Haessler R, Brandl F, Zeller M, Briegel J, Peter K
Institute of Anesthesiology, University of Munich, Germany.
J Cardiothorac Vasc Anesth. 1992 Dec;6(6):668-73. doi: 10.1016/1053-0770(92)90048-c.
This study evaluated arterial catheter oximetry versus pulse oximetry in eight patients (ASA III-IV) who underwent cardiac surgery. Co-oximeter saturation values served as the standard. Arterial oxygen saturation was determined simultaneously with these three methods at 162 prospectively defined points of measurement before, during, and after cardiopulmonary bypass (CPB). At the same times before and after CPB, arterial, pulmonary arterial, and central venous pressures, and cardiac output determinations were recorded. Saturation readings were obtained in more than 99% of measurements with catheter oximetry and in only 59% to 84% of measurements with pulse oximetry. Failure of pulse oximetry correlated with low mean arterial pressures and low cardiac outputs, but not with high systemic vascular resistance. The mean saturation values determined by catheter oximetry as well as by pulse oximetry differed from the mean values obtained by co-oximetry by less than 1% (= bias). The standard deviations of the individual differences between readings of catheter or pulse oximetry and readings of co-oximetry (= precision) were +/- 0.5% to +/- 1.0% for catheter oximetry and +/- 1.0% to +/- 1.2% for pulse oximetry. In summary, catheter oximetry was superior to pulse oximetry with regard to obtaining readings and to reliability of the obtained readings. Invasiveness and high costs influence the decision as to whether to use catheter oximetry, but if reliable and precise measurements of saturation are important at any time during surgery, pulse oximetry is an insufficient method and co-oximetry is a time-consuming method of analysis, whereas catheter oximetry is quick, reliable, and precise.
本研究评估了八名接受心脏手术的患者（美国麻醉医师协会III - IV级）使用动脉导管血氧饱和度测定法与脉搏血氧饱和度测定法的情况。采用共血氧计测定的饱和度值作为标准。在体外循环（CPB）前、中、后162个预先确定的测量点，同时用这三种方法测定动脉血氧饱和度。在CPB前后相同时间，记录动脉压、肺动脉压、中心静脉压及心输出量测定值。导管血氧饱和度测定法在超过99%的测量中获得了饱和度读数，而脉搏血氧饱和度测定法仅在59%至84%的测量中获得读数。脉搏血氧饱和度测定失败与平均动脉压低和心输出量低相关，但与高体循环血管阻力无关。导管血氧饱和度测定法和脉搏血氧饱和度测定法所测定的平均饱和度值与共血氧计所测得的平均值相差不到1%（即偏差）。导管或脉搏血氧饱和度测定读数与共血氧计读数之间个体差异的标准差（即精密度），导管血氧饱和度测定法为±0.5%至±1.0%，脉搏血氧饱和度测定法为±1.0%至±1.2%。总之，在获取读数及所获读数的可靠性方面，导管血氧饱和度测定法优于脉搏血氧饱和度测定法。侵入性和高成本会影响是否使用导管血氧饱和度测定法的决策，但如果手术过程中随时都需要可靠且精确的饱和度测量，脉搏血氧饱和度测定法是一种不足的方法，而共血氧计分析方法耗时，相比之下导管血氧饱和度测定法快速、可靠且精确。
