脉搏血氧测定法检测牙髓血流的临床研究

目的探讨脉搏血氧测定法检测牙髓血氧饱和度的可行性。方法采用Nellcor OxiMax N560脉搏血氧仪加分离探头,测定100名年龄12～18岁体检牙齿健康者恒上颌中切牙、上颌侧切牙及上颌尖牙和食指的血氧饱和度,并进行统计分析。结果食指血氧饱和度为（98.59±1.06）%,健康上颌前牙血氧饱和度为（84.18±2.26）%,差异有统计学意义（P〈0.05））;上颌中切牙、侧切牙和尖牙的血氧饱和度水平比较差异均无统计学意义（P〉0.05）;牙齿血氧饱和度水平与食指血氧饱和度水平无相关性（P〉0.05）。结论脉搏血氧测定法检测牙髓血氧饱和度可用于判定牙齿的牙髓活力状况。     

重症监护护士的脉搏血氧仪知识

在当代医疗保健环境里,血氧饱和度监测是非常重要的,因为它是血氧测定的重要部分。血氧饱和度监测被描述为患者监测方面的最重要进展之一。1980年以前,连续性判断患者组织缺氧主要根据皮肤紫绀程度进行估计。这种方法缺乏客观性。紫绀只是组织严重缺氧的标志,氧饱和度下降到80%~85%之前,临床上可无任何皮肤颜色的改变。由于脉搏血氧仪的应用,使临床血氧饱和度监测能在临床上有效开展。血氧饱和度持续监测(SpO2)已成为许多卫生保健体系中一种护理标准,在重症监护、手术室、麻醉后护理及给予镇静剂期间,其显得尤为重要。常规脉搏血氧仪的工作…     

脉搏血氧饱和仪对慢性阻塞性肺疾病患者进行血氧监测的价值研究

目的探究慢性阻塞性肺疾病(COPD)患者脉搏血氧饱和度(SpO₂)与动脉血气分析血氧饱和度(SaO₂)的一致性,以确定脉搏血氧饱和仪对COPD患者进行血氧监测的价值。方法收集2019年1-6月我院急诊科收治入院的69例慢性支气管炎和/或肺气肿患者相关数据,根据住院后的肺功能和胸部平扫检查结果分为慢支炎组16例、肺气肿组11例和COPD组42例,用GraphPad Prism 8统计学软件对3组患者的SpO₂值和SaO₂值进行一致性检验(Bland-Altman分析)和偏倚分析;用Excel 2007对3组病例SpO₂值的敏感性、特异性、阴性预测值和阳性预测值进行公式计算。结果 Bland-Altman分析提示,当患者血氧饱和度>90%时,SpO₂值与SaO₂值的差值在"0"上下,随着患者缺氧程度的加重,SaO₂和SpO₂之间的差值也越来越大。3组病例数据均显示其SpO₂     

脉搏血氧饱和度仪的研究进展

脉搏血氧饱和度仪已广泛应用于临床危重症患的监测和术中麻醉监测，对其原理的不断深入研究促进了仪器发展。本就脉搏血氧饱和度仪的发展历史、设计原理及进展和未来的展望做简要综述。     

脉搏血氧饱和度仪用于氧疗患儿的监测

脉搏血氧饱和度仪是连续或间断监测血氧饱和度（SsO2）和脉率的电子仪器。2005年10月至2006年10月通过对178例氧疗患儿运用脉搏血氧饱和度仪进行合理的监测，测得的结果能够及时准确地为医护人员提供患儿的呼吸状况、缺氧程度以及机体组织的氧和情况等信息，在呼吸道准备、合理用氧、及时调整氧浓度、预防氧中毒等并发症的诊断、治疗、护理等方面具有十分重要的临床指导意义。     

监测脉搏血氧饱和度的护理

监测脉搏血氧饱和度的护理６１００４１四川省肿瘤医院陈潭绥监测脉搏血氧饱和度，具有无创、简便、安全、迅速的优势，在重症监护中居于重要地位。好多国家明文规定将监测脉搏血氧饱和度作为重症监护的必备手段。重症监护护士如何准确进行脉搏血氧饱和度的监测，并正确评...     

