Kopp Rüdger, Dommann Katja, Rossaint Rolf, Schälte Gereon, Grottke Oliver, Spillner Jan, Rex Steffen, Marx Gernot
Department of Intensive Care, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
Department of Anaesthesiology, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
BMC Anesthesiol. 2015 Oct 30;15:158. doi: 10.1186/s12871-015-0140-7.
In this observational study near infrared spectroscopy (NIRS) was evaluated as a non-invasive monitor of impaired tissue oxygenation (StO2) after cardiac surgery. StO2, cardiac output, mixed venous oxygen saturation and mean arterial pressure were compared with lactate clearance as established measure for sufficient tissue perfusion and oxygen metabolism.
Forty patients after cardiac surgery (24 aortocoronary bypass grafting, 5 heart valve, 3 ascending aorta and 8 combined procedures) were monitored until postoperative day 1 with NIRS of the thenar muscle (InSpectra™ StO2-monitor, Hutchinson Technology), a pulmonary-artery catheter and intermittent blood gas analyses for the assessment of lactate clearance.
StO2 was reduced 4 h after surgery (75 ± 6 %), but recovered at day 1 (84 ± 5 %), while lactate concentration remained increased. Using uni- and multivariate regression analysis, minimum StO2 (r = 0.46, p <0.01) and cardiac index (r = 0.40, p <0.05) correlated with lactate clearance at day 1, while minimum mixed venous saturation and mean arterial pressure did not. In a receiver-operating characteristics (ROC) analysis, minimum StO2 (with a threshold of 75 %) predicted a lactate clearance <10 % at day 1 with an area under the ROC-curve of 0.83, a sensitivity of 78 % and a specificity of 88 %. In the subgroup with StO2 <75 %, troponin and creatine kinase MB were significantly increased at day 1.
StO2 below 75 % in the first hours after surgery was a better early indicator of persistent impaired lactate clearance at day 1 than cardiac index, mixed venous oxygen saturation or mean arterial pressure.
在这项观察性研究中，近红外光谱技术（NIRS）被评估为心脏手术后组织氧合受损（StO2）的一种非侵入性监测方法。将StO2、心输出量、混合静脉血氧饱和度和平均动脉压与乳酸清除率进行比较，乳酸清除率是评估组织灌注和氧代谢充足的既定指标。
对40例心脏手术后患者（24例行主动脉冠状动脉搭桥术，5例行心脏瓣膜手术，3例行升主动脉手术，8例行联合手术）进行监测，直至术后第1天，采用鱼际肌近红外光谱技术（InSpectra™ StO2监测仪，哈钦森技术公司）、肺动脉导管和间歇性血气分析来评估乳酸清除率。
术后4小时StO2降低（75±6%），但在第1天恢复（84±5%），而乳酸浓度仍升高。采用单因素和多因素回归分析，最低StO2（r = 0.46，p <0.01）和心脏指数（r = �.40，p <0.05）与第1天的乳酸清除率相关，而最低混合静脉血氧饱和度和平均动脉压则不相关。在受试者工作特征（ROC）分析中，最低StO2（阈值为75%）预测第1天乳酸清除率<10%，ROC曲线下面积为0.83，灵敏度为78%，特异性为88%。在StO2<75%的亚组中，第1天肌钙蛋白和肌酸激酶MB显著升高。
术后最初几小时StO2低于75%，比心脏指数、混合静脉血氧饱和度或平均动脉压更能作为第1天持续性乳酸清除受损的早期指标。
