SpO2检测在颅脑急症患者足背动脉有创监测中的应用

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目的 观察脉搏血氧饱和度(pulseoximetry,SpO2)监测在足背动脉有创血压监测中应用的准确性及安全性.方法 意识障碍的颅脑急症患者60例,随机分为甲床实验组和SpO2+实验组,分别通过甲床颜色和SpO2波形及数值的变化评估足背侧支循环功能,对比实验结果.结果 甲床实验组30例患者,阳性8例,SpO2+实验组30例患者,2例为阳性(P<0.05).28例患者SpO2+实验前后SpO2值无统计学差异,拔出足背动脉穿刺导管后24 h,两组患者侧支循环功能评估比较无统计学差异.同时两组患者均未出现血肿,动脉血栓,肢体坏死等相关并发症.结论 SpO2+实验是对足背动脉有创监测前甲床实验的一个重要补充,通过对血氧饱和度数值及波形恢复时间的观察,可以排除部分人为因素干扰,对患者配合度的要求低、准确客观,可以很好的替代踇指甲床实验.临床工作中,更适合不能准确检测甲床实验的颅脑急症危重患者,并对于甲床实验可疑病例也可以应用此方法来快速验证.“,”Objective Observe the accuracy and the security of pulse oxygen saturation (SpO2) applied to the dorsalis pedis artery invasive blood pressure monitoring. Methods Select 30 patients with craniocerebral emergency and disturbance of consciousness. Compress the foot thumb hyponychium and the dorsalis pedis; the tibialis posterior arteria and the dorsalis pedis. Then, stop compressing the foot thumb hyponychium and the tibialis posterior arteria. Observe and record the time blood supply recovery costs (hyponychium test). Monitor the value and waveform of saturation of pulse oximetry (SpO2+test). Detect the status of collateral circulation. Make a comparison between the test results. Result The time that hyponychium test and SpO2+test cost respectively of 2 patients was more than 7s .So they were not included in the scope of observation .there were 22 negative patients with hyponychium test during the 28 cases, and 28 cases were negative for SpO2+test, the difference was statistically significant. There was no statistically difference between the value before SpO2+test and the value after the test. The time achieving normal value costs and the time waveform recovery costs both was less than 7s. 1 day later after removing the dorsalis pedis artery duct, repeated SpO2+test, all the cases were negative, except only 1 patient was still positive after correcting shock. But blood supply recovery cost 11 s, the status of collateral circulation proved normal. Conclusion SpO2+test is an important supplement of the hyponychium test before the arteria dorsalis pedis invasive monitoring. Through observing the value of blood oxygen saturation and the time of waveform recovery, we can eliminate some factitious factors, lower the requirement for patient compliance, and the result is accurate and objective. So SpO2+test replaces foot thumb hyponychium test. During the Clinical work, SpO2+test is more suitable for craniocerebral emergency patients who cannot be detected accurately with hyponychium test. And suspect cases of hyponychium test can also be verified quickly with this method.
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