Assessment of muscle oxygenation in children with congenital heart disease.
Assessment of muscle oxygenation in children with congenital heart disease.
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先天性心脏病儿童的肌肉氧合评估。
DOI：
10.1111/pan.13668
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Schenkman,KennethA
中科院分区：
文献类型：
--
作者：
Ross,FaithJ;Arakaki,LorileeSL;Ciesielski,WayneA;McMullan,DMichael;Richards,MichaelJ;Geiduschek,Jeremy;Latham,Gregory;Hsieh,Vincent;Schenkman,KennethA
背景先天性心脏病的适应性反应导致肌肉灌注和肌肉代谢的改变。这种变化可能是检测使用非侵入性光谱monitors.AimsIn这项研究中，我们的目的是确定是否静息肌氧饱和度（MOx）是较低的儿童与紫绀或紫绀型先天性心脏病比健康儿童，并确定差异肌肉耗氧量与紫绀型和非紫绀型先天性心脏病。从49名患者的小腿或前臂获得光学测量结果（17名患有非紫绀型先天性心脏病，18名患有紫绀型先天性心脏病，14名对照）。另外20名对照患者用于开发分析模型。光谱被用来确定MOx在基线，在动脉闭塞，并在再灌注。还评估了动脉闭塞期间肌肉去饱和的速率。双样本检验被用来比较每个心脏病组与controls.ResultsPatients与非紫绀型和紫绀型先天性心脏病有较低的基线MOx比对照组。无紫绀患者的基线MOx为91.3%（CI 85.9%，96.7%），紫绀患者为91.1%（CI 86.3%，95.9%），对照组为98.9%（CI 96.7%，101.1%）。同样，再灌注后，无紫绀和紫绀组的MOx低于对照组（84.6% [CI 74.1%，95.1%]和82.1% [CI 74.5%，89.7%] vs 98.9% [96.5%，101.3%]）。氧合下降率显着更大的紫绀患者与对照组（0.46%/s（CI 0.30%，0.62%/s）与0.17%/s（0.13%，0.21%/s））。这表明，肌肉氧合的无创监测可能提供有价值的信息，在儿童先天性心脏病可能在血流动力学损害的风险。
BackgroundAdaptive responses to congenital heart disease result in altered muscle perfusion and muscle metabolism. Such changes may be detectable using noninvasive spectroscopic monitors.AimsIn this study we aimed to determine if resting muscle oxygen saturation (MOx) is lower in children with acyanotic or cyanotic congenital heart disease than in healthy children and to identify differences in muscle oxygen consumption in children with cyanotic and acyanotic congenital heart disease.MethodsUsing a custom fiber optic spectrometer system, optical measurements were obtained from the calf or forearm of 49 patients (17 with acyanotic congenital heart disease, 18 with cyanotic congenital heart disease, and 14 control). Twenty additional control patients were used to develop the analytic model. Spectra were used to determine MOx at baseline, during arterial occlusion, and during reperfusion. The rate of muscle desaturation during arterial occlusion was also evaluated. Two‐samplet‐tests were used to compare each heart disease group with the controls.ResultsPatients with acyanotic and cyanotic congenital heart disease had lower baseline MOx than controls. Baseline MOx was 91.3% (CI 85.9%, 96.7%) for acyanotic patients, 91.1% (CI 86.3%, 95.9%) for cyanotic patients, and 98.9% (CI 96.7%, 101.1%) for controls. Similarly, MOx was lower in the acyanotic and cyanotic groups than the controls after reperfusion (84.6% [CI 74.1%, 95.1%] and 82.1% [CI 74.5%, 89.7%] vs 98.9% [96.5%, 101.3%]). The rate of decline in oxygenation was significantly greater in cyanotic patients versus controls (0.46%/s (CI 0.30%, 0.62%/s) vs 0.17%/s (0.13%, 0.21%/s)).ConclusionThis study demonstrates that muscle oxygenation is abnormal in children with both cyanotic and acyanotic congenital heart disease. This suggests that noninvasive monitoring of muscle oxygenation may provide valuable information in situations where children with congenital heart disease may be at risk of hemodynamic compromise.
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