Clinical Department of Intensive Care Medicine, University Clinical Centre Ljubljana, Zaloska cesta 7, Ljubljana, Slovenia.
Crit Care. 2010;14(2):R42. doi: 10.1186/cc8929. Epub 2010 Mar 23.
Discrepancies of 5-24% between superior vena cava oxygen saturation (ScvO2) and mixed venous oxygen saturation (SvO2) have been reported in patients with severe heart failure. Thenar muscle tissue oxygenation (StO2) measured with near-infrared spectroscopy (NIRS) during arterial occlusion testing decreases slower in sepsis/septic shock patients (lower StO2 deoxygenation rate). The StO2 deoxygenation rate is influenced by dobutamine. The aim of this study was to determine the relationship between the StO2 deoxygenation rate and the ScvO2-SvO2 discrepancy in patients with severe left heart failure and additional sepsis/septic shock treated with or without dobutamine.
Fifty-two patients with severe left heart failure due to primary heart disease with additional severe sepsis/septic shock were included. SvO2 and ScvO2 were compared to the thenar muscle StO2 before and during arterial occlusion.
SvO2 correlated significantly with ScvO2 (Pearson correlation 0.659, P = 0.001), however, Bland Altman analysis showed a clinically important difference between both variables (ScvO2-SvO2 mean 72 +/- 8%, ScvO2-SvO2 difference 9.4 +/- 7.5%). The ScvO2-SvO2 difference correlated with plasma lactate (Pearson correlation 0.400, P = 0.003) and the StO2 deoxygenation rate (Pearson correlation 0.651, P = 0.001). In the group of patients treated with dobutamine, the ScvO2-SvO2 difference correlated with plasma lactate (Pearson correlation 0.389, P = 0.011) and the StO2 deoxygenation rate (Pearson correlation 0.777, P = 0.0001).
In patients with severe heart failure with additional severe sepsis/septic shock the ScvO2-SvO2 discrepancy presents a clinical problem. In these patients the skeletal muscle StO2 deoxygenation rate is inversely proportional to the difference between ScvO2 and SvO2; dobutamine does not influence this relationship. When using ScvO2 as a treatment goal, the NIRS measurement may prove to be a useful non-invasive diagnostic test to uncover patients with a normal ScvO2 but potentially an abnormally low SvO2.
NCT00384644 ClinicalTrials.Gov.
在患有严重心力衰竭的患者中，上腔静脉血氧饱和度（ScvO2）和混合静脉血氧饱和度（SvO2）之间存在 5-24%的差异。在脓毒症/脓毒性休克患者中，通过近红外光谱（NIRS）测量的鱼际肌组织氧饱和度（StO2）在动脉闭塞试验期间下降较慢（较低的 StO2去氧速率）。StO2 去氧速率受多巴酚丁胺的影响。本研究的目的是确定严重左心衰竭患者和接受或不接受多巴酚丁胺治疗的伴发严重脓毒症/脓毒性休克患者的 StO2 去氧速率与 ScvO2-SvO2 差异之间的关系。
纳入了 52 例因原发性心脏病导致严重左心衰竭且伴有严重脓毒症/脓毒性休克的患者。在进行动脉闭塞前和动脉闭塞期间，对 SvO2 和 ScvO2 与鱼际肌 StO2 进行了比较。
SvO2 与 ScvO2 呈显著相关（Pearson 相关系数 0.659，P=0.001），但 Bland Altman 分析显示两者之间存在临床重要差异（ScvO2-SvO2 平均值为 72+/-8%，ScvO2-SvO2 差值为 9.4+/-7.5%）。ScvO2-SvO2 差值与血浆乳酸（Pearson 相关系数 0.400，P=0.003）和 StO2 去氧速率（Pearson 相关系数 0.651，P=0.001）相关。在接受多巴酚丁胺治疗的患者中，ScvO2-SvO2 差值与血浆乳酸（Pearson 相关系数 0.389，P=0.011）和 StO2 去氧速率（Pearson 相关系数 0.777，P=0.0001）相关。
在伴有严重脓毒症/脓毒性休克的严重心力衰竭患者中，ScvO2-SvO2 差异存在临床问题。在这些患者中，骨骼肌 StO2 去氧速率与 ScvO2 和 SvO2 之间的差值呈反比关系；多巴酚丁胺不会影响这种关系。当使用 ScvO2 作为治疗目标时，NIRS 测量可能被证明是一种有用的非侵入性诊断测试，可以发现 ScvO2 正常但 SvO2 可能异常低的患者。
NCT00384644 ClinicalTrials.Gov。
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