Noninvasive muscle oxygenation to guide fluid resuscitation after traumatic shock
Noninvasive muscle oxygenation to guide fluid resuscitation after traumatic shock
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DOI：
10.1016/j.surg.2003.11.017
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发表时间：
2004-06-01
期刊：
影响因子：
3.8
通讯作者：
Proctor, KG
中科院分区：
文献类型：
--
作者：
Crookes, BA;Cohn, SM;Proctor, KG
背景三种不同的协议测试的假设，后肢肌肉组织氧饱和度（StO（2）），测量非侵入性近红外光谱（NIRS），是作为可靠的侵入性全身氧合指数，以指导液体复苏。在系列1中，猪（n = 30）被麻醉，然后接受无流体、固定体积的胶体（15 mL/kg）或放血加滴定至MAP > 60 mm Hg的乳酸林格氏液（LR）。在系列2中，猪（n = 16）接受穿透性股骨损伤，47%至55%的出血以确定半数致死剂量（LD 50），然后流血加上LR滴定至MAP > 60 mm Hg。第三组，猪（n = 5）股骨损伤加LD 50出血，用LR滴定至StO（2）> 50%复苏。在系列1中，StO（2）追踪混合静脉氧饱和度（SvO（2）），但区分3个存活组优于SvO（2）、动脉乳酸或动脉碱过剩。在系列2中，StO（2）追踪SvO（2），但区分2个存活组优于SvO（2）、动脉乳酸盐或动脉碱过剩。在系列3中，当复苏至StO（2）目标时，动物存活至拔管。近红外光谱法测定无创性肌肉StO（2）较有创性氧疗更可靠。作为震惊的指标。由于在紧急情况下可以很容易地监测肌肉StO（2），它可能代表了一种改进的方法来衡量休克的严重程度或创伤后液体复苏的充分性。
Background. Three different protocols tested the hypothesis that hind limb muscle tissue O-2 saturation (StO(2)), measured noninvasively with near-infrared spectroscopy (NIRS), is as reliable as invasive systemic oxygenation indices to guide fluid resuscitation.Methods. In series 1, swine (n = 30) were hemorrhaged, then received either no fluid, a fixed volume of colloid (15 mL/kg), or shed blood plus lactated Ringer's (LR) titrated to MAP > 60 mm Hg. In series 2, swine (n = 16) received a penetrating femur injury, a 47% to 55% hemorrhage to determine a median lethal dose (LD50) then shed blood plus LR titrated to MAP > 60 mm Hg. In series 3, swine (n = 5) received the femur injury plus LD50 hemorrhage, and were resuscitated with LR titrated to StO(2) > 50%.Results. In series 1, StO(2) tracked mixed venous O-2 saturation (SvO(2)), but discriminated between 3 survivor groups better than SvO(2), arterial lactate, or arterial base excess. In series 2, StO(2) tracked SvO(2) but discriminated between 2 survivor groups better than SvO(2), arterial lactate, or arterial base excess. In series 3, animals survived to extubation when resuscitated to an StO(2) target.Conclusions. Noninvasive muscle StO(2) determined by NIRS was more reliable than invasive oxygenaft. on variables as an index of shock. Because muscle StO(2) can be easily monitored in emergency situations, it may represent an improved method to gauge the severity of shock or the adequacy of fluid resuscitation after trauma.