Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea.
Institute of New Frontier Stroke Research, College of Medicine, Hallym University, Chuncheon, Republic of Korea.
Neurocrit Care. 2021 Dec;35(3):767-774. doi: 10.1007/s12028-021-01223-2. Epub 2021 May 7.
The objective of this study was to investigate the clinical feasibility of near-infrared spectroscopy (NIRS) for the detection of delayed cerebral ischemia (DCI) in patients with poor-grade subarachnoid hemorrhage (SAH) treated with coil embolization.
Cerebral regional oxygen saturation (rSO) was continuously monitored via two-channel NIRS for 14 days following SAH. The rSO levels according to DCI were analyzed by using the Mann-Whitney U-test. A receiver operating characteristic curve was generated on the basis of changes in rSO by using the rSO level on day 1 as a reference value to determine the optimal cutoff value for identifying DCI.
Twenty-four patients with poor-grade SAH were included (DCI, n = 8 [33.3%]; non-DCI, n = 16 [66.7%]). The rSO levels of patients with DCI were significantly lowered from 6 to 9 days compared with those in without DCI. The rSO level was 62.55% (58.30-63.40%) on day 6 in patients with DCI versus 65.40% (60.90-68.70%) in those without DCI. By day 7, it was 60.40% (58.10-61.90%) in patients with DCI versus 64.25% (62.50-67.10%) those without DCI. By day 8, it was 58.90% (56.50-63.10%) in patients with DCI versus 66.05% (59.90-69.20%) in those without DCI, and by day 9, it was 60.85% (58.40-65.20%) in patients with DCI versus 65.80% (62.70-68.30%) in those without DCI. A decline of greater than 14.5% in the rSO rate yielded a sensitivity of 92.86% (95% confidence interval: 66.1-99.8%) and a specificity of 88.24% (95% confidence interval: 72.5-96.7%) for identifying DCI. A decrease by more than 14.7% of the rSO level indicates a sensitivity of 85.7% and a specificity of 85.7% for identifying DCI.
Near-infrared spectroscopy shows some promising results for the detection of DCI in patients with poor-grade SAH. Further studies involving a large cohort of the SAH population are required to confirm our results.
本研究旨在探讨近红外光谱（NIRS）用于检测蛛网膜下腔出血（SAH）后接受线圈栓塞治疗的差分级患者迟发性脑缺血（DCI）的临床可行性。
SAH 后连续 14 天通过双通道 NIRS 监测脑局部血氧饱和度（rSO）。采用 Mann-Whitney U 检验分析 rSO 与 DCI 的关系。根据 rSO 变化绘制受试者工作特征曲线，以第 1 天的 rSO 水平作为参考值，确定识别 DCI 的最佳截断值。
共纳入 24 例差分级 SAH 患者（DCI 患者 8 例[33.3%]；非 DCI 患者 16 例[66.7%]）。与非 DCI 患者相比，DCI 患者 rSO 水平从第 6 天至第 9 天明显降低。DCI 患者 rSO 水平在第 6 天为 62.55%（58.30-63.40%），而非 DCI 患者为 65.40%（60.90-68.70%）。第 7 天，DCI 患者 rSO 水平为 60.40%（58.10-61.90%），而非 DCI 患者为 64.25%（62.50-67.10%）。第 8 天，DCI 患者 rSO 水平为 58.90%（56.50-63.10%），而非 DCI 患者为 66.05%（59.90-69.20%），第 9 天，DCI 患者 rSO 水平为 60.85%（58.40-65.20%），而非 DCI 患者为 65.80%（62.70-68.30%）。rSO 下降超过 14.5%可使 DCI 的灵敏度为 92.86%（95%置信区间：66.1-99.8%），特异性为 88.24%（95%置信区间：72.5-96.7%）。rSO 水平下降超过 14.7%提示 DCI 的灵敏度为 85.7%，特异性为 85.7%。
近红外光谱技术对检测蛛网膜下腔出血后接受线圈栓塞治疗的差分级患者迟发性脑缺血具有一定的应用价值。需要进一步的研究来证实我们的研究结果。
