急性脳卒中の成人の死亡および障害に対する定期的な低用量酸素補給の効果:脳卒中の酸素試験 ランダム化臨床試験
Christine Roffe1,2, Tracy Nevatte2,3, Julius Sim2
1University Hospital of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom.
JAMA
|October 4, 2017
まとめ
低用量の酸素治療は,非低毒性急性脳卒中患者の死亡や障害を軽減しませんでした. これらの発見は,この患者集団における通常の酸素使用を支持しません.
科学分野:
- 神経学
- クリティカル ケア 医療
- 臨床試験
背景:
- 急性脳卒中後の最初の数日間,低酸素症は一般的であり,しばしば検出されません.
- 酸素補給は 副次神経学的悪化を予防し,脳卒中の回復を改善する可能性があります.
- 急性脳卒中患者の日常的な低用量の酸素の有効性は,さらなる調査を必要としています.
研究 の 目的:
- 脳卒中の90日後の死亡と障害を減らすために,定期的な低用量酸素療法の有効性を評価する.
- 夜間のみの酸素投与が継続的な酸素療法よりも,脳卒中のアウトカムを改善するかどうかを判断する.
- 低用量の酸素の安全性と有効性を評価する.
主な方法:
- 24時間以内に入院した急性脳卒中患者8003人を対象とした単盲ランダム化臨床試験です.
- 参加者はランダムに72時間連続酸素,夜間酸素3日間,またはコントロール (臨床的に指示された場合にのみ酸素) を受けた.
- 主要なアウトカム値は,オーダーナルロジスティック回帰を用いて,修正されたランキンスケールで90日後に評価された.
主要な成果:
- この研究では,対照群と比較して,予防用酸素を投与された患者の死亡や障害の有意な減少は認められませんでした (OR 0. 97,P=.47).
- 継続的な酸素療法が夜間酸素療法より効果的であることが判明しなかった (OR1. 03,P=.61).
- 酸素補給の恩恵を受けた特定のサブグループはなく,重大な害も特定されなかった.
結論:
- 低用量の酸素補給は,急性脳卒中の非低毒性患者の死亡や障害を軽減しなかった.
- 研究結果は,この臨床環境で低用量の酸素を日常的に使用することを支持しません.
- 酸素療法から恩恵を受ける特定の脳卒中患者集団を特定するために,さらなる研究が必要になるかもしれません.
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