RÉSUMÉ
The present study investigated the reliability and sensitivity of a wearable near-infrared spectroscopy (wNIRS) device in moderate and heavy exercise intensity domains. On three separate days, eleven males performed an incremental test to exhaustion, and in the following visits, four submaximal constant-load bouts (i.e., test and retest) were performed in the moderate-intensity domain (100 and 130 W) and heavy-intensity domain (160 and 190 W). The local tissue oxygen saturation index (SmO2) and pulmonary oxygen uptake (V̇O2) were measured continuously. The absolute SmO2 and V̇O2 values and the change (Δ) from the 3rd to 6th min of exercise were calculated. There was good reliability for SmO2 measurements, as indicated by the high intraclass correlation coefficient analysis (ICC ≥0.84 for all) and low coefficient of variation between the two trials (CV ≤4.1% for all). Steady-state responses were observed for SmO2 and V̇O2 from the 3rd to the 6th min in the two moderate-intensity bouts (P>0.05), whereas SmO2 decreased and V̇O2 increased from the 3rd to the 6th min in the two heavy-intensity bouts (P<0.05). Together, these findings suggested that the SmO2 measured with a wNIRS device is reliable and sensitive to track local metabolic changes provoked by slight increments in exercise intensity.
RÉSUMÉ
【Objective】 To explore the clinical effect of blood transfusion in children with anemia of different severity. 【Methods】 135 premature infants admitted to our hospital from January 2018 to December 2019 were selected as research subjects. They were divided into study group(n=99) and the control group(n=36) according to the presence or absence of anemia. The children in the study group were treated with red blood cell transfusion, and the vital signs, Hb, Hct and tissue oxygen saturation of the two groups were compared. 【Results】 After treatment, HR of severe anemicgroup was (118.4±9.2) times/min, which was significantly lower than that of control group as (127.1±12.4) times/min and mildanemic group as (125.7±11.5) times/min; RR of severe anemic group was (25.0±4.7) times/min, which was significantly lower than that of control group as (30.4±5.9) times/min and mild anemic group as(28.5±5.6) times/min.And the differences were statistically significant (P<0.05). After treatment, Hb in severe anemicgroup and moderate anemic group were (140.3±6.5) g/L and (147.4±7.2) g/L, respectively, and Hct in severe anemic group and moderate anemic group were (0.43±0.02) L/L and (0.46±0.02) L/L respectively, which were significantly higher than those before treatment (P<0.05). After treatment, cerebral oxygen saturation and intestinal tissue oxygen saturation of severe anemic group were (79.2±4.0)%and (80.0±4.3)%, which were significantly lower than those of control group (P<0.05). 【Conclusion】 Blood transfusion treatment can significantly improve Hb and Hct levels, as well astissue oxygen saturationof premature infants.
RÉSUMÉ
Objective To investigate the influence of different delayed cord clamping(DCC) time on cerebral tissue oxygen saturation in normal newborns after birth and to explore the causes.Methods From November 2018 to February 2019,164 healthy full term newborns were delivered in the Department of Obstetrics,Binhu Hospital,the Southern District of the Third Affiliated Hospital of Anhui Medical University.The newborns were divided into early cord clamping (ECC) group,DCC groups for 1 minute,2 minutes and 3 minutes according to the different cord clamping time,and the changes of cerebral tissue oxygen saturation index (cTOI) and cerebral tissue hemoglobin index (cTHI) were monitored by near infrared spectroscopy (NIRS) for 15 minutes after birth.Results After birth,cTOI increased gradually but cTHI was basically stable.The cTOI in DCC group was higher than ECC group,but there was no difference between group 3 and group 4.In ECC group,the cTOI tended to be stable about 6 minutes after birth,and the stable range was 55％-59％.In DCC group,group 2 tended to be stable about 8 minutes after birth,and the stable range was 59％-64％.Group 3 and group 4 tended to be stable about 10 minutes after birth,the stable range was 64％-69％.There was no difference in cTHI among the groups.Conclusions Delayed cord clamping can increase cerebral oxygenation in newborns.The cause may not be due to the direct increase in cerebral blood flow,but the increase in brain oxygen content,and the optimal duration of DCC is 2 minutes.
