量和心肌耗氧量。不合并心源性休克和低氧血症的STEMI患者给予高浓度吸氧同样可以造成冠脉血流量进一步减少、降低心输出量、增加外周血管阻力使血压升高。另有研究证实，吸氧可促进氧自由基产生，增加心肌再灌注损伤风险。

AVOID研究中，吸氧A组STEMI患者给予8L/min面罩吸氧，结果显示，吸氧组的肌酸激酶平均峰值明显高于非吸氧组，肌钙蛋白I也较高。第6个月的心脏磁共振成像(MRI)结果显示，吸氧组梗死面积较大，因心梗复发入院的概率也明显升高。其不良结果考虑与上述高浓度吸氧心肌损伤的可能机制相关。

新近阿尼尔(Anil)等研究结果显示，与常规鼻吸氧管滴定吸氧相比，6L/min面罩吸氧并未给无心源性休克和低氧血症的STEMI患者带来任何益处或危害，两者的30天死亡率和心梗面积无显著差异。

事实上，目前绝大部分STEMI患者入院后普遍接受鼻吸氧管低流量吸氧，究竟这种吸氧治疗方法是否真正使其获益?是否需要常规应用?何种吸氧方式最适于STEMI患者?仍是悬而未决的实际问题。我们期待大规模临床随机对照研究为STEMI患者最佳吸氧治疗方案提供依据


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    2015-08-08 12498c32m68暂无昵称

    #STEMI患者#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1936691, encodeId=35af19366919e, content=<a href='/topic/show?id=74bd16e850c' target=_blank style='color:#2F92EE;'>#STEMI患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16785, encryptionId=74bd16e850c, topicName=STEMI患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=48732500158, createdName=12498c32m68暂无昵称, createdTime=Sat Aug 08 11:14:00 CST 2015, time=2015-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16249, encodeId=90db162499b, content=已阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=da6b7222, createdName=chinayinhan, createdTime=Tue Feb 17 01:01:00 CST 2015, time=2015-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15496, encodeId=f4fa15496e2, content=明白, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200609/ef6a57dbe7f1489dad7446b7c5217858/d5e4fe65996c4446a029b0f5d056abb1.jpg, createdBy=6b011518214, createdName=午夜星河, createdTime=Sun Feb 15 14:04:00 CST 2015, time=2015-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481854, encodeId=636c148185425, content=<a href='/topic/show?id=8cc416e78f3' target=_blank style='color:#2F92EE;'>#STEM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16778, encryptionId=8cc416e78f3, topicName=STEM)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1067833268, createdName=12498bb3m92(暂无昵称), createdTime=Sun Jan 25 04:14:00 CST 2015, time=2015-01-25, status=1, ipAttribution=)]
    2015-02-17 chinayinhan

    已阅

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1936691, encodeId=35af19366919e, content=<a href='/topic/show?id=74bd16e850c' target=_blank style='color:#2F92EE;'>#STEMI患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16785, encryptionId=74bd16e850c, topicName=STEMI患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=48732500158, createdName=12498c32m68暂无昵称, createdTime=Sat Aug 08 11:14:00 CST 2015, time=2015-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16249, encodeId=90db162499b, content=已阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=da6b7222, createdName=chinayinhan, createdTime=Tue Feb 17 01:01:00 CST 2015, time=2015-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15496, encodeId=f4fa15496e2, content=明白, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200609/ef6a57dbe7f1489dad7446b7c5217858/d5e4fe65996c4446a029b0f5d056abb1.jpg, createdBy=6b011518214, createdName=午夜星河, createdTime=Sun Feb 15 14:04:00 CST 2015, time=2015-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481854, encodeId=636c148185425, content=<a href='/topic/show?id=8cc416e78f3' target=_blank style='color:#2F92EE;'>#STEM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16778, encryptionId=8cc416e78f3, topicName=STEM)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1067833268, createdName=12498bb3m92(暂无昵称), createdTime=Sun Jan 25 04:14:00 CST 2015, time=2015-01-25, status=1, ipAttribution=)]
    2015-02-15 午夜星河

    明白

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1936691, encodeId=35af19366919e, content=<a href='/topic/show?id=74bd16e850c' target=_blank style='color:#2F92EE;'>#STEMI患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16785, encryptionId=74bd16e850c, topicName=STEMI患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=48732500158, createdName=12498c32m68暂无昵称, createdTime=Sat Aug 08 11:14:00 CST 2015, time=2015-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16249, encodeId=90db162499b, content=已阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=da6b7222, createdName=chinayinhan, createdTime=Tue Feb 17 01:01:00 CST 2015, time=2015-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15496, encodeId=f4fa15496e2, content=明白, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200609/ef6a57dbe7f1489dad7446b7c5217858/d5e4fe65996c4446a029b0f5d056abb1.jpg, createdBy=6b011518214, createdName=午夜星河, createdTime=Sun Feb 15 14:04:00 CST 2015, time=2015-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481854, encodeId=636c148185425, content=<a href='/topic/show?id=8cc416e78f3' target=_blank style='color:#2F92EE;'>#STEM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16778, encryptionId=8cc416e78f3, topicName=STEM)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1067833268, createdName=12498bb3m92(暂无昵称), createdTime=Sun Jan 25 04:14:00 CST 2015, time=2015-01-25, status=1, ipAttribution=)]
    2015-01-25 12498bb3m92(暂无昵称)

    #STEM#

    0