Sander Michael, Spies Claudia D, Foer Achim, Weymann Lisa, Braun Jan, Volk Thomas, Grubitzsch Herko, von Heymann Christian
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Charité, Campus Charité Mitte/Campus Virchow Klinikum, Charité Universitätsmedizin, Charitéplatz 1, 10098, Berlin, Germany.
Intensive Care Med. 2007 Oct;33(10):1719-25. doi: 10.1007/s00134-007-0684-1. Epub 2007 May 25.
Comparison of the bias and the limits of agreement (LOA; 2 SD) of the central venous saturation (S(cv)O(2)) before, during and after coronary artery bypass graft surgery with a simultaneous measurement of the mixed venous saturation (S(v)O(2)).
Prospective controlled study in a university hospital department of anaesthesiology.
60 patients with coronary artery bypass surgery, 300 paired measurements of S(v)O(2) and S(cv)O(2).
S(cv)O(2) and S(v)O(2) were analysed after induction of anaesthesia 15 min after cardiopulmonary bypass and 1, 6 and 18 h after admission to the intensive care unit. Regression analysis for the pooled measurements of S(cv)O(2) and S(v)O(2) showed a correlation R (2) = 0.52. After induction of anaesthesia 15 min after weaning from cardiopulmonary bypass and 6 h after admission to the intensive care unit the correlation coefficient was R (2) = 0.46, on admission to the intensive care unit it was R (2) = 0.42, and at 18 h it was R (2) = 0.38. Bland-Altman analysis for the measurements of S(cv)O(2) and S(v)O(2) showed a mean bias and LOA of 0.3% and -11.9 to +12.4%. In patients with a low S(cv)O(2) there was a trend to overestimate the S(v)O(2) by using the S(cv)O(2). The only factor that influenced the DeltaS(v)O(2) - S(cv)O(2) was the oxygen extraction rate (R (2) = 0.16). In patients with S(cv)O(2) below 70% this association was more pronounced (R (2) = 0.60).
Our findings demonstrate that oxygen extraction rate is the major factor in the difference between S(v)O(2) and S(cv)O(2). Under certain circumstances S(cv)O(2) differed substantially from S(v)O(2). Therefore in selected patients both parameters should be monitored to exclude general or focal hypoperfusion.
比较冠状动脉搭桥手术前、手术期间及手术后中心静脉血氧饱和度（S(cv)O(2)）与同时测量的混合静脉血氧饱和度（S(v)O(2)）的偏差及一致性界限（LOA；2 标准差）。
在一所大学医院麻醉科进行的前瞻性对照研究。
60 例行冠状动脉搭桥手术的患者，对 S(v)O(2)和 S(cv)O(2)进行 300 次配对测量。
在麻醉诱导后、体外循环后 15 分钟以及入住重症监护病房后 1、6 和 18 小时对 S(cv)O(2)和 S(v)O(2)进行分析。对 S(cv)O(2)和 S(v)O(2)的汇总测量进行回归分析显示相关性 R(2)=0.52。在麻醉诱导后、体外循环脱机后 15 分钟以及入住重症监护病房后 6 小时，相关系数为 R(2)=0.46，入住重症监护病房时为 R(2)=0.42，18 小时时为 R(2)=0.38。对 S(cv)O(2)和 S(v)O(2)测量值进行 Bland - Altman 分析显示平均偏差和 LOA 分别为 0.3%和 -11.9%至 +12.4%。在 S(cv)O(2)较低的患者中，使用 S(cv)O(2)时有高估 S(v)O(2)的趋势。影响 DeltaS(v)O(2)-S(cv)O(2)的唯一因素是氧摄取率（R(2)=0.16）。在 S(cv)O(2)低于 70%的患者中，这种关联更为明显（R(2)=0.60）。
我们的研究结果表明，氧摄取率是 S(v)O(2)和 S(cv)O(2)差异的主要因素。在某些情况下，S(cv)O(2)与 S(v)O(2)有很大差异。因此，对于特定患者，应同时监测这两个参数以排除全身性或局部性灌注不足。