RÉSUMÉ
Objective@#To investigate the influence of different delayed cord clamping(DCC) time on cerebral tissue oxygen saturation in normal newborns after birth and to explore the causes.@*Methods@#From November 2018 to February 2019, 164 healthy full term newborns were delivered in the Department of Obstetrics, Binhu Hospital, the Southern District of the Third Affiliated Hospital of Anhui Medical University.The newborns were divided into early cord clamping (ECC) group, DCC groups for 1 minute, 2 minutes and 3 minutes according to the different cord clamping time, and the changes of cerebral tissue oxygen saturation index (cTOI) and cerebral tissue hemoglobin index(cTHI) were monitored by near infrared spectroscopy (NIRS) for 15 minutes after birth.@*Results@#After birth, cTOI increased gradually but cTHI was basically stable.The cTOI in DCC group was higher than ECC group, but there was no difference between group 3 and group 4.In ECC group, the cTOI tended to be stable about 6 minutes after birth, and the stable range was 55%-59%.In DCC group, group 2 tended to be stable about 8 minutes after birth, and the stable range was 59%-64%.Group 3 and group 4 tended to be stable about 10 minutes after birth, the stable range was 64%-69%.There was no difference in cTHI among the groups.@*Conclusions@#Delayed cord clamping can increase cerebral oxygenation in newborns.The cause may not be due to the direct increase in cerebral blood flow, but the increase in brain oxygen content, and the optimal duration of DCC is 2 minutes.
RÉSUMÉ
@#Objective To evaluate the possibility of monitoring regional tissue oxygen saturation by near-infrared spectroscopy (NIRS) for early predicting adverse events in patients with pulmonary atresia. Methods Twenty-six patients aged under 3 months who were diagnosed with pulmonary atresia and admitted to cardiovascular intensive care unit in our hospital between January 2016 and May 2017, accepted regional tissue oxygenation (cerebral and splanchnic) by near-infrared spectroscopy. There were 19 males and 7 females at age of 2–89 days. A total of 625 times of heart rate, blood pressure, pulse saturation, regional tissue oxygenation, and 98 serum lactate were retrospectively analyzed. The relationship of the tissue oxygen saturation and clinical adverse events was explored. Results The adverse event by routine monitoring was 69 (11.04%) person-time: isolated hypoxia in 27, hypoxia combined increased lactate in 16, hypotension in 6, hypotension combined increased lactate in 17, isolated increased lactate in 3. A reduction of 12.80% in cranial oxygen predicted the high probability of adverse events, with a sensitivity of 85.30% and a specificity of 87.00%. A reduction of 20.60% in splanchnic oxygen predicted the high probability of adverse event, with a sensitivity of 73.50% and a specificity of 91.2%. On average, the splanchnic oxygenation had fell 3 minutes before a reduction of blood pressure, or 45 minutes before an increase in lactate. Conclusion For preoperative patients with pulmonary atresia, a fall of 12.80%in cranial oxygen saturations, or of 20.60% in splanchnic oxygen saturation, should attract clinician’s awareness.
RÉSUMÉ
Objective:To determine the intervention measures for the decrease of cerebral tissue oxygen saturation during anesthesia for the congenital heart disease in children.Methods:Twenty-eight children with cardiac surgery were enrolled.Anesthesia was deepened with propofol (3 mg/kg) intravenous injection.The data of cerebral tissue oxygen saturation(SctO2),mean arterial pressure (MAP),HR,bispectral index (BIS),arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide (PaCO2),hemoglobin (Hb) and middle cerebral artery (MCA) mean flow velocity (Vm) at different points were collected after intravenous injection ofpropofol at 3 mg/kg.The changes of SctO2 and the influential factors were analyzed.Results:SctO2 decreased by 4.99％ after deepen anesthesia,with 95％ CI 4.33％ to 5.65％ (P＞0.05).There was no significant differince in MAP,PaO2,PaCO2,and Hb between the time points after deepen anesthesia and the baseline (P＞0.05).MCA Vm decreased obviously after deepen anesthesia for 1,5,10 min (P＜0.05).The decrease in MAP,HR,PaCO2 and MCAVm is positively correlated with the decrease in SctO2.Conclusion:The decrease of MAP,HR,PaCO2,and MCAVm is the risk factor for SctO2.To avoid the decrease,it needs to maintain the stability of SctO2 and prevent neurological complications.
