Mutsuyoshi Yuko, Ito Kiyonori, Ookawara Susumu, Uchida Takayuki, Morishita Yoshiyuki
Division of Nephrology, First Department of Integrated Medicine, Jichi Medical University Saitama Medical Center, Saitama, JPN.
Department of Clinical Engineering, Jichi Medical University Saitama Medical Center, Saitama, JPN.
Cureus. 2021 Jan 30;13(1):e13023. doi: 10.7759/cureus.13023.
Near-infrared spectroscopy has been used to measure regional oxygen saturation (rSO), and intradialytic tissue rSO measurements have been playing an important role in evaluating changes in tissue oxygenation in various clinical settings of hemodialysis (HD) therapy.However, few reports have described changes in hepatic oxygenation associated with body fluid management in overhydrated HD patients. We herein report an HD patient with congestive heart failure (CHF) that had improved systemic and tissue oxygenation, including in the brain and liver, during HD with ultrafiltration. A 73-year-old man undergoing HD was admitted to our hospital with CHF. After admission, HD with ultrafiltration was performed to adequately manage his body fluid excess. Because of deterioration of systemic oxygenation on admission, we monitored his percutaneous arterial oxygen saturation (SpO) using a pulse oximeter and regional oxygen saturation (rSO) in the brain and liver using an INVOS 5100c oxygen saturation monitor during HD. At HD initiation, his cerebral and hepatic rSO levels were relatively low, at 43.2% and 34.1%, respectively, in addition to the SpO of 88%. During HD with ultrafiltration, systemic oxygenation evaluated by SpO and tissue oxygenation by cerebral and hepatic rSO improved. Interestingly, the hepatic rSO ratio, defined as the ratio of rSO values at (min) during HD and the initial rSO value before HD, increased larger than the cerebral rSO ratio during HD. After the adjustment of body fluid condition under the maintained SpO values, we confirmed the hepatic and cerebral SO ratio again during HD, and these two values changed nearly in the same manner. Throughout our experience, in this case, we confirmed a remarkable increase in hepatic rSO ratio relative to cerebral rSO ratio under a CHF status during HD, and these differences disappeared after the adjustment of the body fluid status.
近红外光谱已被用于测量局部氧饱和度（rSO），透析期间组织rSO测量在评估血液透析（HD）治疗各种临床环境中的组织氧合变化方面发挥着重要作用。然而，很少有报告描述过HD患者过度水合时与体液管理相关的肝脏氧合变化。我们在此报告1例充血性心力衰竭（CHF）的HD患者，其在HD超滤过程中全身和包括脑及肝脏在内的组织氧合得到改善。1例接受HD的73岁男性因CHF入住我院。入院后，进行HD超滤以充分管理其体液过多问题。由于入院时全身氧合恶化，我们在HD期间使用脉搏血氧仪监测其经皮动脉血氧饱和度（SpO），并使用INVOS 5100c氧饱和度监测仪监测脑和肝脏的局部氧饱和度（rSO）。HD开始时，其脑和肝脏rSO水平相对较低，分别为43.2%和34.！%，SpO为88%。在HD超滤过程中，通过SpO评估的全身氧合以及通过脑和肝脏rSO评估的组织氧合均得到改善。有趣的是，肝脏rSO比值（定义为HD期间（分钟）的rSO值与HD前初始rSO值之比）在HD期间的升高幅度大于脑rSO比值。在维持SpO值的情况下调整体液状况后，我们在HD期间再次确认了肝脏和脑的SO比值，这两个值的变化几乎相同。在我们的整个经验中，在此病例中，我们证实在HD期间CHF状态下肝脏rSO比值相对于脑rSO比值显著升高，而在调整体液状态后这些差异消失。
