Validation of Near-Infrared Spectroscopy for Monitoring Cerebral Autoregulation in Comatose Patients.
Validation of Near-Infrared Spectroscopy for Monitoring Cerebral Autoregulation in Comatose Patients.
复制标题
验证近红外光谱法，以监测昏迷患者的脑自动调节。
DOI：
10.1007/s12028-017-0421-8
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发表时间：
2017-12
影响因子：
3.5
通讯作者：
Hogue C
中科院分区：
文献类型：
--
作者：
Rivera-Lara L;Geocadin R;Zorrilla-Vaca A;Healy R;Radzik BR;Palmisano C;Mirski M;Ziai WC;Hogue C
经颅多普勒(TCD)无创测量脑血流速度(CBF)，是监测脑自动调节(CA)的常用方法。近红外光谱分析(NIRS)是一种以局部脑血氧饱和度(RSO2)代替脑血流量(CBF)的无创连续检测CA的方法。对于其在颅内病变患者中测定CA的准确性，人们知之甚少。本研究的目的是评估TCD方法监测急性神经损伤昏迷患者基于rSO2的CA的准确性。对33例昏迷患者进行床边监护，用TCD和NIRS测量CA。从昏迷开始，患者每天都要接受长达三天的监测。计算脑血氧饱和度指数(COX)作为rSO2慢波与平均动脉压(MAP)之间的运动相关。计算平均血流速度指数(Mx)为TCD测量的CBF慢波速度与MAP的相似系数。最佳血压定义为Mx和COX最低的MAP。用皮尔逊相关法比较平均Mx和COX以及基于Mx和COX的最优MAP。在这些相同的CA指标之间进行偏差分析。监测时间的中位数为60分钟(四分位数范围：48-78)。COX平均值与Mx-ABP值呈中度相关(R=0.4，P=0.005)。同样，COX和Mx-ABP计算的最佳MAP之间也有很强的相关性(R=0.87P<；0.001)。Bland-Altman分析显示COX对Mx与−的偏差(±标准差)为0.107(±0.191)，而由COX与Mx确定的最优MAP的偏差为1.9(±7.94)。用NIRS派生的COX监测CA是相关的，并与先前验证的基于TCD的方法有很好的一致性。这些结果表明，COX可作为急性颅脑损伤患者Mx监测的替代方法。
Transcranial Doppler (TCD) non-invasively measure cerebral blood flow (CBF) velocity and is a well-studied method to monitor cerebral autoregulation (CA). Near-infrared spectroscopy (NIRS) has emerged as a promising non-invasive method to determine CA continuously by using regional cerebral oxygen saturation (rSO2) as a surrogate for CBF. Little is known about its accuracy to determine CA in patients with intracranial lesions. The purpose of this study was to assess the accuracy of rSO2 based CA monitoring with TCD methods in comatose patients with acute neurologic injury. Thirty-three comatose patients were monitored at the bedside to measure CA using both TCD and NIRS. Patients were monitored daily for up to three days from coma onset. The cerebral oximetry index (COx) was calculated as the moving correlation between the slow waves of rSO2 and mean arterial pressure (MAP). The mean velocity index (Mx) was calculated as a similar coefficient between slow waves of TCD-measured CBF velocity and MAP. Optimal blood pressure was defined as the MAP with the lowest Mx and COx. Averaged Mx and COx as well as optimal MAP, based on both Mx and COx were compared using Pearson’s correlation. Bias analysis was performed between these same CA metrics. The median duration of monitoring was 60 minutes (Interquartile range [IQR]: 48 – 78). There was a moderate correlation between the averaged values of COx and Mx-ABP (R=0.40, p=0.005). Similarly, there was strong correlation between optimal MAP calculated for COx and Mx-ABP (R=0.87, P<0.001). Bland-Altman analysis showed moderate agreement with bias (± standard deviation) of −0.107 (±0.191) for COx versus Mx, and good agreement with bias of 1.90 (±7.94) for optimal MAP determined by COx versus Mx. Monitoring CA with NIRS-derived COx is correlated and had good agreement with previously validated TCD-based method. These results suggest that COx may be an acceptable substitute for Mx monitoring in patients with acute intracranial injury.
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影响因子：
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作者：
Hori, Daijiro;Hogue, Charles;Mandal, Kaushik
通讯作者：
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影响因子：
5.7
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