From the Medical Intensive Care Unit (A.S.N., V.G..M.P., J.A.M., D.C.E.), ABC Medical School (FMABC), Santo André; and Department of Critical Care Medicine (A.S.N.), Hospital Israelita Albert Einstein, São Paulo, Brazil; and Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (M.J.S., A.S.N), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
J Trauma Acute Care Surg. 2014 Jan;76(1):226-33. doi: 10.1097/TA.0b013e3182a9221f.
Oxygen delivery and consumption disturbances are frequently seen with critically illness, potentially leading to pathologic changes in tissue oxygenation (StO2). Near-infrared spectroscopy (NIRS) is a potentially useful method to monitor StO2, but the role of NIRS in prognostication of septic patients is uncertain. The aim of this study was to systematically review the literature and evaluate static and dynamic NIRS in patients with sepsis.
This is a systematic review and meta-analysis of publications between 1966 and 2013. The MEDLINE and EMBASE databases were searched for studies on StO2 in patients with severe sepsis or septic shock. Meta-analysis was limited to studies about static and dynamic variables derived from NIRS in patients with sepsis. The association between StO2, reperfusion slope (Rres), occlusion slope, and maximum StO2 minus basal StO2 (ΔStO2) and prognosis in septic patients was evaluated.
The search identified 20 articles (962 participants; 717 with severe sepsis or septic shock, and 245 healthy controls). Compared with healthy controls, septic patients had lower levels of StO2 (78.27% [4.91%] vs. 82.02% [3.57%], p = 0.012), Rres (2.75% [0.63%] vs. 5.19% [2.86%] per second, p = 0.003), and ΔStO2 (7.86% [0.11%] vs. 12.53% [2.65%], p = 0.011). Survivors from sepsis presents higher levels of StO2 (81.68% [4.68%] vs. 74.54% [5.31%], p = 0.02) and Rres (3.37% [0.44%] vs. 2.16% [0.51%] per second, p = 0.016).
Septic patients have lower levels of StO2, Rres and ΔStO2, and survivors from sepsis present higher levels of StO2 and Rres compared with nonsurvivors.
Systematic review/meta-analysis, level III.
危重病患者常出现氧输送和消耗紊乱，可能导致组织氧合的病理变化（StO2）。近红外光谱（NIRS）是一种监测 StO2 的潜在有用方法，但 NIRS 在预测脓毒症患者预后方面的作用尚不确定。本研究旨在系统地回顾文献并评估脓毒症患者的静态和动态 NIRS。
这是一项 1966 年至 2013 年期间发表的文献的系统评价和荟萃分析。检索 MEDLINE 和 EMBASE 数据库中关于严重脓毒症或感染性休克患者 StO2 的研究。荟萃分析仅限于脓毒症患者 NIRS 得出的静态和动态变量的研究。评估 StO2、再灌注斜率（Rres）、闭塞斜率和最大 StO2 减去基础 StO2（ΔStO2）与脓毒症患者预后之间的关系。
搜索确定了 20 篇文章（962 名参与者；717 名患有严重脓毒症或感染性休克，245 名健康对照）。与健康对照组相比，脓毒症患者的 StO2 水平较低（78.27%[4.91%]与 82.02%[3.57%]，p=0.012），Rres（2.75%[0.63%]与 5.19%[2.86%]每秒，p=0.003）和ΔStO2（7.86%[0.11%]与 12.53%[2.65%]，p=0.011）。脓毒症幸存者的 StO2 水平较高（81.68%[4.68%]与 74.54%[5.31%]，p=0.02）和 Rres（3.37%[0.44%]与 2.16%[0.51%]每秒，p=0.016）。
脓毒症患者的 StO2、Rres 和ΔStO2 水平较低，而脓毒症幸存者的 StO2 和 Rres 水平高于非幸存者。
系统评价/荟萃分析，III 级。
