From the Department of Emergency Medicine (M.H.T., G.T.D., K.R.W.) and the Michigan Center for Integrative Research in Critical Care (M.H.T., G.T.D., K.R.W.), University of Michigan, Ann Arbor, Michigan; Departments of Emergency Medicine (R.W.B.) and Chemistry (J.T.), the Virginia Commonwealth University Reanimation Engineering Science Center (R.W.B., J.T.), Virginia Commonwealth University, Richmond, Virginia; Damage Control Resuscitation (I.T.F.), US Army Institute for Surgical Research, Fort Sam Houston, San Antonio, Texas; Pendar Medical (P.R., D.V.), Cambridge, Massachusetts.
J Trauma Acute Care Surg. 2014 Feb;76(2):402-8. doi: 10.1097/TA.0000000000000088.
The ability to monitor the patient of hemorrhage noninvasively remains a challenge. We examined the ability of resonance Raman spectroscopy to monitor tissue hemoglobin oxygenation (RRS-StO2) during hemorrhage and compared its performance with conventional invasive mixed venous (SmvO2) and central venous (ScvO2) hemoglobin oxygen saturation as well as with near-infrared spectroscopy tissue hemoglobin oxygenation (NIRS-StO2).
Five male swine were anesthetized and instrumented followed by hemorrhage at a rate of 30 mL/min for 60 minutes. RRS-StO2 was continuously measured from the buccal mucosa, and NIRS-StO2 was continuously measured from the forelimb. Paired interval measures of SmvO2, ScvO2, and lactate were made. Pearson correlation was used to quantify the degree to which any two variables are related. Receiver operating characteristic (ROC) area under the curve values were used for pooled data for RRS-StO2, NIRS-StO2, SmvO2, and ScvO2 to compare performance in the ability of tissue oxygenation methods to predict the presence of an elevated arterial blood lactate level.
Sequential RRS-StO2 changes tracked changes in SmvO2 (r = 0.917; 95% confidence interval [CI], 0.867-0.949) and ScvO2 (r = 0.901; 95% CI, 0.828-0.944) during hemorrhage, while NIRS-StO2 failed to do so for SmvO2 (r = 0.283; 95% CI, 0.04919-0.4984) and ScvO2 (r = 0.142; 95% CI, -0.151 to 0.412). ROC curve performance of oxygenation measured to indicate lactate less than or greater than 3 mM yielded the following ROC area under the curve values: SmvO2 (1.0), ScvO2 (0.994), RRS-StO2 (0.972), and NIRS-StO2 (0.611).
RRS-StO2 seems to have significantly better ability to track central oxygenation measures during hemorrhage as well as to predict shock based on elevated lactate levels when compared with NIRS-StO2.
能够无创监测患者出血情况仍然是一个挑战。我们检查了共振拉曼光谱监测组织氧合血红蛋白（RRS-StO2）的能力，比较了其在出血期间的表现，与传统的有创混合静脉（SmvO2）和中心静脉（ScvO2）血红蛋白氧饱和度以及近红外光谱组织氧合血红蛋白（NIRS-StO2）的表现。
5 只雄性猪被麻醉并进行了仪器操作，然后以 30mL/min 的速度出血 60 分钟。从口腔颊黏膜连续测量 RRS-StO2，从前肢连续测量 NIRS-StO2。同时测量 SmvO2、ScvO2 和乳酸的配对间隔。采用 Pearson 相关来量化两个变量之间的相关程度。应用受试者工作特征（ROC）曲线下面积值对 RRS-StO2、NIRS-StO2、SmvO2 和 ScvO2 的汇总数据进行比较，以比较组织氧合方法预测动脉血乳酸水平升高的能力。
连续的 RRS-StO2 变化与 SmvO2（r=0.917；95%置信区间[CI]，0.867-0.949）和 ScvO2（r=0.901；95%CI，0.828-0.944）的变化同步，而 NIRS-StO2 未能同步 SmvO2（r=0.283；95%CI，0.04919-0.4984）和 ScvO2（r=0.142；95%CI，-0.151 至 0.412）。测量血氧饱和度以指示乳酸小于或大于 3mM 的 ROC 曲线性能得到以下 ROC 曲线下面积值：SmvO2（1.0）、ScvO2（0.994）、RRS-StO2（0.972）和 NIRS-StO2（0.611）。
与 NIRS-StO2 相比，RRS-StO2 在出血期间似乎具有更好的跟踪中心氧合测量值的能力，并且能够基于升高的乳酸水平预测休克。
