Effect of Prolonged Pressure on Hemodynamics of Sacral Tissues Assessed by Diffuse Optical Imaging: A Pilot Study
Effect of Prolonged Pressure on Hemodynamics of Sacral Tissues Assessed by Diffuse Optical Imaging: A Pilot Study
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通过漫射光学成像评估长时间压力对骶组织血流动力学的影响：初步研究
DOI：
10.1007/978-3-030-48238-1_53
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发表时间：
2021
影响因子：
--
通讯作者：
Day, B
Pollonini
中科院分区：
文献类型：
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作者：
Day, B
Pollonini
压力损伤（PI）是由于长时间的压力施加在皮肤和骨骼损伤上的下层组织（例如，下背部、脚跟、肩膀）。最大限度地减少压力一直被认为是最有效的预防方法，目前的指南要求每两小时进行一次皮肤目视检查和重新定位。然而，这些策略通常应用不足，不能充分防止PI成为穿透性伤口。最近的研究将PI的发展归因于细胞变形、炎症和缺血性损伤，这些损伤在一到几个小时内从微观尺度（少数细胞死亡）累积传播到宏观尺度（组织坏死）。虽然PI发病机制的性质是复杂的和多因素的，实时测量组织变化可以阐明起源机制，并最终允许在最早阶段检测PI。在这项初步研究中，我们评估了弥散光学成像（DOI）的能力，以评估血液动力学变化所造成的长期压力对骶骨组织在5名健康志愿者奠定不动，仰卧位2小时。使用一个薄的、符合人体的光学成像探头，包括在160 × 160 mm区域上以规则间隔网格排列的256个光极，以构建DOI体积图像，代表氧合血红蛋白（HbO2）和脱氧血红蛋白（HHb）浓度相对于归零基线的变化。在持续体重加压2小时后，所有受试者的血流动力学图像与其个体基线基本不同。我们还发现，在受试者之间成对计算的血流动力学相似性显示出较高的值和平均值附近的有限变异性，因此表示受试者之间的图像相似性水平一致。这些初步结果表明，长时间的压力导致独特的血流动力学模式，可以有效地调查与DOI和监测功能的变化，随着时间的推移，有可能澄清PI的发展机制。
Pressure injuries (PIs) are wounds resulting from prolonged pressure exerting on the skin and underlying tissues over bony prominences (e.g., lower back, heels, shoulders) in bed-bound patients and wheelchair users. Minimizing pressure has long been considered the most effective preventative method, and current guidelines require visual skin inspection and repositioning every two hours. However, these strategies are often applied deficiently and do not adequately prevent PIs from becoming penetrating wounds. Recent studies attribute the development of PIs to cell deformation, inflammatory, and ischemic damages that cumulatively propagate from the microscale (death of few cells) to the macroscale (tissue necrosis) within one to several hours. Although the nature of the PI pathogenesis is complex and multifactorial, measuring tissue alterations in real-time may elucidate the origination mechanism and ultimately allow detecting PIs at the earliest stage. In this pilot study, we evaluated the ability of diffuse optical imaging (DOI) to assess hemodynamic changes resulting from prolonged pressure on the sacral tissues in five healthy volunteers laying immobile in a supine position for 2 hours. A thin, body-conforming optical imaging probe encompassing 256 optodes arranged in a regularly spaced grid over a 160 × 160 mm area was used to construct DOI volumetric images representing changes of oxyhemoglobin (HbO2) and deoxyhemoglobin (HHb) concentration from a zeroed baseline. After 2 hours of continuous body weight pressure, hemodynamic images in all subjects were substantially dissimilar from their individual baseline. We also found that hemodynamic similarity computed pairwise across subjects exhibited a high value and limited variability around the mean, thus denoting a consistent level of image similarity across subjects. These preliminary results indicate that prolonged pressure causes distinctive hemodynamic patterns that can be effectively investigated with DOI and that monitoring functional changes over time holds potential for clarifying the development mechanisms of PIs.