高压氧治疗中发生脑卒中的相关因素分析

背景既往认为高压氧可以防治脑卒中,但有学者认为高压氧治疗中反而可诱发脑卒中,其发生因素以及以何种药物防治尚不甚清楚.目的探讨高压氧诱发脑血栓形成的原因及药物的预防作用.设计以患者为研究对象的回顾性研究.单位一所军区总医院的高压氧科.对象1996-12/1998-08广州军区广州总医院行高压氧治疗的的192例住院患者,其中男127例,女65例,年龄9～78岁.治疗中发生脑血栓形成的患者共6例,男女各3例,年龄51～76岁.方法对192例行高压氧治疗患者及其中发生的6例脑血栓形成患者的背景因素进行分析,将192例患者分为3组①硝酸酯类组.②钙拮抗组.③未特殊用药组,在不同危险因子簇集水平上分析药物的预防作用.对192例行高压氧治疗的3组患者在常规使用活血化瘀、神经营养、血管扩张剂等药物的前提下,硝酸酯类组口服消心痛或硝酸甘油,钙拮抗剂组口服西比灵或络活喜等,未特殊用药组则没有预防性使用药物.主要观察指标患者的症状、体征以及头颅CT或MRI.结果高压氧诱发脑血栓形成以高脂血症、高血压病等基础疾病为危险因子,危险因子簇集4个以下者共115例,无一例发病,4个或4个以上者共31例,有6例发病,发病率大为增加;在4个危险因子的水平上,硝酸酯类药物有有效的预防作用(0/13),而钙拮抗剂组中有33.3%发病(5/15),两者差异有显著性意义(P＜0.05).结论危险因子的簇集性水平与高压氧诱发脑血栓形成机率有密切关系,硝酸酯类药物对此有显著的预防作用.

Correlative analysisof stroke during hyperbaric oxygen therapy

BACKGROUND: It is believed previously that hyperbaric oxygen(HBO)therapy can prevent stroke, but some scholars think HBO therapy on the contrary can induce stroke although its pathogen and prevention are unclear.OBJECTIVE: To study the reason of cerebral thrombosis induced by HBO and the preventive effects of the medicine.DESIGN: A retrospective study based on patients as subjects.SETTING: Department of HBO in a military area command hospital ofChinese PLA.PARTICIPANTS: Totally 192 hospitalized patients receiving HBO therapy in Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA were selected, in which there were 127 males and 65 females aged between 9 and 78 years old. A total of 6 cases including 3 male and 3 female cases aged between 51 and 76 years old developed cerebral thrombosis during therapy.METHODS: The background factors of 192 patients who received HBO therapy and the included 6 cerebral thrombosis cases were analyzed. Totally preventive effects of the medicine on a cluster level of different risk factor. Three groups of patients received different interventions under the prerequisites of routine medications including blood-activating and stasis-eliminating, neurotrophy, and vasodilator patients of nitric ether group received oral administration of isosorbide dinitrate or glycerin trinitrate; patients of calcium antagonist group received oral administration of Sibelium or Novarsc; and patients of no specific medication group did not receive any preventive medicine.MAIN OUTCOME MEASURES: Patients' symptoms, physical signs andhead CT or MRI.RESULTS: The risk factor of cerebral thrombosis induced by HBO was the basic disease of hyperlipidemia or hypertension, etc. A total of 115 cases had the cluster with less than 4 risk factors and none of them developed thrombosis. A total of 31 cases had the cluster with 4 or more than 4 risk factors and 6 of them developed thrombosis with greatly increased morbidity. Above the level of 4 risk factors, nitrate ether had effective preventive effect(0/13) while there was 33.3% of the patients(5/15) in calcium antagonist group developed thrombosis, and the difference between the above two groups was significant( P ＜ 0.05).CONCLUSION: The cluster level of risk factors has close relationship with the probability of thrombosis induced by HBO. Nitrate ether has significant preventive effects.