Bickler Philip E, Feiner John R, Severinghaus John W
Department of Anesthesia and Perioperative Care, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA.
Anesthesiology. 2005 Apr;102(4):715-9. doi: 10.1097/00000542-200504000-00004.
It is uncertain whether skin pigmentation affects pulse oximeter accuracy at low HbO2 saturation.
The accuracy of finger pulse oximeters during stable, plateau levels of arterial oxygen saturation (Sao2) between 60 and 100% were evaluated in 11 subjects with darkly pigmented skin and in 10 with light skin pigmentation. Oximeters tested were the Nellcor N-595 with the OxiMax-A probe (Nellcor Inc., Pleasanton, CA), the Novametrix 513 (Novametrix Inc., Wallingford, CT), and the Nonin Onyx (Nonin Inc., Plymouth, MN). Semisupine subjects breathed air-nitrogen-carbon dioxide mixtures through a mouthpiece. A computer used end-tidal oxygen and carbon dioxide concentrations determined by mass spectrometry to estimate breath-by-breath Sao2, from which an operator adjusted inspired gas to rapidly achieve 2- to 3-min stable plateaus of desaturation. Comparisons of oxygen saturation measured by pulse oximetry (Spo2) with Sao2 (by Radiometer OSM3) were used in a multivariate model to determine the interrelation between saturation, skin pigmentation, and oximeter bias (Spo2 - Sao2).
At 60-70% Sao2, Spo2 (mean of three oximeters) overestimated Sao2 (bias +/- SD) by 3.56 +/- 2.45% (n = 29) in darkly pigmented subjects, compared with 0.37 +/- 3.20% (n = 58) in lightly pigmented subjects (P < 0.0001). The SD of bias was not greater with dark than light skin. The dark-light skin differences at 60-70% Sao2 were 2.35% (Nonin), 3.38% (Novametrix), and 4.30% (Nellcor). Skin pigment-related differences were significant with Nonin below 70% Sao2, with Novametrix below 90%, and with Nellcor at all ranges. Pigment-related bias increased approximately in proportion to desaturation.
The three tested pulse oximeters overestimated arterial oxygen saturation during hypoxia in dark-skinned individuals.
在低血红蛋白氧饱和度（HbO2）时，皮肤色素沉着是否会影响脉搏血氧仪的准确性尚不确定。
对11名皮肤色素沉着较深的受试者和10名皮肤色素沉着较浅的受试者，评估手指脉搏血氧仪在动脉血氧饱和度（Sao2）稳定在60%至100%平台期时的准确性。所测试的血氧仪包括带有OxiMax - A探头的Nellcor N - 595（Nellcor公司，加利福尼亚州普莱森顿）、Novametrix 513（Novametrix公司，康涅狄格州沃灵福德）以及Nonin Onyx（Nonin公司，明尼苏达州普利茅斯）。半仰卧位的受试者通过咬嘴呼吸空气 - 氮气 - 二氧化碳混合气体。一台计算机利用质谱法测定的呼气末氧气和二氧化碳浓度来逐次估算Sao2，操作人员据此调整吸入气体，以快速达到2至3分钟的稳定低氧平台期。在多变量模型中，将脉搏血氧仪测量的氧饱和度（Spo2）与Sao2（通过Radiometer OSM3测量）进行比较，以确定饱和度、皮肤色素沉着和血氧仪偏差（Spo2 - Sao2）之间的相互关系。
在Sao2为60%至70%时，皮肤色素沉着较深的受试者中，Spo2（三种血氧仪的平均值）高估Sao2（偏差±标准差）3.56±2.45%（n = 29），而皮肤色素沉着较浅的受试者中为0.37±3.20%（n = 58）（P < 0.0001）。色素沉着较深皮肤组偏差的标准差并不比色素沉着较浅皮肤组更大。在Sao2为60%至70%时，深色与浅色皮肤的差异在Nonin血氧仪上为2.35%，Novametrix血氧仪上为3.38%，Nellcor血氧仪上为4.30%。皮肤色素相关差异在Nonin血氧仪低于70% Sao2时显著，Novametrix血氧仪低于90%时显著，Nellcor血氧仪在所有范围均显著。色素相关偏差大致与低氧程度成比例增加。
在皮肤黝黑的个体中，三种测试的脉搏血氧仪在低氧期间高估了动脉血氧饱和度。
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