空气与氧气在ST段-升高心肌梗塞中
Dion Stub1, Karen Smith2, Stephen Bernard1
1From The Alfred Hospital, Melbourne, Australia (D.S., S.B., J.E.B., A.H.E., A.J.T., D.M.K.); Baker IDI Heart and Diabetes Institute, Melbourne, Australia (D.S., A.H.E., A.J.T., D.M.K.); Western Health, Melbourne, Australia (D.S.); Ambulance Victoria, Melbourne, Australia (K.S., S.B., Z.N., M.S., B.B.); Monash University, Melbourne, Australia (K.S., S.B., Z.N., M.S., M.E.B., P.C., I.T.M., D.M.K.); University of Western Australia, Western Australia, Australia (K.S.); and Monash Medical Centre, Melbourne, Australia (I.T.M.).
补充氧气可能会使ST升高心肌梗塞患者没有缺氧的结果恶化. 这种疗法与早期损伤增加,心脏病发作复发,心律不整以及六个月内心脏病发作的大小有关.
科学领域:
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
- 关键护理医学 关键护理医学
背景情况:
- 在ST升高心肌梗塞 (STEMI) 患者中,常规氧气给药是常见的.
- 人们担心氧气的潜在危害,包括冠心血管收缩和氧化应激增加.
- 之前的研究对氧气对STEMI的影响产生了相互矛盾的结果.
研究的目的:
- 研究补充氧气对心肌损伤和心脏梗塞大小在没有缺氧的STEMI患者的影响.
- 评估二次结局,如复发性心肌梗塞和心律失常.
主要方法:
- 进行了一项多中心,前性,随机对照试验.
- 638名通过护理人员ECG诊断的STEMI患者被随机分配到接受氧气 (8L/分钟) 或没有补充氧气.
- 主要终点是心肌梗塞的大小,由心脏酶 (热素I,肌酸激酶) 评估;次要终点包括复发性心肌梗塞,心律失常和6个月后MRI评估的心脏梗塞大小.
主要成果:
- 平均峰值热素水平在各组之间是相似的 (P=0.18).
- 氧气组中,肌酸激酶的平均峰值显著高于氧气组 (P=0.01).
- 氧气组在6个月后出现了复发性心肌梗塞 (5.5%对0.9%,P=0.006),心律失常 (40.4%对31.4%,P=0.05) 和更大的心脏梗塞大小 (20.3g对13.1g,P=0.04) 的增加率.
结论:
- 对于没有缺氧的STEMI患者,补充氧气治疗可能会增加早期心肌损伤.
- 氧气的使用与6个月内心肌梗塞的大小有关.
- 研究结果表明,在正常性STEMI患者中,需要重新考虑日常使用氧气.
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