Microvascular response to transfusion in elective spine surgery  

作　　者：J Matthias Walz Ottokar Stundner Federico P Girardi Bruce A Barton Aimee R Koll-Desrosiers Stephen O Heard Stavros G Memtsoudis 

机构地区：[1]Department of Anesthesi-ology and Perioperative Medicine,UMass Memorial Healthcare [2]Department of Anesthesiology,Hospital for Special Surgery,Weill Cornell Medical Center [3]Department of Anesthesiology,PerioperativeMedicine and Intensive Care Medicine,Paracelsus Medical University [4]Department of Orthopedic Surgery,Hospital for Special Surgery,Weill Cornell Medical Center [5]Department of Quantitative Health Sciences,University of Massachusetts Medical School

出　　处：《World Journal of Orthopedics》2017年第1期49-56,共8页世界骨科杂志（英文版）

摘　　要：AIM To investigate the microvascular(skeletal muscle tissue oxygenation; SmO_2) response to transfusion in patients undergoing elective complex spine surgery.METHODS After IRB approval and written informed consent, 20 patients aged 18 to 85 years of age undergoing > 3level anterior and posterior spine fusion surgery were enrolled in the study. Patients were followed throughout the operative procedure, and for 12 h postoperatively. In addition to standard American Society of Anesthesiologists monitors, invasive measurements including central venous pressure, continual analysis of stroke volume(SV), cardiac output(CO), cardiac index(CI), and stroke volume variability(SVV) was performed. To measure skeletal muscle oxygen saturation(SmO_2) during the study period, a non-invasive adhesive skin sensor based on Near Infrared Spectroscopy was placed over the deltoid muscle for continuous recording of optical spectra. All administration of fluids and blood products followed standard procedures at the Hospital for Special Surgery, without deviation from usual standards of care at the discretion of the Attending Anesthesiologist based on individual patient comorbidities, hemodynamic status, and laboratory data. Time stamps were collected for administration of colloids and blood products, to allow for analysis of SmO_2 immediately before, during, and after administration of these fluids, and to allow for analysis of hemodynamic data around the same time points. Hemodynamic and oxygenation variables were collected continuously throughout the surgery, including heart rate, blood pressure, mean arterial pressure, SV, CO, CI, SVV, and SmO_2. Bivariate analyses were conducted to examine the potential associations between the outcome of interest, SmO_2, and each hemodynamic parameter measured using Pearson's correlation coeffi-cient, both for the overall cohort and within-patients individually. The association between receipt of packed red blood cells and SmO_2 was performed by running an interrupted time series model, with SmO_2 AIM To investigate the microvascular(skeletal muscle tissue oxygenation; SmO_2) response to transfusion in patients undergoing elective complex spine surgery.METHODS After IRB approval and written informed consent, 20 patients aged 18 to 85 years of age undergoing > 3level anterior and posterior spine fusion surgery were enrolled in the study. Patients were followed throughout the operative procedure, and for 12 h postoperatively. In addition to standard American Society of Anesthesiologists monitors, invasive measurements including central venous pressure, continual analysis of stroke volume(SV), cardiac output(CO), cardiac index(CI), and stroke volume variability(SVV) was performed. To measure skeletal muscle oxygen saturation(SmO_2) during the study period, a non-invasive adhesive skin sensor based on Near Infrared Spectroscopy was placed over the deltoid muscle for continuous recording of optical spectra. All administration of fluids and blood products followed standard procedures at the Hospital for Special Surgery, without deviation from usual standards of care at the discretion of the Attending Anesthesiologist based on individual patient comorbidities, hemodynamic status, and laboratory data. Time stamps were collected for administration of colloids and blood products, to allow for analysis of SmO_2 immediately before, during, and after administration of these fluids, and to allow for analysis of hemodynamic data around the same time points. Hemodynamic and oxygenation variables were collected continuously throughout the surgery, including heart rate, blood pressure, mean arterial pressure, SV, CO, CI, SVV, and SmO_2. Bivariate analyses were conducted to examine the potential associations between the outcome of interest, SmO_2, and each hemodynamic parameter measured using Pearson's correlation coeffi-cient, both for the overall cohort and within-patients individually. The association between receipt of packed red blood cells and SmO_2 was performed by running an interrupted time series model, with SmO_2

关 键 词：TRANSFUSION Complex SPINE surgery Near infrared spectroscopy MICROVASCULAR BLOOD flow HEMODYNAMIC monitoring 

分 类 号：R687.3[医药卫生—骨科学] R457.1[医药卫生—外科学]