指甲油颜色对脉搏血氧饱和度监测的影响

目的　探讨不同颜色指甲油对脉搏血氧饱和度 (SpO2 )监测数值的影响。方法　对 30例志愿者进行自身对照 ,每位志愿者分别涂有 4种不同颜色的指甲油 ,与不涂指甲油的空白手指进行比较 ,观察吸空气和吸氧气时不同颜色指甲油对SpO2 监测数值的影响。结果　吸空气和吸氧气时 ,蓝色指甲油对SpO2 监测有显著影响 (与空白组对照 ) ,P <0 .0 1。结论　无论患者吸氧与否 ,蓝色指甲油都会影响SpO2 监测的数值。为减少临床测量误差 ,吸氧时应去除指甲油 ,或者将探头侧夹 ,以保证监测的准确性     

Pulse oximetry: Analysis of theory,technology, and practice

Interest in two-wavelength classic, that is, nonpulse, oximetry began early in the 20th century. Noninvasive in vivo measurements of oxygen saturation showed promise, but the methods were beset by several problems. The pulse oximetry technique, by focusing on the pulsatile arterial component, neatly circumvented many of the problems of the classic nonpulse arterial approach. Today's pulse oximeter owes a good measure of its success to the technologic advances in light emission and detection and the ready availability of microcomputers and their software. Many clinicians have recognized how valuable the assessment of the patient's oxygenation in real time can be. This appreciation has propelled the use of pulse oximeters into many clinical fields, as well as nonclinical fields such as sports training and aviation. Understanding how and what pulse oximetry measures, how pulse oximetry data compare with data derived from laboratory analysis, and how the pulse oximeter responds to dyshemoglobins, dyes, and other interfering conditions must be understood for the correct application and interpretation of this revolutionary monitor.     

Evaluation of the palmar circulation by pulse oximetry

The usual method of substantiating collateral circulation of the hand is with Allen's test. We used the pulse-detecting capability of the pulse oximeter to assess the presence of collateral circulation of the hand. Thirty-one patients undergoing radial artery cannulation for intraoperative monitoring were evaluated before cannulation with a modified Allen's test and by pulse oximetry. After the collateral circulation of the hand was tested by the modified Allen's test, a pulse oximeter probe was placed on the index finger. Both radial and ulnar arteries were occluded until no perfusion was detected by the pulse oximeter. The test was repeated twice on each hand, once for each artery. The time to reperfusion after arterial release was recorded. Reperfusion times greater than 15 seconds were considered abnormal. This sequence was repeated postoperatively after the radial artery cannulae were removed. A total of 68 tests were performed before cannulation; 3 showed an abnormal Allen's test, a finding confirmed by pulse oximetry evaluation. The Allen's test was indeterminate 13 times. In all of these cases, pulse oximetry demonstrated collateral blood flow. When collateral circulation was determined to be present by Allen's test, it was also found to be present with pulse oximetry. Three days after cannulation was discontinued, 8 patients had abnormal Allen's test results, a finding again confirmed by pulse oximetry evaluation. Of 15 patients with indeterminate Allen's test results, 12 had collateral blood flow determined by pulse oximetry and 3 had abnormal results. The ability of pulse oximetry to detect collateral circulation was significantly different (P<0.001) when compared with Allen's test both before and after radial artery cannulation. Using the photoplethysmographic component of the pulse oximeter may improve the assessment of collateral circulation of the hand in which arterial cannulation is being contemplated.     

Evaluation of the palmar circulation by pulse oximetry

The usual method of substantiating collateral circulation of the hand is with Allen's test. We used the pulse-detecting capability of the pulse oximeter to assess the presence of collateral circulation of the hand. Thirty-one patients undergoing radial artery cannulation for intraoperative monitoring were evaluated before cannulation with a modified Allen's test and by pulse oximetry. After the collateral circulation of the hand was tested by the modified Allen's test, a pulse oximeter probe was placed on the index finger. Both radial and ulnar arteries were occluded until no perfusion was detected by the pulse oximeter. The test was repeated twice on each hand, once for each artery. The time to reperfusion after arterial release was recorded. Reperfusion times greater than 15 seconds were considered abnormal. This sequence was repeated postoperatively after the radial artery cannulae were removed. A total of 68 tests were performed before cannulation; 3 showed an abnormal Allen's test, a finding confirmed by pulse oximetry evaluation. The Allen's test was indeterminate 13 times. In all of these cases, pulse oximetry demonstrated collateral blood flow. When collateral circulation was determined to be present by Allen's test, it was also found to be present with pulse oximetry. Three days after cannulation was discontinued, 8 patients had abnormal Allen's test results, a finding again confirmed by pulse oximetry evaluation. Of 15 patients with indeterminate Allen's test results, 12 had collateral blood flow determined by pulse oximetry and 3 had abnormal results. The ability of pulse oximetry to detect collateral circulation was significantly different (P<0.001) when compared with Allen's test both before and after radial artery cannulation. Using the photoplethysmographic component of the pulse oximeter may improve the assessment of collateral circulation of the hand in which arterial cannulation is being contemplated.     

