Bloomsbury Institute of Intensive Care Medicine, Department of Medicine, University College London, London, UK.
Curr Opin Crit Care. 2011 Jun;17(3):281-9. doi: 10.1097/MCC.0b013e328344f1dc.
The holy grail of circulatory monitoring is an accurate, continuous and relatively noninvasive means of assessing the adequacy of organ perfusion. This could be then advantageously used to direct therapeutic interventions to prevent both under-treatment and over-treatment and thus improve outcomes. However, in view of the heterogeneous response (adaptive or maladaptive) of different organs to various shock states, any monitor of perfusion adequacy cannot reflect every organ system, but should at least detect early deterioration in a 'canary' organ. Tissue oxygen tension reflects the balance between local oxygen supply and demand, and could thus be a potentially useful monitoring modality. This article examines the different technologies available and reviews the current literature regarding its utility as a monitor.
Tissue oxygen tension, measured at a variety of sites in both human and laboratory studies, does appear to be a sensitive indicator of organ perfusion in different shock states. However, responses can vary not only between organs and between different shock states, but also over time. These changes reflect the particular oxygen supply-demand balance present in that tissue bed at that specific time point in the disease process. The response to a dynamic oxygen challenge test provides further information that allows severity to be more readily differentiated.
Monitoring of tissue oxygen tension may offer a potentially useful tool for clinical management though significant validation needs to be first performed to confirm its promise.
循环监测的圣杯是一种准确、连续且相对非侵入性的方法，用于评估器官灌注的充分性。这将有利于指导治疗干预措施，以防止治疗不足和过度治疗，从而改善预后。然而，鉴于不同器官对各种休克状态的反应（适应性或失调性）存在异质性，任何灌注充足性监测器都不能反映每个器官系统，而至少应检测到“金丝雀”器官的早期恶化。组织氧张力反映了局部氧供应和需求之间的平衡，因此可能是一种潜在有用的监测方式。本文研究了不同的可用技术，并回顾了关于其作为监测器的效用的现有文献。
在人体和实验室研究的不同部位测量的组织氧张力似乎是不同休克状态下器官灌注的敏感指标。然而，反应不仅在器官之间和不同的休克状态之间存在差异，而且随时间变化。这些变化反映了疾病过程中特定时间点该组织床中存在的特定氧供应-需求平衡。对动态氧挑战测试的反应提供了进一步的信息，有助于更轻松地区分严重程度。
尽管需要首先进行大量验证来确认其潜力，但监测组织氧张力可能为临床管理提供一种潜在有用的工具。
