Can the cerebral regional oxygen saturation be a perfusion parameter in shock?
Can the cerebral regional oxygen saturation be a perfusion parameter in shock?
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DOI：
10.1016/j.jcrc.2016.11.006
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发表时间：
2017-04-01
影响因子：
3.7
通讯作者：
Mohiuddeen, Khaja
中科院分区：
文献类型：
--
作者：
Al Tayar, Ashraf;Abouelela, Amr;Mohiuddeen, Khaja
前言：休克定义为组织低灌注和组织再灌流的状态，是休克治疗的主要目标。中心静脉饱和度的增加(CVSo(2))和血乳酸水平的降低对评估组织灌注的充分性是有用的。近红外光谱是一种无创的实时观察局部脑饱和度变化的方法，已被用于不同脑部疾病的患者。有少量文献表明，脑局部氧饱和度(CrSo(2))监测在重症监护病房(ICU)患者的评估和管理中具有一定的价值。目的：本研究的目的是确定CrSo(2)是否可以作为ICU休克患者组织灌注的指标，并确定CrSo(2)在生存预测中的预后价值。方法：这是一项前瞻性的单中心试点研究，20名在沙特阿拉伯达兰King Fahd军事医疗综合体住院的成年ICU患者被诊断为休克。采用InVOS血氧仪5100C(Covidien，Mansfield，MASS)双侧额部电极，采用近红外光谱分析技术，分别于基线时间、8、24、48、72小时监测血CrSO(2)、血乳酸水平、CvSO(2)、平均动脉压和心脏指数。结果：入院后8、24、48、72hCrSO2与血乳酸呈显著负相关(r分别为-0.625、-0.711、-0.745、-0.722，P=-0.05)。003、.001，。分别为.001和.001)。入院后8、24、48、72hCrSo(2)与CvSo(2)呈显著正相关(r分别为0.572、0.674、0.527、0.757；P值分别为0.008、0.001、0.017、0.001)。此外，入院后24、48和72小时的平均动脉压与CrSO(2)呈显著正相关(r分别为0.523、0.513和0.626，P=0.05)。018、.021和.003)。存活组(12例)和死亡组(8例)入院后72hCrSo(2)分别为52.58%+/-7.33%和44.75%+/-9.44%(P=0.049)，差异有统计学意义(P=0.049)。结论：脑局部血氧饱和度可作为休克患者脑血流灌注参数之一，对预后有一定的预测价值。然而，仍需要更大样本量的进一步研究来验证这些结果。(C)2016 Elsevier Inc.保留所有权利。
Introduction: Shock, defined as a state of tissue hypoperfusion and the tissues reperfusion, is the main goal of management of shock. Increase in central venous saturation (CVSo(2)) and decrease in blood lactate level are useful in assessment of adequacy of tissue perfusion. Near-infrared spectroscopy is a noninvasive way to observe real-time changes in regional cerebral saturation and has been used in patients with different brain diseases. There is a small body of literature suggesting that cerebral regional oxygen saturation (CrSo(2)) monitoring added a value in assessment and management of intensive care unit (ICU) patients.Objectives: The aim of this study was to determine if CrSo(2) can be used as an indicator of tissue perfusion in ICU patients with shock, and to determine the prognostic value of CrSo(2) in survival prediction.Methods: This is a prospective single-center pilot study entailed 20 patients who were diagnosed with shock admitted to adult ICU at King Fahd Military Medical Complex, Dhahran, Saudi Arabia. The CrSo(2) was monitored with near-infrared spectroscopy using Somatic, INVOS Oximeter 5100C (Covidien, Mansfield, Mass) with bilateral frontal electrode and mean value of the 2 readings was taken as well as blood lactate level, CvSo(2), mean arterial blood pressure, and cardiac index at baseline time, 8, 24, 48, and 72 hours. All patients with history of cerebrovascular diseases and those who presented with neurological deficits were excluded from the study.Results: Significant negative correlation was noticed between CrSo(2) and lactic acid at 8, 24, 48, and 72 hours from admission (r = -0.625, -0.711, -0.745, and -0.722, respectively; P =. 003,. 001,. 001, and .001, respectively). Significant positive correlation was noticed between CrSo(2) and CvSo(2) at 8, 24, 48, and 72 hours from admission (r = 0.572, 0.674, 0.527, and 0.757; P = .008, .001, .017, and .001, respectively). In addition, significant positive correlation was found between CrSo(2) and mean arterial pressure at 24,48, and 72 hours from admission (r = 0.523, 0.513, and 0.626, respectively; P =. 018, .021, and .003, respectively). Significant difference was also detected between the value of CrSo(2) in the survivors (12 patients) and the nonsurvivors (8 patients) after 72 hours from admission, as it was 52.58% +/- 7.33% and 44.75% +/- 9.44% (P = .049), whereas it was not significantly different in the first 3 days.Conclusions: Cerebral regional oxygen saturation might be helpful as one of the perfusion parameters in patients with shock and it could have a prognostic value in mortality prediction. However, further studies with larger sample size are still needed to validate these results. (C) 2016 Elsevier Inc. All rights reserved.