Pulse oximetry during cardiac catheterization in children with congenital heart disease

One hundred and five children with congenital heart disease were monitored by pulse oximetry during cardiac catheterization. Excellent correlation (r = 0.95) was found between oxygen saturation values obtained with pulse oximetry and those obtained from arterial blood in 133 data pairs. This correlation was described by the regression equation y = 0.91 x + 8.1. The correlation was also excellent in 47 data pairs with saturation values of less than 90% (r = 0.94, y = 0.93x + 6.0) from 36 cyanotic children. The clinical usefulness of pulse oximetry in the early recognition of decreased pulmonary blood flow or partial airway obstruction was demonstrated. Early diagnosis of changes in oxygenation was especially helpful in children with cyanotic congenital heart disease, in whom small changes in arterial oxygen tension may cause large changes in oxygen saturation.     

Reflectance pulse oximetry at the forehead of newborns: The influence of varying pressure on the probe

Objective: Transmission pulse oximetry (TPO) is not a practical method of intrapartum fetal monitoring of arterial oxygen saturation. Reflectance pulse oximetry (RPO) requires a sensor applied to the skin of the fetal head and may be a useful technique. During labor, various degrees of pressure will be exerted on the RPO sensor. Previous studies have shown that moderate pressure on the sensor can improve the RPO signal. At increasing pressure, however, blood flow underneath the sensor will be occluded. This study examines the influence of pressure applied to the RPO sensor on the signal from the forehead of healthy newborns as a model for the fetal situation.Methods: After institutional approval, 12 healthy newborns were studied. The RPO probe was placed at the forehead. Pressure on the probe was increased stepwise from 0 to 80 mmHg, and the effect on the ratio between the relative changes of the red and infrared light intensities (R/IR, inversely related to oxygen saturation) and pulse sizes was evaluated. Additionally, the effect of firm pressure (>150 mmHg) on the probe was evaluated.Results: R/IR values remained virtually unchanged when pressure onto the probe was increased from 0 to 80 mmHg, although the standard deviation slightly decreased. The pulse size increased as pressure on the probe increased. During firm pressure on the probe (> 150 mmHg), plethysmographic signals remained detectable, but R/IR values markedly increased.Conclusions: In newborns, mild to moderate pressure on the probe has little influence on the RPO signal at the forehead. Even during firm pressure, RPO can be used to obtain pulsatile signals, that presumably derive from tissue underneath the skull, such as the cerebral circulation.     

Failure rate of pulse oximetry in the postanesthesia care unit

Objective. The objective of this study was to prospectively examine the incidence of patient-related failure of pulse oximetry in the postanesthesia care unit (PACU).Methods. We studied 2,937 patients who, after receiving anesthesia, were admitted to the PACU at the University of Washington Medical Center from December 1989 through May 1990. Pulse oximetry readings were recorded using a Nellcor N-200 oximeter without electrocardiographic synchronization. Failure was defined as the inability to obtain a pulse oximetry reading for 2 or more 15-minute periods after eliminating probe position or mechanical malfunctions.Results. The overall failure rate in our study was 0.64%, with 19 patient-related pulse oximetry failures from 2,937 cases. Patients on whom the device failed were significantly older (62±18 vs 46±19 yr [mean ± SD];p<0.01), had higher median American Society of Anesthesiologists status (3 vs 2), and had longer operations than nonfailure patients (328±182 vs 185±127 min;p<0.01). There was no difference in the duration of PACU times for both groups.Conclusions. The failure rate and patient characteristics compare favorably with a previously published study of intraoperative pulse oximetry failure. We conclude that while the pulse oximeter is a reliable instrument for the measurement of blood oxygenation, there is a small but consistent incidence of patient-related failure with this monitoring device in the PACU.

