在肢体隔离灌注期间对骨骼肌肉氧合的无创和有创测量。
Non-invasive and invasive measurement of skeletal muscular oxygenation during isolated limb perfusion.
机构信息
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
出版信息
Perfusion. 2023 Jul;38(5):1019-1028. doi: 10.1177/02676591221093201. Epub 2022 May 16.
BACKGROUND
Isolated limb perfusion (ILP) is a regional surgical treatment for localized metastatic disease. High doses of chemotherapeutic agents are administered within an extracorporeal circulated isolated extremity, treating the metastasis, while systemic toxicity is avoided. To our knowledge, indexed oxygen supply/demand relationship during ILP has not previously been described. Our aim was to measure and describe oxygen metabolism, specifically oxygen delivery, consumption, and extraction, in an isolated leg/arm during ILP. Also investigate whether invasive oxygenation measurement during ILP correlates and can be used interchangeable with the non-invasive method, near infrared spectroscopy (NIRS).
METHODS
Data from 40 patients scheduled for ILP were included. At six time points blood samples were drawn during the procedure. DO2, VO2, and O2ER were calculated according to standard formulas. NIRS and hemodynamics were recorded every 10 min.
RESULTS
For all observations, the mean of DO2 was 190±59 ml/min/m2, VO2 was 35±8 ml/min/m2, and O2ER was 21±8%. VO2 was significantly higher in legs compared to arms (38±8 vs. 29±7 ml/min/m2, p=0.02). Repeated measures showed a significant decrease in DO2 in legs (209±65 to 180±66 ml/min/m2, p=<0.01) and in arms (252±72 to 150±57 ml/min/m2, p=<0.01). Significant increase in O2ER in arms was also found (p=0.03). Significant correlation was detected between NIRS and venous extremity oxygen saturation (SveO2) (rrm=0.568, p=<. 001, 95% CI 0.397-0.701). When comparing SveO2 and NIRS using a Bland-Altman analysis, the mean difference (bias) was 8.26±13.03 (p=<. 001) and the limit of agreement was - 17.28-33.09, with an error of 32.5%.
CONCLUSION
DO2 above 170 ml/min/m2 during ILP kept O2ER below 30% for all observations. NIRS correlates significant to SveO2; however, the two methods do not agree sufficiently to work interchangeable. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT04460053 and NCT03073304.
背景
孤立肢体灌注（ILP）是一种针对局部转移性疾病的区域外科治疗方法。将高剂量的化疗药物在体外循环的隔离肢体中给药，以治疗转移灶，同时避免全身毒性。据我们所知，在 ILP 期间，氧供需关系的指数尚未被描述。我们的目的是测量和描述孤立肢体灌注期间的氧代谢，特别是氧输送、消耗和提取。还研究了在 ILP 期间进行的侵入性氧合测量是否与非侵入性方法（近红外光谱（NIRS））相关，并且可以互换使用。
方法
纳入了 40 名计划接受 ILP 的患者的数据。在手术过程中，在六个时间点抽取血样。根据标准公式计算 DO2、VO2 和 O2ER。每 10 分钟记录 NIRS 和血液动力学。
结果
对于所有观察结果，DO2 的平均值为 190±59 ml/min/m2，VO2 为 35±8 ml/min/m2，O2ER 为 21±8%。腿部的 VO2 明显高于手臂（38±8 比 29±7 ml/min/m2，p=0.02）。重复测量显示腿部的 DO2 显著下降（209±65 至 180±66 ml/min/m2，p<0.01），手臂的 DO2 也显著下降（252±72 至 150±57 ml/min/m2，p<0.01）。手臂的 O2ER 也明显增加（p=0.03）。还检测到 NIRS 与静脉肢体氧饱和度（SveO2）之间存在显著相关性（rrm=0.568，p<0.001，95%CI 0.397-0.701）。当使用 Bland-Altman 分析比较 SveO2 和 NIRS 时，平均差异（偏差）为 8.26±13.03（p<0.001），一致性界限为-17.28-33.09，误差为 32.5%。
结论
在 ILP 期间，DO2 高于 170 ml/min/m2 可使所有观察结果的 O2ER 保持在 30%以下。NIRS 与 SveO2 显著相关；然而，这两种方法的一致性不足以进行互换使用。临床试验注册网址：https://www.clinicaltrials.gov。独特标识符：NCT04460053 和 NCT03073304。
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