Cohn Stephen M, Nathens Avery B, Moore Frederick A, Rhee Peter, Puyana Juan Carlos, Moore Ernest E, Beilman Gregory J
Department of Surgery, University of Texas Health Science Center, San Antonio, Texas 78229, USA.
J Trauma. 2007 Jan;62(1):44-54; discussion 54-5. doi: 10.1097/TA.0b013e31802eb817.
Near-infrared spectroscopy (NIRS) can continuously and noninvasively monitor tissue oxygen saturation (StO2) in muscle and may be an indicator of shock severity. Our purpose was to evaluate how well StO2 predicted outcome in high-risk torso trauma patients presenting in shock.
The primary outcome in this prospective study was multiple organ dysfunction syndrome (MODS). StO2 data were obtained upon hospital arrival and for 24 hours along with other known predictors of hypoperfusion and clinical outcomes. Clinicians were blinded to StO2 measurements.
Seven Level I trauma centers enrolled 383 patients, 50 of whom developed MODS. Minimum StO2 performed similarly to maximum base deficit (BD) in discrimination of MODS patients. The sensitivity for both measures (StO2 cutoff = 75%; BD cutoff = 6 mEq/L) was 78%, the specificity was 34% to 39%, the positive predictive value was 18% to 20% and the negative predictive value was 88% to 91%. StO2 and BD were also comparable in predicting death.
NIRS-derived muscle StO2 measurements perform similarly to BD in identifying poor perfusion and predicting the development of MODS or death after severe torso trauma, yet have the additional advantages of being continuous and noninvasive.
近红外光谱技术（NIRS）能够连续、无创地监测肌肉中的组织氧饱和度（StO2），可能是休克严重程度的一个指标。我们的目的是评估StO2对处于休克状态的高危躯干创伤患者的预后预测能力。
这项前瞻性研究的主要结局是多器官功能障碍综合征（MODS）。在患者入院时及之后的24小时内获取StO2数据，同时获取其他已知的低灌注预测指标和临床结局指标。临床医生对StO2测量值不知情。
7个一级创伤中心纳入了383例患者，其中50例发生了MODS。在区分MODS患者方面，最低StO2的表现与最大碱缺失（BD）相似。两种测量方法（StO2临界值 = 75%；BD临界值 = 6 mEq/L）的敏感性均为78%，特异性为34%至39%，阳性预测值为18%至20%，阴性预测值为88%至91%。在预测死亡方面，StO2和BD也具有可比性。
源自NIRS的肌肉StO2测量值在识别灌注不良以及预测严重躯干创伤后MODS或死亡的发生方面与BD表现相似，但具有连续和无创的额外优势。