RÉSUMÉ
BACKGROUND: Cardiopulmonary bypass (CPB) can cause systemic hypoperfusion, which remains undetected by routine monitoring of physiological parameters. Noninvasive tissue perfusion monitoring offers a clinical benefit by detecting low systemic perfusion. In this study, we tried to evaluate whether regional tissue perfusion saturation reflects systemic hypoperfusion during CPB. METHODS: This retrospective study included 29 patients with American Society of Anesthesiologists physical status II–III, who required cardiac surgery with CPB. We evaluated the correlations of serum lactate and delivery oxygen with organ perfusion values of peripheral tissue oxygen saturation and cerebral oxygen saturation. Data were recorded at different stages of CPB: T1 (pre-CPB), T2 (cooling), T3 (hypothermia), T4 (rewarming), and T5 (post-CPB). RESULTS: Lactate levels were elevated after CPB and up to weaning (P < 0.05). The levels of peripheral and tissue oxygen saturation decreased after the start of CPB (P < 0.05). Lactate levels were negatively correlated with peripheral tissue oxygen saturation levels at T4 (R = −0.384) and T5 (R = −0.370) and positively correlated with cerebral oxygen saturation at T3 (R = 0.445). Additionally, delivery oxygen was positively correlated with peripheral tissue oxygen saturation at T4 (R = 0.466). CONCLUSIONS: In this study, we demonstrated that peripheral tissue oxygen saturation can be a reliable tool for monitoring systemic hypoperfusion during CPB period. We also believe that peripheral tissue oxygen saturation is a valuable marker for detecting early stages of hypoperfusion during cardiac surgery.
Sujet(s)
Humains , Pontage cardiopulmonaire , Acide lactique , Oxygène , Perfusion , Études rétrospectives , Chirurgie thoracique , SevrageRÉSUMÉ
Objective To study the variability of oxygen saturation in intestinal tissue of preterm infants during erythrocyte infusion .Method Preterm infants aged over 5 days, hospitalized in our NICU from March 2016 to August 2016 were selected by computer random number generator . Near-infrared spectroscopy was applied to monitor splanchnic tissue oxygen saturation ( SrSO2 ) and cerebral tissue oxygen saturation(CrSO2)during erythrocyte transfusion.The duration of transfusion was 4 hours.The mean value and range of SrSO2 and CrSO2 during transfusion were analyzed.To analysis the average and variable range of SrSO2 and CrSO2 and to illuminate the correlation with post-conceptional age. Result A total of 34 premature infants were collected.The average of SrSO2 was (0.56 ±0.06) and the average of CrSO2 was (0.62 ±0.02) throughout transfusion, There was a significantly greater change in SrSO2 than in CrSO2 during the transfusion period (0.35 ±0.14 vs.0.18 ±0.09) (P<0.05).The changing range of CrSO2 was smaller as the post-conceptional age increased , and was significant different statistically ( P=0.006). While there was little change in the range of SrSO 2 (P=0.191).Conclusion The of SrSO2 change was more significant than CrSO 2 in preterm infants during erythrocyte transfusion , which may cause ischemia-reperfusion injury to the intestinal tissue .It should be more cautious to avoid transfusion-related necrotizing enterocolitis.
RÉSUMÉ
La cirugía artroscópica de hombro en posición de silla de playa es una cirugía frecuente y se asocia a buenos resultados. Causa preocupación el reporte de casos de isquemia cerebral asociados a morbimortalidad. Este artículo hace una revisión de la literatura referente a estos casos, realizando un análisis de los factores involucrados y de los cambios que ocurren al sentar a un paciente bajo el efecto de la anestesia general y/o regional. Es muy importante que el equipo quirúrgico comprenda las limitaciones de la técnica y concilie una buena exposición quirúrgica junto con el menor impacto hemodinámico. Actualmente se sugiere sentar a los pacientes con ángulos no mayores a 45°, evitar errores en la lectura de la presión arterial, que traduzcan un adecuado flujo sanguíneo cerebral. Cuando se mide oxigenación cerebral mediante NIRS (ScO2) las mayores caídas de los valores se asocian a anestesia general en ventilación mecánica con hiperventilación y en ángulos de posición de 80-90°. La anestesia regional se asocia a menores caídas de ScO2, pero requiere de un equipo con experiencia...
Shoulder arthroscopic surgery performed in the beach chair position is common and is associated with good results. The report of cases of cerebral ischaemia associated with morbidity and mortality is a cause for concern. This article presents a review of the literature concerning these cases, as well as an analysis of the factors involved and the changes that occur in patients when the beach chair position is used under general or regional anaesthesia. It is very important that the surgical team understands the limitations of the technique, and combines a good surgical exposure along with the least haemodynamic impact. Beach chair positions with angles not greater than 45°, are now suggested in order avoid errors in the blood pressure reading, which may lead to an adequate cerebral blood flow. When measuring cerebral oxygenation using NIRS (ScO2), the biggest drops in the values are associated with general anaesthesia and mechanical ventilation with hyperventilation and position angles of 80-90 degrees. Regional anaesthesia is associated with lower falls of ScO2, but requires an experienced team...
