利用脑组织局部氧饱和度与平均动脉压之间的关系来确定心脏骤停患者的最佳平均动脉压：一项概念验证性初步研究。
Using the relationship between brain tissue regional saturation of oxygen and mean arterial pressure to determine the optimal mean arterial pressure in patients following cardiac arrest: A pilot proof-of-concept study.
作者信息
Sekhon Mypinder S, Smielewski Peter, Bhate Tahara D, Brasher Penelope M, Foster Denise, Menon David K, Gupta Arun K, Czosnyka Marek, Henderson William R, Gin Kenneth, Wong Graham, Griesdale Donald E
机构信息
Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge University, Cambridge, United Kingdom.
出版信息
Resuscitation. 2016 Sep;106:120-5. doi: 10.1016/j.resuscitation.2016.05.019. Epub 2016 May 30.
INTRODUCTION
Prospectively assess cerebral autoregulation and optimal mean arterial pressure (MAPOPT) using the dynamic relationship between MAP and regional saturation of oxygen (rSO2) using near-infrared spectroscopy.
METHODS
Feasibility study of twenty patients admitted to the intensive care unit following a cardiac arrest. All patients underwent continuous rSO2 monitoring using the INVOS(®) cerebral oximeter. ICM+(®) brain monitoring software calculates the cerebral oximetry index (COx) in real-time which is a moving Pearson correlation coefficient between 30 consecutive, 10-s averaged values of MAP and correspond rSO2 signals. When rSO2 increases with increasing MAP (COx ≥0.3), cerebral autoregulation is dysfunctional. Conversely, when rSO2 remains constant or decreases with increasing MAP (COx <0.3), autoregulation is preserved. ICM+(®) fits a U-shaped curve through the COx values plotted vs. MAP. The MAPOPT is nadir of this curve.
RESULTS
The median age was 59 years (IQR 54-67) and 7 of 20 were female. The cardiac arrest was caused by myocardial infarction in 12 (60%) patients. Nineteen arrests were witnessed and return of spontaneous circulation occurred in a median of 15.5min (IQR 8-33). Patients underwent a median of 30h (IQR 23-46) of monitoring. COx curves and MAPOPT were generated in all patients. The mean overall MAP and MAPOPT were 76mmHg (SD 10) and 76mmHg (SD 7), respectively. MAP was outside of 5mmHg from MAPOPT in 50% (SD 15) of the time. Out of the 7672 5-min averaged COx measurements, 1182 (15%) were at 0.3 or above, indicating absence of autoregulation. Multivariable polynomial fractional regression demonstrated an increase in COx with increasing temperature (P=0.008).
CONCLUSIONS
We demonstrated the feasibility to determine a MAPOPT using cerebral oximetry in patients after cardiac arrest.
引言
利用近红外光谱技术，通过平均动脉压（MAP）与局部氧饱和度（rSO2）之间的动态关系，前瞻性地评估脑自动调节功能和最佳平均动脉压（MAPOPT）。
方法
对20例心脏骤停后入住重症监护病房的患者进行可行性研究。所有患者均使用INVOS（®）脑氧饱和度仪进行连续rSO2监测。ICM+（®）脑监测软件实时计算脑氧饱和度指数（COx），它是MAP的30个连续10秒平均值与相应rSO2信号之间的移动皮尔逊相关系数。当rSO2随MAP升高而升高时（COx≥0.3），脑自动调节功能失调。相反，当rSO2随MAP升高保持不变或下降时（COx<0.3），自动调节功能得以保留。ICM+（®）通过绘制COx值与MAP的关系拟合出一条U形曲线。MAPOPT为此曲线的最低点。
结果
患者的中位年龄为59岁（四分位间距54 - 67岁），20例中有7例为女性。12例（60%）患者的心脏骤停由心肌梗死引起。19例心脏骤停被目击到，自主循环恢复的中位时间为15.5分钟（四分位间距8 - 33分钟）。患者接受监测的中位时间为30小时（四分位间距23 - 46小时）。所有患者均生成了COx曲线和MAPOPT。总体平均MAP和MAPOPT分别为76mmHg（标准差10）和76mmHg（标准差7）。50%（标准差15）的时间里，MAP与MAPOPT的差值在5mmHg之外。在7672次5分钟平均COx测量中，1182次（15%）在0.3及以上，表明不存在自动调节功能。多变量多项式分数回归显示，随着温度升高，COx升高（P = 0.008）。
结论
我们证明了在心脏骤停患者中使用脑氧饱和度测定法确定MAPOPT的可行性。
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