Heller Benjamin J, Deshpande Pranav, Heller Joshua A, McCormick Patrick, Lin Hung-Mo, Huang Ruiqi, Fischer Gregory, Weiner Menachem M
Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, NY, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai St. Luke's and Mount Sinai West, NY, USA.
Ann Card Anaesth. 2018 Oct-Dec;21(4):371-375. doi: 10.4103/aca.ACA_105_17.
Cerebral oximetry using near-infrared spectroscopy (NIRS) has well-documented benefits during cardiac surgery. The authors tested the hypothesis that NIRS technology can be used at other sites as a tissue oximeter during cardiac surgery and in the Intensive Care Unit (ICU).
To establish feasibility of monitoring tissue oximetry during and after cardiac surgery, to examine the correlations between tissue oximetry values and cerebral oximetry values, and to examine correlations between oximetry values and mean arterial pressure (MAP) in order to test whether cerebral oximetry can be used as an index organ.
A large, single-center tertiary care university hospital prospective observational trial of 31 patients undergoing cardiac surgery with cardiopulmonary bypass was conducted.
Oximetry stickers were applied to both sides of the forehead, the nonarterial line forearm, and the skin above one paraspinal muscle. Data were collected from before anesthesia induction until extubation or for at least 24 h in patients who remained intubated.
Categorical variables were evaluated with Chi-square or Fisher's exact tests, while Wilcoxon rank-sum tests or student's t-tests were used for continuous variables.
The correlation between cerebral oximetry values and back oximetry values ranged from r = 0.37 to 0.40. The correlation between cerebral oximetry values and forearm oximetry values ranged from r = 0.11 to 0.13. None of the sites correlated with MAP.
Tissue oximetry at the paraspinal muscle correlates with cerebral oximetry values while at the arm does not. Further research is needed to evaluate the role of tissue oximetry on outcomes such as acute renal failure, prolonged need for mechanical ventilation, stroke, vascular ischemic complications, prolonged ICU and hospital length of stay, and mortality in cardiac surgery.
使用近红外光谱（NIRS）的脑血氧饱和度监测在心脏手术期间具有充分记录的益处。作者测试了这样一个假设，即NIRS技术可在心脏手术期间及重症监护病房（ICU）中用于其他部位作为组织血氧饱和度仪。
确定在心脏手术期间及术后监测组织血氧饱和度的可行性，检查组织血氧饱和度值与脑血氧饱和度值之间的相关性，并检查血氧饱和度值与平均动脉压（MAP）之间的相关性，以测试脑血氧饱和度是否可作为一个指标器官。
在一所大型单中心三级护理大学医院对31例行体外循环心脏手术的患者进行了一项前瞻性观察性试验。
将血氧饱和度监测贴分别贴于前额两侧、非动脉置管侧前臂以及一侧椎旁肌上方的皮肤。从麻醉诱导前开始收集数据，直至拔管，对于仍需插管的患者则至少收集24小时的数据。
分类变量采用卡方检验或Fisher精确检验进行评估，连续变量则使用Wilcoxon秩和检验或学生t检验。
脑血氧饱和度值与背部血氧饱和度值之间的相关性范围为r = 0.37至0.40。脑血氧饱和度值与前臂血氧饱和度值之间的相关性范围为r = 0.11至0.13。所有部位的血氧饱和度值均与MAP无相关性。
椎旁肌处的组织血氧饱和度与脑血氧饱和度值相关，而手臂处的则不相关。需要进一步研究来评估组织血氧饱和度在诸如急性肾衰竭、机械通气时间延长、中风、血管缺血性并发症、ICU及住院时间延长以及心脏手术死亡率等结局中的作用。
