高壓氧氣在缺血性腦中風治療之初探

腦中風為最常見之威脅性命的神經疾病，也是造成病人長期行動不良和殘障的主要因素。近年來由於醫藥科技的進步，腦中風的死亡率雖然逐漸下降，但此疾病的發生率卻因為人口結構的老化而快速地增加，其中缺血性腦中風發生的機率約佔所有類型腦中風的百分之七十。已知造成缺血性腦中風的病理生理機制有細胞組織的能量代謝缺損、離子衡定失常、細胞酸鹼度改變、興奮性神經細胞毒性及缺血再灌流損傷等。動物和臨床實驗發現，若能在中風後數小時內，儘速確立診斷並即時提供有效之醫療照護，對病人的預後有相當大的助益。針對治療急性缺血性腦中風有兩種基本方式，一是儘速恢復或促進血管阻塞腦區的血流供應，二是直接針對缺血區域腦組織之細胞或代謝問題加以治療。高壓氧氣治療因具有緩解組織缺氧狀況、促進微小血循及血管收縮之作用，可以減輕腦水腫程度、降低顱內壓、保存部分受損組織功能、預防已受損組織進一步損傷以及促進腦部新陳代謝，故在面對缺血性腦中風病患之治療時，具有其臨床應用的潛力。目前有關高壓氧氣在缺血性腦中風方面的研究報告，在動物實驗方面，多呈現正面的療效。在臨床實驗方面，有礙於個案研究的限制及差異，仍呈現不一致的研究結果。本篇論文茲就目前研究的結果和臨床應用的狀況加以整理，探討高壓氧氣對於缺血性腦中風治療可能之作用機制及未來臨床廣泛運用之可行性。

關鍵字

腦血流；高壓氧氣治療；缺血性腦中風

並列摘要

Stroke is the most common life-threatening neurological disease, and is a major cause of long-term disability and handicap. Recently, with the improvement of medical technique, a significant decline in the mortality rate of stroke has been observed. However, the incidence and prevalence of stroke increase for the continuing aging of the population. Over 70% of strokes are ischemic and caused by arterial obstruction or inadequate perfusion pressure. The pathophysiology of ischemic stroke includes the failure of tissue energy metabolism in anoxia, disturbances in ion homeostasis and acid-base balance, excitotoxic damage, and the reperfusion injury. Animal and clinical studies suggest that to make a precise diagnosis and to provide effective therapeutic strategies as soon as possible after the stroke onset may improve the prognosis of the patients. Therapy for acute ischemic stroke can be approached in two basic ways: first, by an attempt to restore blood flow in an occluded vascular territory and, second, via therapy directed at the cellular and metabolic targets. The possible mechanisms of the effectiveness of hyperbaric oxygen (HBO2) therapy in ischemic stroke are relief of hypoxia, improvement of microcirculation, relief of cerebral edema by vasoconstrictive effect, preservation of partially damaged tissue and prevention of further progression of secondary effect of cerebral lesions, and improvement of cerebral metabolism. It appears that the HBO2 therapy has the beneficial potential for stroke therapy. Although many animal studies support a positive role of HBO2 in stroke treatment, results of clinical studies are still controversial at present. The current article is aimed to discuss the possible mechanisms and future application of HBO2 therapy in treating the ischemic stroke.

並列關鍵字

cerebral blood flow ； hyperbaric oxygen therapy ； ischemic stroke

國際替代計量

高壓氧氣在缺血性腦中風治療之初探

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