对肌肉氧合的非侵入性评估可能有助于优化门诊儿科患者的输血阈值决策。
Non-invasive assessment of muscle oxygenation may aid in optimising transfusion threshold decisions in ambulatory paediatric patients.
作者信息
Schenkman K A, Hawkins D S, Ciesielski W A, Delaney M, Arakaki L S L
机构信息
Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA.
Department of Anesthesiology, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA.
出版信息
Transfus Med. 2017 Feb;27(1):25-29. doi: 10.1111/tme.12384. Epub 2017 Jan 10.
OBJECTIVE
To assess the potential utility of a novel non-invasive muscle oxygen measurement to determine the presence of muscle hypoxia in patients with anaemia.
BACKGROUND
Recent assessment of the risk/benefit ratio of blood transfusion has led to clinical strategies optimising transfusion decisions. These decisions are primarily based on haematocrit (Hct) but not oxygen delivery, the primary function of red blood cells (RBCs). We hypothesised that muscle oxygenation (MOx) would correlate with Hct in patients with anaemia and may be a physiologically relevant determinant of the transfusion threshold.
METHODS/MATERIALS: MOx was non-invasively determined in children in the Cancer and Blood Disorders Center ambulatory clinic at Seattle Children's Hospital using a custom-designed optical probe and spectrometer. MOx was compared with contemporaneous Hct. In subjects receiving RBCs, MOx and Hct were also determined following transfusion.
RESULTS
MOx ranged from 36·7 to 100%, and Hct ranged from 17·0 to 38·6% in 27 measurements from 16 patients. High MOx values were associated with high Hct. Mean MOx for patients with normal Hct for age (n = 5) was 95·9 ± 2·9%. RBC transfusion increased mean Hct from 19·1 ± 1·5% to 29·3 ± 2·0 and mean MOx from 67·9 ± 21·1% to 89·9 ± 9·8%. Among six transfusion episodes (in five patients) with initial Hct < 22, only three had a pre-transfusion MOx of <70%. Patients with the lowest pre-transfusion MOx had the largest increase in MOx after transfusion.
CONCLUSIONS
These preliminary data suggest that MOx may aid in making transfusion decisions when used in combination with Hct.
目的
评估一种新型非侵入性肌肉氧测量方法在确定贫血患者肌肉缺氧情况方面的潜在效用。
背景
近期对输血风险/效益比的评估促使临床策略优化输血决策。这些决策主要基于血细胞比容（Hct），而非红细胞（RBC）的主要功能——氧输送。我们假设贫血患者的肌肉氧合（MOx）与Hct相关，且可能是输血阈值的生理相关决定因素。
方法/材料：在西雅图儿童医院癌症与血液疾病中心门诊，使用定制设计的光学探头和光谱仪对儿童进行非侵入性MOx测定。将MOx与同期的Hct进行比较。在接受RBC输血的受试者中，输血后也测定了MOx和Hct。
结果
16例患者的27次测量中，MOx范围为36.7%至100%，Hct范围为17.0%至38.6%。高MOx值与高Hct相关。年龄Hct正常的患者（n = 5）的平均MOx为95.9±2.9%。RBC输血使平均Hct从19.1±1.5%增至29.3±2.0%，平均MOx从67.9±21.1%增至89.9±9.8%。在6次输血事件（5例患者）中，初始Hct<22时，仅3例输血前MOx<70%。输血前MOx最低的患者输血后MOx增加最大。
结论
这些初步数据表明，MOx与Hct联合使用时可能有助于做出输血决策。
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