Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Int J Artif Organs. 2020 Nov;43(11):695-700. doi: 10.1177/0391398820910751. Epub 2020 Mar 6.
Near-infrared spectroscopy has been used to measure the regional oxygen saturation (rSO) of the brain, and decreases in cerebral rSO have been reported to lead to cognitive impairment in patients undergoing hemodialysis. However, reports about the association between changes in cerebral oxygenation and clinical parameters at hemodialysis initiation, including hemoglobin level, are lacking.
This study included 33 patients at the hemodialysis initiation phase. Cerebral rSO2 was monitored using an INVOS 5100C. Included patients were assessed twice (at hemodialysis initiation and 42.7 ± 20.8 days after the first measurement), and changes in cerebral rSO2 were compared with changes in clinical parameters.
Cerebral rSO2 at the second measurement significantly increased compared with that at hemodialysis initiation (57.2 ± 6.8% vs 54.4 ± 8.8%, < 0.05). Changes in cerebral rSO2 represented a significant correlation with changes in hemoglobin level, pulse rate, and serum albumin level. Multivariate linear regression analysis was performed using significant factors in simple linear regression analysis. Changes in hemoglobin (standardized coefficient: 0.37) and serum albumin (standardized coefficient: 0.45) levels were identified as independent factors influencing the changes in cerebral rSO2.
Cerebral rSO2 was low in the presence of low hemoglobin levels at hemodialysis initiation and improved in response to hemoglobin increase in addition to changes in serum albumin levels. Attention should be paid to changes in hemoglobin levels even at hemodialysis initiation to prevent the deterioration of cerebral oxygenation, and this might contribute to the maintenance of cognitive function in patients undergoing hemodialysis.
近红外光谱已被用于测量脑的局部氧饱和度（rSO），并且据报道，脑 rSO 的降低会导致接受血液透析的患者认知障碍。然而，关于血液透析开始时脑氧合变化与血红蛋白水平等临床参数之间的关联的报告尚缺乏。
本研究纳入了 33 名处于血液透析起始阶段的患者。使用 INVOS 5100C 监测脑 rSO2。纳入的患者接受了两次评估（在血液透析起始时和第一次测量后 42.7±20.8 天），并比较了脑 rSO2 的变化与临床参数的变化。
与血液透析起始时相比，第二次测量时脑 rSO2 显著增加（57.2±6.8%对 54.4±8.8%，<0.05）。脑 rSO2 的变化与血红蛋白水平、脉搏率和血清白蛋白水平的变化呈显著相关。使用简单线性回归分析中的显著因素进行多元线性回归分析。血红蛋白（标准化系数：0.37）和血清白蛋白（标准化系数：0.45）水平的变化被确定为影响脑 rSO2 变化的独立因素。
在血液透析起始时血红蛋白水平较低的情况下，脑 rSO2 较低，并且随着血红蛋白水平的增加以及血清白蛋白水平的变化而改善。即使在血液透析起始时也应注意血红蛋白水平的变化，以防止脑氧合恶化，这可能有助于维持接受血液透析的患者的认知功能。
