Zusammenfassung
Wir untersuchten, ob die mit Hilfe der Nah-Infrat-Spektroskopie (NIRS) eine kontinuierliche, nicht-invasive zuverlässige Überwachung der zerebralen Gewebeoxygenierung bei Kindern zur Verfügung steht. Das Nah-Infrarot-Spektroskop NIRO 300 (Hamamatsu Photonics, Japan) liefert nicht nur die üblichen Messwerte bezüglich der Änderungen von Hämoglobin- und Cytochromkonzentrationen, zusätzlich können mit Hilfe der so genannten „Spatially resolved spectroscopy“ Methode absolute Werte als so genannter „Gewebeoxygenierungsindex“ (TOI= tissue oxygenation index) erfasst werden. Im Rahmen elektiver Herzkatheteruntersuchungen wurden die zerebralen TOI-Werte mit den Werten der Sauerstoffsättigung im Bulbus jugularis der Vena jugularis interna (SjO2) durch Co-Oximetrie (OSM3-Hemoximeter, Radiometer Kopenhagnen, Dänemark), die als Referenzmethode fungierte, verglichen. Wir untersuchten 60 Kinder mit zyanotischen (n=15) und nicht-zyanotischen (n=45) Herzfehlern in einem mittleren Alter von 4,4 (0,1–16) Jahren während elektiver Herzkatheteruntersuchungen. Die Daten wurden mit der linearen Regressionsanalyse ausgewertet und der Pearson’s Korrelationskoeffizient ermittelt. Das untersuchte Kollektiv wurde in zwei Gruppen aufgeteilt: Patienten unter und über 10 kg Körpergewicht. Die mittels NIRS gemessene zerebralen TOI-Werte (65,7±7,2%; 39–80%) zeigten eine signifikante Korrelation mit den Sättigungswerten im Bulbus jugularis (67,3±9,8%, 40–84,1%) (r=0,72; p<0,001). Die Korrelation in der Gruppe der Patienten unter 10 kg (n=29) Körpergewicht war besser (r=0,81, p<0,001), wobei sie bei den Patienten über 10 kg zwar signifikant, aber schwach korrelierend war (r=0,44, p<0,05). Es zeigte sich, dass vor allem bei Kindern unter 10 kg Körpergewicht die Messung des zerebralen Gewebeoxygenierungsindex TOI eine verlässliche Aussage über den zerebralen Oxygenierungszustand liefert.
Summary
We investigated whether near infrared spectroscopy (NIRS) is a satisfactory continuous non-invasive diagnostic tool for monitoring cerebral oxygenation in infants. New generations of NIRS devices, such as the NIRO 300 (Hamamatsu Photonics, Japan), use spatially resolved spectroscopy (SRS) not only to provide the usual measurements of changes in haemoglobin concentration, but also to allow calculation of a tissue oxygenation index (TOI) as an absolute term, independent of a tissue path length factor. We compared cerebral TOI measured by NIRS and, as the reference method, venous oxygen saturation in the jugular bulb (SjO2) measured by co-oximetry (OSM3 Hemoximeter, Radiometer Copenhagen, Denmark) during elective cardiac catheterization of children with cyanotic and non-cyanotic congenital heart defects. We examined 60 infants (median age: 4.4 years, 0.1–16 years) admitted for cardiac catheterization because of cyanotic (n=15) and non-cyanotic (n=45) congenital heart defects. Cerebral TOI was compared to SjO2 taken from the jugular bulb during cardiac catheterization. Linear regression analysis and Pearson’s correlation coefficient were calculated. Patients were divided into two groups regarding body weight: below and above 10 kg. Simultaneously measured values for SjO2 (67.3±9.8%, 40–84.1%) and cerebral TOI (65.7±7.2%, 39–80%) showed a significant correlation (r=0.72, p<0.001). Correlation in the group of children under 10 kg body weight (n=29) was even stronger (r=0.81, p<0.001), whereas correlation in children over 10 kg body weight was less satisfactory (r=0.44, p<0.05). The results demonstrate that cerebral tissue oxygenation index measured by NIRS provides reliable information concerning cerebral oxygenation, particularly in children with less than 10 kg body weight.
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Nagdyman, N., Fleck, T.P., Schubert, S. et al. Vergleich des zerebralen Oxygenierungsindex gemessen mittels Nah-Infrarot-Spektroskopie mit der Sauerstoffsättigung im Bulbus jugularis bei Kindern. Z Herz-, Thorax-, Gefäßchir 18, 216–221 (2004). https://doi.org/10.1007/s00398-004-0458-9
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DOI: https://doi.org/10.1007/s00398-004-0458-9
Schlüsselwörter
- Zerebrale Oxygenierung
- Nahinfrarot-Spektroskopie (NIRS)
- Gewebeoxygenierungsindex (TOI)
- Jugularvenöse Sauerstoffsättigung (SjO2)
- Kinder