Shinozaki Koichiro, Capilupi Michael J, Saeki Kota, Hirahara Hideaki, Horie Katsuyuki, Kobayashi Naoki, Weisner Steve, Kim Junhwan, Lampe Joshua W, Becker Lance B
The Feinstein Institute for Medical Research, Northwell Health System, 350 Community Dr., Manhasset, NY, 11030, USA.
Department of Emergency Medicine, Northshore University Hospital, Northwell Health System, Manhasset, NY, USA.
J Clin Monit Comput. 2019 Apr;33(2):259-267. doi: 10.1007/s10877-018-0159-7. Epub 2018 May 30.
Capillary refill time has been accepted as a method to manually assess a patient's peripheral blood perfusion. Recently, temperature has been reported to affect capillary refill time and therefore temperature may interfere with accurate bedside peripheral blood perfusion evaluation. We applied a new method of analysis that uses standard hospital pulse oximetry equipment and measured blood refill time in order to test whether lowered fingertip temperature alters peripheral blood perfusion. Thirty adult healthy volunteers of differing races (skin colors) and age (young: 18-49 years and old: ≥ 50 years) groups were recruited. We created a high fidelity mechanical device to compress and release the fingertip and measure changes in blood volume using infrared light (940 nm). Capillary refill times were measured at the fingertip at three different temperature settings: ROOM TEMPERATURE, COLD by 15 °C cold water, and REWARM by 38 °C warm water. The COLD group has decreased fingertip temperature (23.6 ± 3.6 °C) and increased blood refill time (4.67 s [95% CI 3.57-5.76], p < 0.001). This was significantly longer than ROOM TEMPERATURE (1.96 [1.60-2.33]) and REWARM (1.96 [1.73-2.19]). Blood refill time in older subjects tended to be longer than in younger subjects (2.28 [1.61-2.94] vs. 1.65 [1.36-1.95], p = 0.077). There was a negative correlation (r = - 0.471, p = 0.009) between age and temperature. A generalized linear mixed-effects model revealed that lower temperature (OR 0.63 [95% CI 0.61-0.65], p < 0.001) rather than age (OR 1.00 [0.99-1.01], p = 0.395) was the independent factor most associated with increased blood refill time. Lowered fingertip temperatures significantly increase blood refill time which then returns to baseline when the fingertip is rewarmed. In our limited number of population, we did not find an association with age after the adjustment for the fingertip temperature.
毛细血管再充盈时间已被公认为一种手动评估患者外周血灌注的方法。最近，有报道称温度会影响毛细血管再充盈时间，因此温度可能会干扰准确的床边外周血灌注评估。我们应用了一种新的分析方法，该方法使用标准的医院脉搏血氧饱和度测定设备并测量血液再充盈时间，以测试指尖温度降低是否会改变外周血灌注。招募了30名不同种族（肤色）和年龄（年轻：18 - 49岁，年老：≥50岁）组的成年健康志愿者。我们制造了一种高保真机械设备来挤压和释放指尖，并使用红外光（940纳米）测量血容量变化。在三种不同温度设置下测量指尖的毛细血管再充盈时间：室温、用15°C冷水降温、用38°C温水复温。降温组的指尖温度降低（23.6±3.6°C），血液再充盈时间增加（4.67秒[95%置信区间3.57 - 5.76]，p<0.001）。这明显长于室温组（1.96[1.60 - 2.33]）和复温组（1.96[1.73 - 2.19]）。老年受试者的血液再充盈时间往往比年轻受试者长（2.28[1.61 - 2.94]对1.65[1.36 - 1.95]，p = 0.077）。年龄与温度之间存在负相关（r = -0.471，p = 0.009）。广义线性混合效应模型显示，较低温度（比值比0.63[95%置信区间0.61 - 0.65]，p<0.001）而非年龄（比值比1.00[0.99 - 1.01]，p = 0.395）是与血液再充盈时间增加最相关的独立因素。指尖温度降低会显著增加血液再充盈时间，当指尖复温时又会恢复到基线水平。在我们有限的研究人群中，在调整指尖温度后，我们未发现与年龄有关联。
