Association of intraoperative tissue oxygenation with suspected risk factors for tissue hypoxia

作者：Spruit R J^*; Schwarte L A; Hakenberg O W; Scheeren T W L

来源：Journal of Clinical Monitoring and Computing, 2013, 27(5): 541-550.

DOI：10.1007/s10877-013-9460-7

• Anesthesia, general
• Blood pressure
• Microcirculation
• Monitoring, oxygen/metabolism
• Tissue oxygenation
• Spectroscopy, near-infrared

Tissue hypoxia may cause organ dysfunction, but not much is known about tissue oxygenation in the intraoperative setting. We studied microcirculatory tissue oxygen saturation (StO(2)) to determine representative values for anesthetized patients undergoing urological surgery and to test the hypothesis that StO(2) is associated with known perioperative risk factors for morbidity and mortality, conventionally monitored variables, and hypotension requiring norepinephrine. Using near-infrared spectroscopy, we measured StO(2) on the thenar eminence in 160 patients undergoing open urological surgery under general anesthesia (FiO(2) 0.35-0.4), and calculated its correlations with age, risk level for general perioperative complications and mortality (high if age a parts per thousand yen70 and procedure is radical cystectomy), mean arterial pressure (MAP), hemoglobin concentration (Hb), central venous oxygen saturation (ScvO(2)), and norepinephrine use. The time averaged StO(2) was 86 +/- A 6 % (mean +/- A SD). In the multivariate analysis, Hb [standardized coefficient (SC) 0.21, p = 0.003], ScvO(2) (SC 0.53, p %26lt; 0.001) and high risk level (SC 0.06, p = 0.03) were significant independent variables correlated with StO(2). StO(2) was partly dependent on MAP only when this was below 65 mmHg (lowest MAP SC 0.20, p = 0.006, MAP area under the curve %26lt; 65 mmHg SC 0.03, p = 0.02). Finally, StO(2) was slightly lower in patients requiring norepinephrine (85 +/- A 6 vs. 89 +/- A 6 %, p = 0.001). Intraoperative StO(2) in urological patients was comparable to that of healthy volunteers breathing room air as reported in the literature and correlated with known perioperative risk factors. Further research should investigate its association with outcome and the effect of interventions aimed at optimizing StO(2).

• 出版日期2013-10