猪大量出血和复苏性主动脉内球囊阻断术（REBOA）的非侵入性双通道宽带漫射光学光谱分析
Non-invasive Dual-Channel Broadband Diffuse Optical Spectroscopy of Massive Hemorrhage and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Swine.
作者信息
Lam Jesse H, O'Sullivan Thomas D, Park Tim S, Choi Jae H, Warren Robert V, Chen Wen-Pin, McLaren Christine E, Cancio Leopoldo C, Batchinsky Andriy I, Tromberg Bruce J
机构信息
Laser Microbeam and Medical Program, Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Road, Irvine, CA 92617.
Department of Electrical Engineering, University of Notre Dame, 275 Fitzpatrick Hall, Notre Dame, IN 46556.
出版信息
Mil Med. 2018 Mar 1;183(suppl_1):150-156. doi: 10.1093/milmed/usx163.
OBJECTIVE
To quantitatively measure tissue composition and hemodynamics during resuscitative endovascular balloon occlusion of the aorta (REBOA) in two tissue compartments using non-invasive two-channel broadband diffuse optical spectroscopy (DOS).
METHODS
Tissue concentrations of oxy- and deoxyhemoglobin (HbO2 and HbR), water, and lipid were measured in a porcine model (n = 10) of massive hemorrhage (65% total blood volume over 1 h) and 30-min REBOA superior and inferior to the aortic balloon.
RESULTS
After hemorrhage, hemoglobin oxygen saturation (StO2 = HbO2/[HbO2 + HbR]) at both sites decreased significantly (-29.9% and -42.3%, respectively). The DOS measurements correlated with mean arterial pressure (MAP) (R2 = 0.79, R2 = 0.88), stroke volume (SV) (R2 = 0.68, R2 = 0.88), and heart rate (HR) (R2 = 0.72, R2 = 0.88). During REBOA, inferior StO2 continued to decline while superior StO2 peaked 12 min after REBOA before decreasing again. Inferior DOS parameters did not associate with MAP, SV, or HR during REBOA.
CONCLUSIONS
Dual-channel regional tissue DOS measurements can be used to non-invasively track the formation of hemodynamically distinct tissue compartments during hemorrhage and REBOA. Conventional systemic measures MAP, HR, and SV are uncorrelated with tissue status in inferior (downstream) sites. Multi-compartment DOS may provide a more complete picture of the efficacy of REBOA and similar resuscitation procedures.
目的
使用无创双通道宽带漫射光谱法（DOS）定量测量两个组织腔室在主动脉复苏性血管内球囊阻断术（REBOA）期间的组织成分和血流动力学。
方法
在猪大量出血模型（1小时内失血65%总血容量）中，测量主动脉球囊上下方在30分钟REBOA期间氧合血红蛋白和脱氧血红蛋白（HbO₂和HbR）、水和脂质的组织浓度（n = 10）。
结果
出血后，两个部位的血红蛋白氧饱和度（StO₂ = HbO₂/[HbO₂ + HbR]）均显著下降（分别为-29.9%和-42.3%）。DOS测量值与平均动脉压（MAP）（R² = 0.79，R² = 0.88）、每搏输出量（SV）（R² = 0.68，R² = 0.88）和心率（HR）（R² = 0.72，R² = 0.88）相关。在REBOA期间，下方的StO₂持续下降，而上方的StO₂在REBOA后12分钟达到峰值，随后再次下降。在REBOA期间，下方的DOS参数与MAP、SV或HR无关。
结论
双通道区域组织DOS测量可用于无创追踪出血和REBOA期间血流动力学不同的组织腔室的形成。传统的全身指标MAP、HR和SV与下方（下游）部位的组织状态无关。多腔室DOS可能为REBOA和类似复苏程序的疗效提供更完整的情况。
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