新西兰奥克兰城市医院Ralph A H Stewart团队研究了疑似急性冠状动脉综合征患者采用高流量氧治疗和死亡风险的相关性。2021年3月2日，该研究发表在《英国医学杂志》上。
为了探讨疑似急性冠脉综合征（ACS）患者高流量补充氧与30天死亡率的相关性，研究组在新西兰的四个地理区域进行了一项实用、整群随机的交叉试验。研究组共招募了经全国登记或救护车转运的40872名疑似或确诊ACS患者，其中20304例采用高氧方案，20568例采用低氧方案。ST段抬高型心肌梗死（STEMI）和非STEMI的最终诊断根据登记和ICD-10出院代码确定。
四个地理区域被随机分配到两个氧气方案中的一个，为期6个月。高氧方案建议在缺血症状或心电图改变时使用面罩供氧6-8 L/min，而不考虑经毛细血管氧饱和度（SpO2）。低氧方案仅在SpO2低于90%时才推荐吸氧，目标SpO2低于95%。主要观察指标为30天全因死亡率。
两种氧疗方案下患者的个人特征和临床特征相匹配。对于疑似ACS的患者，高氧组和低氧组的30天死亡数分别为613例（3.0%）和642例（3.1%），差异不显著。在4159例（10%）STEMI患者中，高氧组和低氧组的30天死亡率分别为8.8%（n=178）和10.6%（n=225），在10218例（25%）非STEMI患者中，30天死亡率分别为3.6%（n=187）和3.5%（n=176），组间差异均不显著。
研究结果表明，对于疑似ACS的患者，采用高流量氧疗并不能降低30天死亡率。
附：英文原文
Title: High flow oxygen and risk of mortality in patients with a suspected acute coronary syndrome: pragmatic, cluster randomised, crossover trial
Author: Ralph A H Stewart, Peter Jones, Bridget Dicker, Yannan Jiang, Tony Smith, Andrew Swain, Andrew Kerr, Tony Scott, David Smyth, Anil Ranchord, John Edmond, Martin Than, Mark Webster, Harvey D White, Gerard Devlin
Issue&Volume: 2021/03/02
Abstract:
Objective To determine the association between high flow supplementary oxygen and 30 day mortality in patients presenting with a suspected acute coronary syndrome (ACS).
Design Pragmatic, cluster randomised, crossover trial.
Setting Four geographical regions in New Zealand.
Participants 40872 patients with suspected or confirmed ACS included in the All New Zealand Acute Coronary Syndrome Quality Improvement registry or ambulance ACS pathway during the study periods. 20304 patients were managed using the high oxygen protocol and 20568 were managed using the low oxygen protocol. Final diagnosis of ST elevation myocardial infarction (STEMI) and non-STEMI were determined from the registry and ICD-10 discharge codes.
Interventions The four geographical regions were randomly allocated to each of two oxygen protocols in six month blocks over two years. The high oxygen protocol recommended oxygen at 6-8 L/min by face mask for ischaemic symptoms or electrocardiographic changes, irrespective of the transcapillary oxygen saturation (SpO2). The low oxygen protocol recommended oxygen only if SpO2 was less than 90%, with a target SpO2 of less than 95%.
Main outcome measure 30 day all cause mortality determined from linkage to administrative data.
Results Personal and clinical characteristics of patients managed under both oxygen protocols were well matched. For patients with suspected ACS, 30 day mortality for the high and low oxygen groups was 613 (3.0%) and 642 (3.1%), respectively (odds ratio 0.97, 95% confidence interval 0.86 to 1.08). For 4159 (10%) patients with STEMI, 30 day mortality for the high and low oxygen groups was 8.8% (n=178) and 10.6% (n=225), respectively (0.81, 0.66 to 1.00) and for 10218 (25%) patients with non-STEMI was 3.6% (n=187) and 3.5% (n=176), respectively (1.05, 0.85 to 1.29).
Conclusion In a large patient cohort presenting with suspected ACS, high flow oxygen was not associated with an increase or decrease in 30 day mortality.
DOI: 10.1136/bmj.n355
Source: https://www.bmj.com/content/372/bmj.n355
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
