局部脑氧饱和度监测的临床应用进展  

Research progress on the clinical application of monitoring brain oxygen saturation

作　　者：张凤 高逸龙 高金贵[1] ZHANG Feng;GAO Yilong;GAO Jingui(Department of Anesthesia,The Second Hospital of Hebei Medical University,Hebei,Shijiazhuang 050000,China;不详)

机构地区：[1]河北医科大学第二医院麻醉科,石家庄市050000 [2]郑州大学医学院临床医学系

出　　处：《河北医药》2021年第17期2678-2683,共6页Hebei Medical Journal

摘　　要：大脑是人体能量代谢最活跃、需氧及耗氧量最大而氧储备量最小的器官,对缺氧环境比较敏感,短暂缺氧即可造成不可逆的中枢神经系统损伤。近年来近红外光谱(near-infrared spectroscopy,NIRS)技术可以监测额叶皮质脑组织局部脑氧饱和度(regional cerebral oxygen saturation,rScO_(2))的变化,通过脑组织微脉管水平(其中包括了25%小动脉、70%小静脉和5%毛细血管)的血氧饱和度来反映脑组织氧的供需平衡情况,判断脑缺血的发生。基本原理主要是根据Beer-Lambert定律,即光线在溶液中的通透性取决于溶液中可吸收分子的密度(浓度)及光波的波长。在很多诊疗过程中都存在着脑组织灌注不足的风险,诊疗过程中如果患者出现rScO_(2)下降则发生神经系统并发症如神经心理功能障碍、脑卒中、认知功能障碍等风险将显著增加。由于NIRS技术监测rScO_(2)操作简单、无创,可以进行连续监测而广泛应用于临床。此技术较常规监测指标有更高的灵敏度和特异度,故更有利于保障患者脑功能安全,减少神经系统并发症的发生。文章结合近年国内外最新研究,分析NIRS技术监测rScO_(2)的实用性及准确性,介绍NIRS技术监测rScO_(2)的基本原理、围术期应用新进展以及未来展望、心肺复苏、新生儿领域应用及影响因素。推广其在诊疗过程中高危人群的应用,以减少神经系统并发症,改善患者预后,使其在临床工作中发挥更大的功效。The brain is the organ with the most active energy metabolism,the highest oxygen demand and oxygen consumption,and the lowest oxygen reserve,and it is sensitive to the hypoxia environment,and transient hypoxia can cause irreversible central nervous system damage.In recent years,near-infrared spectroscopy(NIRS)can monitor the changes of regional cerebral oxygen saturation(rScO_(2))in frontal cortex,and reflect the balance of oxygen supply and demand in brain tissue by blood oxygen saturation of cerebral microvascular level(including 25%arterioles,70%venules and 5%capillaries)to judge the occurrence of cerebral ischemia.The basic principle is mainly based on the Beer-Lambert law,that is,the permeability of light in a solution depends on the density(concentration)of absorbable molecules in the solution and the wavelength of the light wave.During the diagnosis and treatment,there exists a risk of insufficient brain tissue perfusion,if patients have a decline in rScO_(2),the risk of neurological complications including neuropsychological dysfunction,stroke,cognitive dysfunction,will significantly increase.NIRS technique for monitoring rScO_(2) is widely used in clinical practice because it is easy to operated and non-invasive,allowing continuous monitoring.Based on the latest research grogress in home and abroad,this article analyzes the practicability and accuracy of NIRS technology in monitoring rScO_(2),introduces the basic principle of NIRS technology in monitoring rScO_(2),the new progress and future prospect in perioperative application,the application of cardiopulmonary resuscitation,and in neonate department as well as its influencing factors,so as to promote its application in high-risk groups to decrease the neurological complications and improve the prognosis of patients,and make it play a greater role in clinical practice.

关 键 词：脑氧饱和度 监测 临床应用 

分 类 号：R195[医药卫生—卫生统计学]