两种近红外光谱仪测量成人及儿童心脏外科术后脑血氧饱和度的准确性比较

摘要

目的 比较NIRO-200nx和EGOS-600A近红外光谱仪测量成人及儿童心脏外科术后脑血氧饱和度(rScO2)的准确性.方法 实验室实验:使用人体全血40ml、20％脂肪乳剂25ml、磷酸盐缓冲液935ml制作液体血液模型,通过依次向血液模型中充入氧气与添加连二亚硫酸钠使血氧饱和度(SpO2)先升高至100％后阶梯状下降至20％.在每个稳定状态下测量SpO2值.临床试验:随机选取2014年7-8月首都医科大学附属北京安贞医院心脏外科术后l周内的成人20例和儿童31例,将2种仪器的探头随机先后放置在患者前额中部,每2～3h采集1次rScO2数值.使用Bland-Altman检验及相关性分析进行数据分析.结果 2种仪器共采集11对SpO2值和各100对rScO2值.实验室实验中2种仪器相关系数为0.9983,偏差为-2％,一致性界限为-24％～ 20％.当2种仪器所测SpO2均值＜50％时,EGOS-600A高估SpO2,SpO2均值＞50％时,EGOS-600A低估SpO2.在临床生理范围即40％ ～ 80％对SpO2进行分析,偏差为-8％,一致性界限为-20％ ～ 4％.临床试验中儿童组偏差为-5.9％,一致性界限为-13.6％ ～1.8％;成人组偏差为-4.2％,一致性界限为-11.8％ ～3.5％.结论 与NIRO-200nx相比,EGOS-600A略低估rScO2,二者测量rScO2数值的相关性及一致性界限可以接受.EGOS-600A可以广泛用于中国儿童与成人rScO2的临床监测.%Objective To compare NIRO-200nx near-infrared spectroscopy and EGOS-600A near-infrared spectroscopy in measuring cerebral oxygen saturation (rScO2) after cardiac surgery in adults and children.Methods Liquid blood model included human whole blood 40ml,20％ intralipid 25ml and phosphate buffer solution 935 ml;a range of 20％-100％ of oxygen saturation(SpO2) was made by inflating oxygen and adding sodium hydrosulfite;values f SpO2 were measured at stable states.Twenty adults and 31 children 1 week after cardiac surgery from July to August in 2014 in Beijing Anzhen Hospital,Capital Medical University were enrolled;probes of 2 kinds of spectrometers were sequentially randomly placed at the middle of forehead to measure rScO2 every 2-3 h.Bland-Altman test and correlation analysis were used for data analysis.Results Eleven pairs of SpO2 totally and 100 pairs of rScO2 respectively were collected from 2 kinds of spectrometers.In laboratory test,the correlation coefficient was 0.9983,the deviation was-2％ and the consistent limit was-24％-20％.EGOS-600A spectrometer overestimated SpO2 when the mean value was below 50％,and it underestimated SpO2 when the mean value was beyond 50％.Values of SpO2 were analyzed within clinical physiological range (SpO2 40％-80％);the deviation was -8％ and the consistent limit was-20％-4％.In clinical test,the deviations were-5.9％ and-4.1％,the consistent limits were-13.6-1.8％ and-11.8％-3.5％ respectively in children and adults.Conclusion EGOS-600A near-infrared spectroscopy slightly underestimates rScO2 compared to NIRO-200nx near-infrared spectroscopy.EGOS-600A near-infrared spectroscopy can be used in clinical monitoring of rScO2 in adults and children.