Non-invasive assessment of muscle oxygenation may aid in optimising transfusion threshold decisions in ambulatory paediatric patients.
Non-invasive assessment of muscle oxygenation may aid in optimising transfusion threshold decisions in ambulatory paediatric patients.
复制标题
肌肉氧合的无创评估可能有助于优化门诊儿科患者的输血阈值决策。
DOI：
10.1111/tme.12384
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Arakaki,LSL
中科院分区：
文献类型：
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作者：
Schenkman,KA;Hawkins,DS;Ciesielski,WA;Delaney,M;Arakaki,LSL
目的评估一种新的无创肌肉氧测量方法在贫血患者中确定肌肉缺氧存在的潜在效用。背景：最近对输血风险/收益比的评估导致了优化输血决策的临床策略。这些决定主要基于红细胞压积（Hct），而不是红细胞（rbc）的主要功能氧输送。我们假设肌肉氧合（MOx）与贫血患者的Hct相关，并且可能是输血阈值的生理相关决定因素。方法/材料：在西雅图儿童医院癌症和血液疾病中心门诊，使用定制设计的光学探针和光谱仪对儿童进行无创检测。将MOx与同期Hct进行比较。在接受红细胞的受试者中，输血后也要测定MOx和Hct。结果16例患者27次测量的smox值为36.7% ~ 100%，Hct值为17.0% ~ 38.6%。高MOx值与高Hct相关。Hct正常患者（n= 5）的平均MOx为95.9±2.9%。输血使平均Hct从19.1±1.5%增加到29.3±2.0，使平均MOx从67.9±21.1%增加到89.9±9.8%。在初始Hct < 22的6次输血事件（5例患者）中，只有3例输血前MOx <70%。输血前MOx最低的患者输血后MOx增加最多。结论这些初步数据表明，当与Hct联合使用时，MOx可能有助于做出输血决定。
ObjectiveTo assess the potential utility of a novel non‐invasive muscle oxygen measurement to determine the presence of muscle hypoxia in patients with anaemia.BackgroundRecent assessment of the risk/benefit ratio of blood transfusion has led to clinical strategies optimising transfusion decisions. These decisions are primarily based on haematocrit (Hct) but not oxygen delivery, the primary function of red blood cells (RBCs). We hypothesised that muscle oxygenation (MOx) would correlate with Hct in patients with anaemia and may be a physiologically relevant determinant of the transfusion threshold.Methods/MaterialsMOx was non‐invasively determined in children in the Cancer and Blood Disorders Center ambulatory clinic at Seattle Children's Hospital using a custom‐designed optical probe and spectrometer. MOx was compared with contemporaneous Hct. In subjects receiving RBCs, MOx and Hct were also determined following transfusion.ResultsMOx ranged from 36·7 to 100%, and Hct ranged from 17·0 to 38·6% in 27 measurements from 16 patients. High MOx values were associated with high Hct. Mean MOx for patients with normal Hct for age (n= 5) was 95·9 ± 2·9%. RBC transfusion increased mean Hct from 19·1 ± 1·5% to 29·3 ± 2·0 and mean MOx from 67·9 ± 21·1% to 89·9 ± 9·8%. Among six transfusion episodes (in five patients) with initial Hct < 22, only three had a pre‐transfusion MOx of <70%. Patients with the lowest pre‐transfusion MOx had the largest increase in MOx after transfusion.ConclusionsThese preliminary data suggest that MOx may aid in making transfusion decisions when used in combination with Hct.