Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
J Anesth. 2019 Jun;33(3):478-481. doi: 10.1007/s00540-019-02650-4. Epub 2019 May 6.
Regional cerebral oxygen saturation (rSO) measured using near-infrared spectroscopy has been reported to be significantly lower in hemodialysis (HD) patients than in non-HD ones, but the mechanisms are unknown. The aim of this prospective study was to assess the accuracy of near-infrared spectroscopy to estimate cerebral oxygenation in HD patients undergoing cardiovascular surgery. Our hypothesis was that rSO values would underestimate cerebral oxygenation in HD patients. This study included 113 patients (7 HD patients and 106 non-HD ones) undergoing cardiac or major aortic surgery between December 2015 and November 2017. We evaluated the validity of rSO by comparing it with ipsilateral jugular venous oxygen saturation (SjvO). In HD and non-HD patients, rSO and SjvO showed a weak correlation (R: 0.46 and 0.28 in HD and non-HD patients, respectively). Bland-Altman analysis revealed that bias (95% limits of agreement) of rSO compared to SjvO was - 19.2% ( - 41.7-3.3%) in HD patients and - 1.9% (- 19.3-15.5%) in non-HD ones. The large negative bias suggests that the rSO values measured using near-infrared spectroscopy substantially underestimate cerebral oxygenation in HD patients.
使用近红外光谱测量的局部脑氧饱和度（rSO）在血液透析（HD）患者中明显低于非 HD 患者，但机制尚不清楚。本前瞻性研究旨在评估近红外光谱在接受心血管手术的 HD 患者中评估脑氧合的准确性。我们的假设是 rSO 值会低估 HD 患者的脑氧合。该研究纳入了 2015 年 12 月至 2017 年 11 月期间接受心脏或大主动脉手术的 113 例患者（7 例 HD 患者和 106 例非 HD 患者）。我们通过将 rSO 与对侧颈内静脉血氧饱和度（SjvO）进行比较来评估 rSO 的准确性。在 HD 和非 HD 患者中，rSO 和 SjvO 之间存在弱相关性（HD 和非 HD 患者分别为 R：0.46 和 0.28）。Bland-Altman 分析显示，与 SjvO 相比，rSO 的偏差（95%一致性界限）在 HD 患者中为-19.2%（-41.7-3.3%），在非 HD 患者中为-1.9%（-19.3-15.5%）。较大的负偏差表明，近红外光谱测量的 rSO 值在 HD 患者中大大低估了脑氧合。
