Institute for Human Health and Performance, University College London, United Kingdom.
Am J Crit Care. 2011 Mar;20(2):138-45. doi: 10.4037/ajcc2011739.
Cardiopulmonary bypass during cardiac surgery can result in a shortfall in oxygen delivery relative to demand, marked by a decrease in muscle tissue oxygen saturation as blood flow is redistributed to vital organs. Such "tissue shock" might impair postoperative recovery.
To determine the association of changes in tissue oxygen saturation with postoperative outcome in cardiac surgery patients.
In 74 adults undergoing cardiac surgery, tissue oxygen saturation in the thenar eminence was recorded using near-infrared spectroscopy before and during induction of anesthesia, throughout surgery, and in the intensive care unit until extubation or for a maximum monitoring time of 24 hours. The measurements were related to postoperative outcome.
Mean tissue oxygen saturation increased from 81.7% to 88.5% with induction of anesthesia and decreased to 78.9% and 69.9% during surgery and on arrival in the intensive care unit, respectively. Saturation increased to 77.8% by 6 hours after surgery and remained stable. Mean saturation during the first minutes of anesthesia and 20 minutes in the intensive care unit was lower in patients with a postoperative morbidity than in patients without such morbidity on day 15 (81.1% vs 87.6%; P = .04) and on day 3 (72.9% vs 85.5%; P = .009). No associations with other outcome measures were observed.
In patients undergoing cardiac surgery, reduced tissue oxygen saturation in the thenar eminence may be associated with poor postoperative outcome. Further studies are needed to confirm these findings and to determine whether measures to improve the balance between oxygen delivery and consumption might improve both tissue oxygen saturation and outcome.
心脏手术中的体外循环会导致氧供相对于需求的不足，表现为血流重新分布到重要器官时肌肉组织氧饱和度下降。这种“组织性休克”可能会损害术后恢复。
确定心脏手术患者组织氧饱和度的变化与术后结果的关系。
在 74 名接受心脏手术的成年人中，使用近红外光谱技术在麻醉诱导前、麻醉期间、手术期间以及在重症监护病房（直至拔管或监测时间最长为 24 小时）期间记录大鱼际的组织氧饱和度。将这些测量值与术后结果相关联。
平均组织氧饱和度从麻醉诱导时的 81.7%增加到 88.5%，然后在手术期间和到达重症监护病房时分别降低到 78.9%和 69.9%。术后 6 小时饱和度增加到 77.8%，并保持稳定。麻醉最初几分钟和重症监护病房 20 分钟内的平均饱和度在术后有发病率的患者中低于无发病率的患者（第 15 天分别为 81.1%比 87.6%；P =.04 和第 3 天分别为 72.9%比 85.5%；P =.009）。没有观察到与其他结果测量指标的关联。
在接受心脏手术的患者中，大鱼际组织氧饱和度降低可能与术后不良结果相关。需要进一步研究来证实这些发现，并确定是否可以采取措施来改善氧供与消耗之间的平衡，以改善组织氧饱和度和结果。
