重症脳損傷患者における近赤外線分光分析装置（ＮＩＲＯ‐３００）を用いた脳酸素代謝障害の評価

DOI 被引用文献2件 参考文献22件

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  • Assessment of Oxygen Metabolism Derangement in Patients with Severe Brain Damage Using Near-infrared Spectroscopy (NIRO-300).

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To assess the derangement of oxygen metabolism in 28 patients with severe brain damage, near-infrared spectroscopy (NIRO-300®) was used in the intensive care unit. The consciousness in all patients scored 300 on the Japan Coma Scale (score 3 on the Glasgow Coma Scale) and bilateral pupils were dilated without light reflex. In addition to changes in oxygenated, deoxygenated, and total hemoglobin concentration, a tissue oxygenation index (TOI)--the ratio of oxygenated to total tissue hemoglobin--was measured at the forehead (TOI-B) and arm (TOI-A) simultaneously. Data was compared to that from 5 healthy subjects. Representative cases showed a correlation between TOI-B and the change in hemoglobin concentration or parameters monitored concurrently. In healthy subjects, TOI-B tended to be higher than TOI-A. In contrast, TOI-B of 28 patients was lower than TOI-A except for 1 with brain stem infarction. The time course of changes in TOI-A and B in transient cardiac arrest whole brain ischemia indicated that TOI-B fluctuated widely, whereas variations in TOI-A were not significant after the return of spontaneous circulation. This sharp variation was not observed in a good recovery without neurological deficit despite transient cardiac arrest. Multiple parameter recording showed a good correlation between the fluctuation in TOI-B and concentration in hemoglobin or cerebral perfusion pressure. We concluded that the breakdown of the relationship between oxygen delivery and consumption in the damaged brain reducted TOI-B. NIRO-300® may therefore have potential for simple, noninvasive diagnostic monitoring in patients with severe brain damage.

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