在急性缺血性中风中接受机械血栓切除术的患者的通风目标:系统性审查
Alessandro Scudellari1, Paula Dudek2, Luca Marino3
1Anaesthetic Department, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
Journal of clinical medicine
|August 12, 2023
概括
机械血栓切除术对于中风需要特定的通风目标. 这次审查发现高氧和低二氧化碳水平存在风险,但证据有限.
科学领域:
- 神经学 神经学
- 关键护理医学 关键护理医学
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 机械血栓切除术 (MT) 是由于大血管封闭 (LVO) 的急性缺血性中风 (AIS) 的标准.
- 带有机械通风的全身麻醉 (GA) 结果与非GA结果相似,但缺乏特定的通风目标.
- 在GA下MT期间优化通风对于患者的治疗结果至关重要.
研究的目的:
- 系统地审查通风策略,以便在接受MT的AIS患者中获得更好的神经结果.
- 在GA下的MT期间专注于特定的氧化和二氧化碳 (CO2) 目标.
- 为了确定通风参数和神经恢复之间的相关性.
主要方法:
- 系统地搜索多个数据库对人工研究的通风策略和AIS的MT的神经结果.
- 包括临床试验,观察性研究和病例控制研究.
- 评估了157项研究,其中11项符合分析的纳入标准.
主要成果:
- 五项研究检查了氧化目标,并指出补充氧气的有争议作用和与更差结果的潜在关联.
- 六项研究探讨了二氧化碳目标,确定了最终潮二氧化碳水平与功能结果之间的潜在联系,低头是不利的.
- 证据表明,在接受MT的AIS患者中,与高氧和低头相关的风险存在.
结论:
- 目前的证据不足以在GA下推MT的特定通风目标.
- 过氧和低头可能会对这种患者群体的神经结果构成风险.
- 需要进一步的研究,以建立最佳的通风策略在MT为AIS.
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