Assessment of cerebral oxygenation using near infrared spectroscopy during isovolemic hemodilution in pediatric patients
Assessment of cerebral oxygenation using near infrared spectroscopy during isovolemic hemodilution in pediatric patients
复制标题
使用近红外光谱评估儿科患者等容血液稀释期间的脑氧合
DOI：
10.1007/s10877-011-9292-2
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发表时间：
2011
影响因子：
2.2
通讯作者：
J. Tobias
中科院分区：
文献类型：
--
作者：
J. Tobias
限制异体输血需求的一种方法是等容血液稀释，即在手术室中将血液取出并用等容液体代替以维持血液容量。虽然氧向组织的输送通常由代偿性生理机制维持，但在实际临床实践中评估组织氧合的数据有限。本研究利用近红外光谱（NIRS）评估等容血稀释对脑氧合的影响。对12名年龄在12岁至16岁之间的儿童患者进行了NIRS监测和等容血稀释。麻醉诱导后，行等容血液稀释术，取血后用胶体置换，使最终红细胞比容达到25-30%。在等容血液稀释过程中，心率、平均动脉压或中心静脉压均无统计学意义的变化。麻醉诱导后基线脑血氧仪右侧为81±8，左侧为82±7。等容血液稀释完成后，右脑饱和度为77±10，左脑饱和度为78±8。在等容血稀释期间，没有患者的脑氧合下降超过10。等容血稀释期间，脑血氧计读数下降幅度最大，为8。我们的数据提供了初步证据，支持中度等容血液稀释在儿科人群中的安全性。我们发现代偿机制很好地维持了脑氧合。监测终末器官氧合的方式，如近红外光谱（NIRS），可能对合并疾病过程的患者特别有价值，这些疾病过程可能影响终末器官氧合或阻止贫血期间维持氧气输送的代偿机制。
One means of limiting the need for allogeneic blood transfusions is isovolemic hemodilution where blood is removed in the operating room and replaced with isotonic fluids to maintain euvolemia. Although the delivery of oxygen to the tissues is generally maintained by compensatory physiologic mechanisms, there are limited data evaluating tissue oxygenation in actual clinical practice. The current study evaluates the effects of isovolemic hemodilution on cerebral oxygenation using near-infrared spectroscopy (NIRS). NIRS was monitored and isovolemic hemodilution achieved in 12 pediatric patients who ranged in age from 12 to 16 years. After anesthetic induction, isovolemic hemodilution was carried out by phlebotomy and the collection of blood which was replaced with colloid to achieve a final hematocrit of 25–30%. There was no statistically significant change in heart rate, mean arterial pressure or central venous pressure during isovolemic hemodilution. The baseline cerebral oximeter obtained after the induction of anesthesia was 81±8 on the right and 82±7 on the left. At the completion of isovolemic hemodilution, the cerebral saturations were 77±10 on the right and 78±8 on the left. No patient had a decreased in cerebral oxygenation of greater than 10 during isovolemic hemodilution. The greatest decrease in the cerebral oximeter reading during isovolemic hemodilution was 8. Our data provides preliminary evidence supporting the safety of moderate isovolemic hemodilution in a pediatric population. We found that cerebral oxygenation is well maintained by compensatory mechanisms. Modalities such as NIRS to monitor end-organ oxygenation may be particularly valuable in patients with co-morbid disease processes which may affect end organ oxygenation or prevent the compensatory mechanisms that maintain oxygen delivery during anemia.