一种连续无创测量混合静脉血氧饱和度的方法

2020
10/12

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米勒之声
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一项对猪的概念验证研究

 本文由“小麻哥的日常”授权转载

临床麻醉中混合静脉血氧饱和度监测具有重要的作用,需要通过置入的肺动脉导管进行测量,该方法属于有创方法,具有一定的并发症和风险,同时需要一定的临床操作经验,下面介绍一种无创的连续监测方法,当然了,还处于动物实验验证阶段,期待能用于临床的,无创的,简便的监测方法。



一种连续无创测量混合静脉血氧饱和度的方法:一项对猪的概念验证研究


背景:混合静脉血氧饱和度(SvO2)在评价供氧与全身耗氧平衡时非常重要。到目前为止,监测SvO2需要肺动脉导管采集血样。本文将容积式容量二氧化碳描记术(volumetric capnography,测量有效的肺血流的方法)与Fick氧耗量原理相结合,建立了一种连续无创的capnodynamic SvO2法来测量SvO2。这项研究的目的是通过SvO2测量金标准来验证这项新技术,通过肺动脉导管获取血样是心输出量(CO)-氧饱和度是SvO2测量的(CO-oximetry SvO2)金标准,并评估肺内分流的潜在影响。


方法:8头麻醉机械通气的家养仔猪(平均体重23.9kg)接受一系列旨在降低和增加SvO2的干预措施。在整个研究方案中,同时记录capnodynamic SvO2和CO-oximetry SvO2以及分流分数,使用Berggren公式。采用Bland-Altman图和协方差分析法评估capnodynamic SvO2和CO-oximetry SvO2绝对值的一致性以及capnodynamic SvO2检测变化的能力。


结果:capnodynamic SvO2与CO-oximetry SvO2的总偏差为-1个百分点(一致性限为-13至+11个百分点),平均百分误差为22%,一致性为100%。分流分数在基线时为13%,在研究结束时为22%,并且测试方法之间的一致性只有微小的变化。


结论:在目前的实验环境下,SvO2的capnodynamic法测量值的绝对值非常接近于CO-oximetry法的测量值,并且有100%的趋势分析能力。


A Continuous Noninvasive Method to Assess Mixed Venous Oxygen Saturation: A Proof-of-Concept Study in Pigs


Background: Mixed venous oxygen saturation (SvO2) is important when evaluating the balance between oxygen delivery and whole-body oxygen consumption. Monitoring SvO2 has so far required blood samples from a pulmonary artery catheter. By combining volumetric capnography, for measurement of effective pulmonary blood flow, with the Fick principle for oxygen consumption, we have developed a continuous noninvasive method, capnodynamic SvO2, for assessment of SvO2. The objective of this study was to validate this new technique against the gold standard cardiac output (CO)-oximetry SvO2 measurement of blood samples obtained from a pulmonary artery catheter and to assess the potential influence of intrapulmonary shunting.


Methods: Eight anesthetized mechanically ventilated domestic-breed piglets of both sexes (median weight 23.9 kg) were exposed to a series of interventions intended to reduce as well as increase SvO2. Simultaneous recordings of capnodynamic and CO-oximetry SvO2 as well as shunt fraction, using the Berggren formula, were performed throughout the protocol. Agreement of absolute values for capnodynamic and CO-oximetry SvO2 and the ability for capnodynamic SvO2 to detect change were assessed using Bland-Altman plot and concordance analysis.


Results: Overall bias for capnodynamic versus CO-oximetry SvO2 was -1 percentage point (limits of agreement -13 to +11 percentage points), a mean percentage error of 22%, and a concordance rate of 100%. Shunt fraction varied between 13% at baseline and 22% at the end of the study and was associated with only minor alterations in agreement between the tested methods.


Conclusions: In the current experimental setting, capnodynamic assessment of SvO2 generates absolute values very close to the reference method CO-oximetry and is associated with 100% trending ability.


 

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本文由作者自行上传,并且作者对本文图文涉及知识产权负全部责任。如有侵权请及时联系(邮箱:guikequan@hmkx.cn
关键词:
饱和度,血氧,静脉,测量,监测

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