Marx Gernot, Reinhart Konrad
Klinik für Anästhesiologie und Intensivtherapie, Klinikum der Friedrich-Schiller-Universität, Jena, Germany.
Curr Opin Crit Care. 2006 Jun;12(3):263-8. doi: 10.1097/01.ccx.0000224872.09077.dc.
Mixed venous and central venous oxygen saturations reflect the balance between oxygen requirement and oxygen delivery, and thus may be used to assess the adequacy of tissue oxygenation. This review discusses recent data on the impact of using venous oximetry by obtaining mixed venous oxygen saturation or central venous oxygen saturation as useful monitoring parameters in critically ill patients.
Monitoring of changes in the central venous oxygen saturation after major surgery has been shown to be associated with outcome. Furthermore, early goal-directed therapy for patients with severe sepsis or septic shock, which includes treatment goals for mean arterial pressure, central venous pressure, and central venous oxygen saturation, was able to increase survival in these patients. In contrast, pulmonary artery catheter usage does not affect outcome in critically ill patients.
Early goal-directed therapy should be implemented in the initial resuscitation of septic patients. Central venous saturation may have prognostic significance following major surgery. Further evaluation of peri-operative trends in central venous saturation is required. Measurement of central venous oxygen saturation can easily be applied in intensive care unit patients and offers a useful, indirect indicator for the adequacy of tissue oxygenation.
混合静脉血氧饱和度和中心静脉血氧饱和度反映了氧需求与氧输送之间的平衡,因此可用于评估组织氧合是否充足。本综述讨论了近期关于通过获取混合静脉血氧饱和度或中心静脉血氧饱和度作为重症患者有用监测参数来使用静脉血氧测定法的影响的数据。
监测大手术后中心静脉血氧饱和度的变化已被证明与预后相关。此外,针对严重脓毒症或脓毒性休克患者的早期目标导向治疗,包括平均动脉压、中心静脉压和中心静脉血氧饱和度的治疗目标,能够提高这些患者的生存率。相比之下,使用肺动脉导管对重症患者的预后没有影响。
在脓毒症患者的初始复苏中应实施早期目标导向治疗。中心静脉血氧饱和度在大手术后可能具有预后意义。需要进一步评估围手术期中心静脉血氧饱和度的变化趋势。中心静脉血氧饱和度的测量可轻松应用于重症监护病房患者,并为组织氧合是否充足提供有用的间接指标。