Sujet(s)
Humains , Arthroscopie/effets indésirables , Arthroscopie/méthodes , Épaule/chirurgie , Encéphalopathie ischémique/prévention et contrôle , Pression artérielle , Anesthésiques/effets indésirables , Complications postopératoires/prévention et contrôle , Hémodynamique , Encéphalopathie ischémique/étiologie , Consommation d'oxygène , Positionnement du patient , Posture , Facteurs de risqueRÉSUMÉ
PURPOSE: Near-infrared spectroscopy (NIRS) can noninvasively assess changes in tissue oxygen saturation (StO₂). The primary concern of the current study is to determine whether StO₂ can be used as a surrogate for global oxygenation parameters such as central venous oxygen saturation (ScvO₂), lactic acid, and base deficit (BD) in patients presenting to the emergency department (ED). METHODS: This was a prospective, observational study in patients requiring central venous catheter placement, admitted to the ED with complaints classified as infectious and non-infectious etiology. The NIRS sensor (15 mm probe) was applied on the thenar eminence for at least 3 minutes and ScvO₂, arterial lactic acid, and BD were measured during insertion of a central venous catheter. Data were analyzed using a simple correlation and Bland-Altman plot. RESULTS: A total of 120 patients were enrolled in the study and further classified as an infection (n=39) and a noninfection (n=81) group. Lactic acid BD showed significant correlation with StO₂ in total and in non-infection patients but the degree of correlation was weak and these correlations were not observed in infection patients. Approximately 94% of the difference between StO₂ and ScvO₂ was placed within limit of agreement but there was a risk that StO₂ may overestimate ScvO₂ when ScvO₂ becomes lower. When patients were assigned to two groups according to laboratory results (lactic acid 4.0 mmol/L; BD > 3.0 mmol/L; ScvO₂> 65% or 75%), no significant difference in StO₂ was observed between the two groups. CONCLUSION: In ED patients suspected of having systemic hypoperfusion, StO₂ showed a weak correlation with lactic acid and BD in non-infection patients and no correlation in infection patients. In addition, as ScvO₂ decreased, the difference between StO₂ and ScvO₂ showed a tendency to increase, and StO₂ was much higher than ScvO₂ at low ScvO₂ level. Therefore, before using StO₂ as surrogate for ScvO₂, lactic acid and BD in critically ill patients presenting to the ED, further investigation should be conducted to overcome the limitations of NIRS addressed in this study.
Sujet(s)
Humains , Voies veineuses centrales , Étude clinique , Maladie grave , Urgences , Service hospitalier d'urgences , Acide lactique , Microcirculation , Étude d'observation , Oxygène , Études prospectives , Spectroscopie proche infrarougeRÉSUMÉ
Poor circulation is considered to be a cause of stiff shoulders, but there have been no studies on deep hemodynamics and the subjective estimation/palpation of stiff shoulders. We evaluated the relationship between deep hemodynamics and the degree of the subjective estimation/palpation of stiff shoulders by near-infrared spectrophotometry.<br>The subjects were 146 patients who visited our center and 23 healthy volunteers. Deep hemodynamics (tissue oxygen saturation: StO<sub>2</sub>, total hemoglobin concentration: total Hb) was measured in the scapular region of the bilateral shoulders using a deep hemodynamics measurement system (PSA-IIIN, Biomedical Science), and its relationship with the severity of the subjective estimation of stiff shoulders (5-grade rating) and that of palpation (4-grade rating) was evaluated. Deep hemodynamic values were affected by the body mass index (BMI) that is highly correlated with subcutaneous fat thickness. Therefore, analysis was performed in 70 patients and 8 healthy volunteers with BMI of 20-24 that does not affect hemodynamic values. Compared with the healthy volunteers, patients who reported marked shoulder stiffness showed a significant decrease in total Hb, and that who reported shoulder stiffness showed a significant decrease in StO<sub>2</sub>. On the other hand, compared with the healthy volunteers, patients with marked shoulder stiffness observed by palpation showed significant decreases in both StO<sub>2</sub> and total Hb; the decreases were more marked with more marked stiffness. These results suggested that deep hemodynamics is a diagnostic parameter of stiff shoulders.