Hypoxia after stroke: a review of experimental and clinical evidence.

Experimental & Translational Stroke Medicine Pub Date : 2016-12-07 eCollection Date: 2016-01-01 DOI:10.1186/s13231-016-0023-0
Phillip Ferdinand, Christine Roffe
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Abstract

Background: Hypoxia is a common occurrence following stroke and associated with poor clinical and functional outcomes. Normal oxygen physiology is a finely controlled mechanism from the oxygenation of haemoglobin in the pulmonary capillaries to its dissociation and delivery in the tissues. In no organ is this process more important than the brain, which has a number of vascular adaptions to be able to cope with a certain threshold of hypoxia, beyond which further disruption of oxygen delivery potentially leads to devastating consequences. Hypoxia following stroke is common and is often attributed to pneumonia, aspiration and respiratory muscle dysfunction, with sleep apnoea syndromes, pulmonary embolism and cardiac failure being less common but important treatable causes. As well as treating the underlying cause, oxygen therapy is a vital element to correcting hypoxia, but excessive use can itself cause molecular and clinical harm. As cerebral vascular occlusion completely obliterates oxygen delivery to its target tissue, the use of supplemental oxygen, even when not hypoxic, would seem a reasonable solution to try and correct this deficit, but to date randomised clinical trials have not shown benefit.

Conclusion: Whilst evidence for the use of supplemental oxygen therapy is currently lacking, it is vital to rapidly identify and treat all causes of hypoxia in the acute stroke patient, as a failure to will lead to poorer clinical outcomes. The full results of a large randomised trial looking at the use of supplemental oxygen therapy are currently pending.

脑卒中后缺氧:实验和临床证据综述。
背景:缺氧是卒中后常见的现象,与不良的临床和功能预后相关。正常的氧生理是一个精细控制的机制,从肺毛细血管血红蛋白的氧合到其在组织中的解离和输送。在任何器官中,这一过程都比大脑更重要,大脑有许多血管适应能力,能够应对一定的缺氧阈值,超过这个阈值,氧气输送的进一步中断可能会导致毁灭性的后果。中风后缺氧很常见,通常归因于肺炎、误吸和呼吸肌功能障碍,睡眠呼吸暂停综合征、肺栓塞和心力衰竭不太常见,但重要的可治疗原因。除治疗潜在原因外,氧疗是纠正缺氧的重要因素,但过度使用本身会造成分子和临床危害。由于脑血管闭塞完全阻断了对目标组织的氧气输送,使用补充氧气,即使在不缺氧的情况下,似乎是试图纠正这种缺陷的合理解决方案,但迄今为止,随机临床试验尚未显示出益处。结论:虽然目前缺乏使用补充氧治疗的证据,但快速识别和治疗急性卒中患者缺氧的所有原因至关重要,因为失败将导致较差的临床结果。一项观察补充氧疗法使用的大型随机试验的完整结果目前尚未公布。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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