Podbregar Matej, Mozina Hugon
Clinical Department for Intensive Care Medicine, University Clinical Centre, Ljubljana, Slovenia.
Crit Care. 2007;11(1):R6. doi: 10.1186/cc5153.
Low cardiac output states such as left heart failure are characterized by preserved oxygen extraction ratio, which is in contrast to severe sepsis. Near infrared spectroscopy (NIRS) allows noninvasive estimation of skeletal muscle tissue oxygenation (StO2). The aim of the study was to determine the relationship between StO2 and mixed venous oxygen saturation (SvO2) in patients with severe left heart failure with or without additional severe sepsis or septic shock.
Sixty-five patients with severe left heart failure due to primary heart disease were divided into two groups: groups A (n = 24) and B (n = 41) included patients without and with additional severe sepsis/septic shock, respectively. Thenar muscle StO2 was measured using NIRS in the patients and in 15 healthy volunteers.
StO2 was lower in group A than in group B and in healthy volunteers (58 +/- 13%, 90 +/- 7% and 84 +/- 4%, respectively; P < 0.001). StO2 was higher in group B than in healthy volunteers (P = 0.02). In group A StO2 correlated with SvO2 (r = 0.689, P = 0.002), although StO2 overestimated SvO2 (bias -2.3%, precision 4.6%). In group A changes in StO2 correlated with changes in SvO2 (r = 0.836, P < 0.001; DeltaSvO2 = 0.84 x DeltaStO2 - 0.67). In group B important differences between these variables were observed. Plasma lactate concentrations correlated negatively with StO2 values only in group A (r = -0.522, P = 0.009; lactate = -0.104 x StO2 + 10.25).
Skeletal muscle StO2 does not estimate SvO2 in patients with severe left heart failure and additional severe sepsis or septic shock. However, in patients with severe left heart failure without additional severe sepsis or septic shock, StO2 values could be used to provide rapid, noninvasive estimation of SvO2; furthermore, the trend in StO2 may be considered a surrogate for the trend in SvO2.
低心排血量状态，如左心衰竭，其特征是氧摄取率保持不变，这与严重脓毒症相反。近红外光谱（NIRS）可用于无创估计骨骼肌组织氧合（StO2）。本研究的目的是确定伴有或不伴有额外严重脓毒症或脓毒性休克的严重左心衰竭患者中StO2与混合静脉血氧饱和度（SvO2）之间的关系。
65例因原发性心脏病导致严重左心衰竭的患者被分为两组：A组（n = 24）和B组（n = 41），分别包括无额外严重脓毒症/脓毒性休克和有额外严重脓毒症/脓毒性休克的患者。使用NIRS测量患者及15名健康志愿者的鱼际肌StO2。
A组的StO2低于B组和健康志愿者（分别为58±13%、90±7%和84±4%；P < 0.001）。B组的StO2高于健康志愿者（P = 0.02）。在A组中，StO2与SvO2相关（r = 0.689，P = 0.002），尽管StO2高估了SvO2（偏差 -2.3%，精密度4.6%）。在A组中，StO2的变化与SvO2的变化相关（r = 0.836，P < 0.001；ΔSvO2 = 0.84×ΔStO2 - 0.67）。在B组中，观察到这些变量之间存在重要差异。仅在A组中，血浆乳酸浓度与StO2值呈负相关（r = -0.522，P = 0.009；乳酸 = -0.104×StO2 + 10.25）。
在伴有额外严重脓毒症或脓毒性休克的严重左心衰竭患者中，骨骼肌StO2不能用于估计SvO2。然而，在无额外严重脓毒症或脓毒性休克的严重左心衰竭患者中，StO2值可用于快速、无创地估计SvO2；此外，StO2的变化趋势可被视为SvO2变化趋势的替代指标。
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