实验性主动脉闭塞时脊髓血流动力学的光纤监测。
Fiber-optic Monitoring of Spinal Cord Hemodynamics in Experimental Aortic Occlusion.
作者信息
Kogler Angela S, Bilfinger Thomas V, Galler Robert M, Mesquita Rickson C, Cutrone Michael, Schenkel Steven S, Yodh Arjun G, Floyd Thomas F
机构信息
From the Departments of Anesthesiology (A.S.K., M.C., T.F.F.), Surgery (T.V.B.), and Neurological Surgery (R.M.G.), Stony Brook University Medical Center, Stony Brook, New York; Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York (A.S.K., T.F.F.); Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania (R.C.M., S.S.S., A.G.Y.); and Institute of Physics, University of Campinas, Campinas, São Paulo, Brazil (R.C.M.).
出版信息
Anesthesiology. 2015 Dec;123(6):1362-73. doi: 10.1097/ALN.0000000000000883.
BACKGROUND
Spinal cord ischemia occurs frequently during thoracic aneurysm repair. Current methods based on electrophysiology techniques to detect ischemia are indirect, non-specific, and temporally slow. In this article, the authors report the testing of a spinal cord blood flow and oxygenation monitor, based on diffuse correlation and optical spectroscopies, during aortic occlusion in a sheep model.
METHODS
Testing was carried out in 16 Dorset sheep. Sensitivity in detecting spinal cord blood flow and oxygenation changes during aortic occlusion, pharmacologically induced hypotension and hypertension, and physiologically induced hypoxia/hypercarbia was assessed. Accuracy of the diffuse correlation spectroscopy measurements was determined via comparison with microsphere blood flow measurements. Precision was assessed through repeated measurements in response to pharmacologic interventions.
RESULTS
The fiber-optic probe can be placed percutaneously and is capable of continuously measuring spinal cord blood flow and oxygenation preoperatively, intraoperatively, and postoperatively. The device is sensitive to spinal cord blood flow and oxygenation changes associated with aortic occlusion, immediately detecting a decrease in blood flow (-65 ± 32%; n = 32) and blood oxygenation (-17 ± 13%, n = 11) in 100% of trials. Comparison of spinal cord blood flow measurements by the device with microsphere measurements led to a correlation of R = 0.49, P < 0.01, and the within-sheep coefficient of variation was 9.69%. Finally, diffuse correlation spectroscopy is temporally more sensitive to ischemic interventions than motor-evoked potentials.
CONCLUSION
The first-generation spinal fiber-optic monitoring device offers a novel and potentially important step forward in the monitoring of spinal cord ischemia.
背景
胸主动脉瘤修复术中脊髓缺血频繁发生。目前基于电生理技术检测缺血的方法是间接的、非特异性的，且在时间上较为缓慢。在本文中，作者报告了在绵羊模型的主动脉阻断过程中，基于扩散相关和光谱学的脊髓血流和氧合监测仪的测试情况。
方法
对16只多塞特绵羊进行测试。评估了该监测仪在主动脉阻断、药物诱导的低血压和高血压以及生理诱导的低氧/高碳酸血症期间检测脊髓血流和氧合变化的敏感性。通过与微球血流测量结果进行比较，确定扩散相关光谱测量的准确性。通过对药物干预的重复测量来评估精度。
结果
光纤探头可经皮放置，能够在术前、术中和术后连续测量脊髓血流和氧合。该设备对与主动脉阻断相关的脊髓血流和氧合变化敏感，在100%的试验中能立即检测到血流减少（-65±32%；n = 32）和血氧合减少（-17±13%，n = 11）。该设备测量的脊髓血流与微球测量结果的比较得出相关系数R = 0.49，P < 0.01，绵羊体内变异系数为9.69%。最后，扩散相关光谱在时间上对缺血干预比运动诱发电位更敏感。
结论
第一代脊髓光纤监测设备在脊髓缺血监测方面向前迈出了新颖且可能重要的一步。
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