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[与测量婴幼儿颈静脉球血氧饱和度相比,采用近红外光谱技术(NIRS)进行区域经颅血氧测定以监测脑氧合]

[Regional transcranial oximetry with near infrared spectroscopy (NIRS) in comparison with measuring oxygen saturation in the jugular bulb in infants and children for monitoring cerebral oxygenation].

作者信息

Abdul-Khaliq H, Troitzsch D, Berger F, Lange P E

机构信息

Abteilung für Angeborene Herzfehler-Kinderkardiologie, Deutsches Herzzentrum Berlin.

出版信息

Biomed Tech (Berl). 2000 Nov;45(11):328-32. doi: 10.1515/bmte.2000.45.11.328.

Abstract

Using a dual channel near infrared (NIR) in vivo optical spectroscopy (INVOS) system (INVOS 3100A, Somanetics Corp. Troy, MI, USA) we investigated the relationship between jugular venous oxygen saturation (SjvO2) and regional cerebral oxygen saturation (rSO2) in 30 infants and children (mean age 4.5 years) with congenital heart disease undergoing cardiac catheterisation. The NIRS-SomaSensor (emitter and dual receiver probe) was applied at a standardised right fronto-temporal location (over the right frontal cortex) on the infant's head and covered with an adhesive flexible bandage. Using NIR light (730 and 810 nm) and two source-detector spacings (3 and 4 cm from the transmitter), percentage values of rSO2 were calculated from detected haemoglobin saturations. Simultaneously, jugular venous oxygen saturation (SjvO2) monitoring was performed via a catheter placed in the right internal jugular vein with its tip positioned in the jugular bulb, as verified by fluoroscopy. To compare the reliability of NIRS measurement characteristics, jugular venous blood was analysed for SjvO2 as a reference measure of global cerebral oxygenation, by co-oximetry (OSM3-Hemoximeter, Radiometer Copenhagen, Denmark). Other measured variables included pulse oximetry, arterial blood pressure, and venous and arterial oxygen saturations. Over a jugular venous oxygen saturation range of 31-83%, a significant positive linear correlation was found between rSO2 (NIRS measurement) and SjvO2 (jugular bulb oximetry) (r = 0.93, p < 0.001). No significant correlation was observed between rSO2 values and arterial blood saturation or pulse oximetry. The quantitative correlation between rSO2 (haemoglobin oxygenation in a small hemi-elliptical area of the brain) and reference SjvO2 measurement (method for monitoring global cerebral oxygenation) suggests that NIRS measurement with subtraction algorithm should identify predominantly intracranial saturation in the pediatric age group, and will tend to reflect global oxygenation under physiological conditions. Transcranial oximetry using dual receiving channel NIRS offers a noninvasive, real-time, reliable and practicable means of monitoring cerebral haemoglobin oxygenation changes infants and children with cyanotic and noncyanotic congenital heart disease.

摘要

我们使用双通道近红外(NIR)体内光学光谱系统(INVOS 3100A,美国密歇根州特洛伊市索曼etics公司),对30例患有先天性心脏病且正在接受心导管插入术的婴幼儿及儿童(平均年龄4.5岁)的颈静脉血氧饱和度(SjvO2)与局部脑血氧饱和度(rSO2)之间的关系进行了研究。将NIRS - SomaSensor(发射器和双接收器探头)应用于婴儿头部标准化的右额颞部位置(右额叶皮质上方),并用粘性弹性绷带覆盖。利用近红外光(730和810纳米)以及两个源 - 探测器间距(距离发射器3厘米和4厘米),根据检测到的血红蛋白饱和度计算rSO2的百分比值。同时,通过放置在右颈内静脉且尖端位于颈静脉球部的导管进行颈静脉血氧饱和度(SjvO2)监测,这通过荧光透视法得到验证。为了比较NIRS测量特征的可靠性,采用共血氧定量法(OSM3 - 血液血氧计,丹麦哥本哈根雷度米特公司)分析颈静脉血中的SjvO2,作为全脑氧合的参考指标。其他测量变量包括脉搏血氧饱和度、动脉血压以及静脉和动脉血氧饱和度。在颈静脉血氧饱和度范围为31%至83%时,发现rSO2(NIRS测量值)与SjvO2(颈静脉球部血氧测定值)之间存在显著的正线性相关性(r = 0.93,p < 0.001)。未观察到rSO2值与动脉血氧饱和度或脉搏血氧饱和度之间存在显著相关性。rSO2(大脑小半椭圆形区域内的血红蛋白氧合)与参考SjvO2测量值(全脑氧合监测方法)之间的定量相关性表明,采用减法算法的NIRS测量在儿科年龄组中应主要识别颅内饱和度,并且在生理条件下倾向于反映全脑氧合情况。使用双接收通道近红外光谱的经颅血氧测定法为监测患有青紫型和非青紫型先天性心脏病的婴幼儿及儿童的脑血红蛋白氧合变化提供了一种无创、实时、可靠且实用的手段。

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