Scrimgeour Gemma E, Griksaitis Michael J, Pappachan John V, Baldock Andrew J
1 University of Southampton, Department of Medicine, Southampton, United Kingdom.
2 Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, United Kingdom.
World J Pediatr Congenit Heart Surg. 2017 Jan;8(1):32-38. doi: 10.1177/2150135116673016.
Children with cyanotic congenital heart disease (CCHD) live with oxyhemoglobin saturations that are typically expressed as percentages in the range of 70s and 80s. Peripheral pulse oximetry (measurement of SpO) performs poorly in this range and yet is widely used to inform clinical decisions in these patients. The reference standard is co-oximetry of arterial samples (SaO).
In this study, 515 paired measurements of SpO and SaO were taken from 19 children who had undergone palliative cardiac surgery.
SpO (Masimo SET LNCS Neo pulse oximeter) overestimated oxyhemoglobin saturation in 82% of measurements (mean 4.6% ± 6.6%). There was a strong negative correlation between mean bias and SaO ( r = -.96, P = .002, 95% confidence interval: -0.99 to -0.68).
The results raise a concern that critical hypoxemia may go undetected and untreated if pulse oximetry is relied upon as the primary means of assessing oxyhemoglobin saturation in children with CCHD. Strong preference must be given to co-oximetry of arterial samples.
患有青紫型先天性心脏病（CCHD）的儿童，其氧合血红蛋白饱和度通常以70%至80%的百分比表示。外周脉搏血氧饱和度测定法（SpO测量）在这个范围内表现不佳，但仍被广泛用于指导这些患者的临床决策。参考标准是动脉样本的共血氧定量法（SaO）。
在本研究中，从19名接受姑息性心脏手术的儿童中获取了515对SpO和SaO测量值。
SpO（Masimo SET LNCS Neo脉搏血氧仪）在82%的测量中高估了氧合血红蛋白饱和度（平均4.6%±6.6%）。平均偏差与SaO之间存在很强的负相关性（r = -0.96，P = 0.002，95%置信区间：-0.99至-0.68）。
研究结果引发了人们的担忧，即如果将脉搏血氧饱和度测定法作为评估CCHD儿童氧合血红蛋白饱和度的主要手段，严重低氧血症可能会未被发现和治疗。必须强烈优先选择动脉样本的共血氧定量法。
