高压氧治疗过程中诱发脑梗死的危险因子水平分析

背景既往认为高压氧可以防治脑梗死,但有报道高压氧也可诱发其发生,其发生原因尚不甚清楚.目的探讨高压氧诱发脑梗死的原因.设计病例分析.单位解放军广州军区广州总医院高压氧科.对象选择1996-12/1998-03在广州军区广州总医院高压氧科行高压氧治疗的192例住院患者.男127例,女65例,年龄9～78岁.纳入标准①因缺氧、缺血性疾病,或由于缺氧、缺血引起的一系列疾病且无高压氧治疗的禁忌证在高压氧科住院治疗的患者.②年龄、性别不限.③患者及家属知情同意.不符合上述标准或虽符合上述标准但未做高压氧治疗的住院患者为排除标准.脑梗死诊断及治愈标准按照<临床疾病诊断依据治愈好转标准>,治疗中发生脑梗死的患者共6例,男女各3例,年龄51～76岁.方法高压氧治疗采用多人空气加压舱,治疗压力为0.2 MPa(2.0ATA),面罩吸纯氧40 min 2次,中间间歇吸空气10 min,1次/d,每10次为1个疗程.对6例发生脑梗死患者、186例未发生脑梗死患者的背景因素及其危险因子水平进行分析.主要观察指标高压氧治疗诱发脑梗死患者危险因子分布及未发生脑梗死患者危险因子水平分析.结果①6例患者均有高脂血症,5例有高血压,5例原有脑梗死或脑出血,4例年龄≥60岁或有高黏血症,有糖尿病者1例.6例患者的危险因子数在4个以上,存在危险因子簇集性.②6例发生脑梗死患者中含4个危险因子的有5例,含5个危险因子的1例.186例未发生脑梗死患者中含4个危险因子的有25例,含5个危险因子的0例,其危险因子蔟集性相对较小(x2=54.37,P＜0.005).结论发生脑梗死患者均存在危险因子簇集性,危险因子的簇集性水平与高压氧诱发脑梗死概率有密切关系.

Analysis of risk factor levels of cerebral infarction during hyperbaric oxygen therapy

BACKGROUND: Hyperbaric oxygen therapy has been considered as an effective therapy for prevention and cure of cerebral infarction traditionally.However, some scholars suggested that hyperbaric oxygen therapy could also result in cerebral infarction, although the mechanism is unclear.OBJECTIVE: To investigate the cause of cerebral infarction due to hyperbaric oxygen therapy.DESIGN: Case-control trial with patients as subjects.SETTING: Department of Hyperbaric Oxygen, Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA.PARTICIPANTS: From December 1996 to March 1998, 192 inpatients receiving hyperbaric oxygen therapy were recruited into the trial from the Department of Hyperbaric Oxygen, Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA. There were 127 males and 65 females aged 9-78 years. Patients admitted to the department of hyperbaric oxygen were eligible if they had hypoxia or ischemia induced disease and had no contraindication to hyperbaric oxygen therapy. Patients were recruited into the study regardless of the gender, and all patients and their family gave informed consent before enrollment. Patients were excluded if they did not receive hyperbaric oxygen therapy. According to the Diagnosis and Curing Criteria of Clinical Diseases, 6 patients developed into cerebral infarction during hyperbaric oxygen therapy, 3 males and 3 females, at the age of 51-76 years.METHODS: Patients were exposed to oxygen at 0.2 MPa in hyperbaric chamber used for many persons, and inhaled oxygen with a facemask once a day for 80 minutes with an interval of 10 minutes at the 40th minute. Ten days was considered as one course. Background and risk factors were analyzed in 6patients with cerebral infarction and 186 patients without cerebral infarction.MAIN OUTCOME MEASURES: Analysis of distribution of risk factors among cerebral infarction patients, and risk factor levels in patients without cerebral infarction.RESULTS: Among the 6 patients with cerebral infarction, hyperlipidemia was in all 6 cases, hypertension in 5 cases, primary cerebral infarction or hemorrhage in 5 cases, ≥ 60 years old or hyperviscosity in 4 cases, and diabetes mellitus in 1 case. Risk factor aggregation existed in the patients with over four risk factors. Of the 6 patients with cerebral infarction due to hyperbaric oxygen therapy, 5 cases had 4 risk factors and 1 had 5 risk factors. Of the 186 patients without cerebral infarction, 25 cases had 4 risk factors, and no case had 5 risk factors. The risk factor aggregation was relatively impossible (x2 = 54. 37, P ＜ 0. 05 ).CONCLUSION: Risk factor aggregation was found in all cerebral infarction patients, which is closely associated with the probability of cerebral infarction resulting from hyperbaric oxygen therapy.