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Kurzfassung Ziel. Ziel dieser Studie war es, das Auftreten von zu erwartenden patientenbezogenen Fehlern bei der Pulsoximetrie im Rahmen der Überwachung nach der Anästhesie zu untersuchen.Methoden. Wir untersuchten 2937 Patienten, die von Dezember 1989 bis Mai 1990 nach einer Anästhesie am University of Washington Medical Center überwacht wurden. Die Pulsoximetrie-Meßwerte wurden mit einem Nellcor N-200-Oximeter ohne elektrokardiographische Synchronisation aufgezeichnet. Ein Fehler wurde definiert als das Unvermögen, Pulsoximetrie-Meßwerte über zwei oder mehr 15-minütige Zeiträume zu erhalten, nachdem Störungen der Fühlerposition oder mechanische Störungen ausgeschaltet worden waren.Ergebnisse. Die Gesamtfehlerrate in unserer Studie betrug 0,64% bei 19 patientenbezogenen Pulsoximetriefehlern in 2937 Fällen. Die Patienten, bei denen ein Fehler am Gerät auftrat, waren signifikant älter (62±18 zu 46±19 Jahre [Mitte] ± SD];p<0,01), besaßen einen höheren mittleren American Society of Anesthesiologists-Status (3 zu 2) und hatten längere Operationen als die Patienten, bei denen kein Gerätefehler aufgetreten war. Es gab keinen Unterschied zwischen den beiden Gruppen in der Dauer der Überwachung nach der Anästhesie.Schlußfolgerung. Die Fehlerrate und die Patientenmerkmale sind mit denen einer früher veröffentlichten Untersuchung über intraoperative Pulsoximetriefehler vergleichbar. Wir schließen daraus, daß, während das Pulsoximeter ein verläßliches Instrument zur Messung der Sauerstoffsättigung ist, im geringen, aber konsistenten Umfang patientenbezogene Fehler bei diesem Überwachungsgerät während der Überwachung nach der Anästhesie auftreten.

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Resumen Objetivo. El objetivo de este estudio fue examinar prospectivamente la incidencia de fracasos relacionados al paciente de la oximetría de pulso en la unidad de cuidados postanestésicos (PACU).Métodos. Estudiamos 2937 pacientes, quienes luego de recibir anestesia fueron admitidos a la PACU del Centro Médico de la Universidad de Washington, entre Diciembre de 1989 y Mayo de 1990. Fracaso fue definido como la imposibilidad de obtener lectura de oximetría de pulso por dos o más períodos de 15 minutos, una vez corregidos los problemas debidos a mala posición del sensor o problemas mecánicos.Resultados. La incidencia global de fracasos relacionados al paciente de la oximetría de pulso en este estudio fue 0.64%, con 19 fracasos en 2,937 casos. Los pacientes en quienes no se pudo obtener señal eran significativamente mayores (62±18 vs 46±19 años [promedio ± DS]; p<0.01), presentaban mayor mediana en el valor del indice de estado físico de la Sociedad Americana de Anestesiología (3 vs 2), y habían sido sometidos a operaciones más prolongadas (328±182 vs 185±127 minutos; p<0.01), que los pacientes en quienes se obtuvo adecuada señal. No hubo diferencia en la duración de la estadía en PACU entre ambos grupos.Conclusiones. La incidencia de fracaso en obtener oximetría de pulso y las características de los pacientes se comparan favorablemente con un estudio previo de fracaso de oximetría de pulso duante el período intraoperatorio. Concluimos que, si bien el oxímetro de pulso es un instrumento confiable para la medición de la oxigenación sanguínea, existe una pequeña pero constante incidencia de fracaso de medición relacionado al paciente usando este equipo de monitorización en PACU.

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Résumé Objectifs. Le but de cette étude est d'examiner de manière prospective l'incidence des éches de l'oxymétrie de pouls dûs au patient dans une unité de réveil.Méthodes. Nous avons étudié 2937 patients en période post-anesthésique admis dans l'unite de réveil deUniversity of Washington Medical Center, de Décember 1989 jusqu'à Mai 1990. La saturation artérielle en oxygène était mesurée à l'aide d'un oxymètre de pouls Nellcor N-200 sans synchronisation électrocardiographique. Un échec était défini comme l'incapacité à obtenir une valeur de saturation artérielle en oxygène durant plus d'une (deux ou plus) périodes de quinze minutes, en dehors de problèmes de positionnement du capteur ou de dysfonctionnements méchaniques.Resultats. le taux global d'échec dans notre étude a été de 0,64%, avec 19 échecs de l'oxymétrie de pouls dûs aux patients parmi les 2937 patients étudiés. Les patients chez lesquels l'oxymétrie de pouls était défaillante étaient significativement plus vieux (62±18 vs 46±19; moyenne ± écart-type; p<0,01), avaient une classification ASA plus élevée (3 vs 2), et bénéficiaient d'interventions plus longues (328±182 vs 185±127 minutes; p<0,01) que les patients sans échec de monitorage. Il n'existait aucune différence dans la durée des séjours en unité de réveil dans les deux groupes.Conclusions. Le taux d'échec et les caractéristiques des patients sont comparables avec ceux issus d'une étude préalable portant sur les échecs de l'oxymètrie de pouls durant la période opératoire. Nous concluons que, alors que l'oxymètre de pouls est un unstrument fiable de mesure de l'oxygénation du sang, il existe une fiable, mais non négligeable, incidence d'échecs dûs au patient de ce monitorage en unité de réveil.

     

Evaluation of Pre- and Posttreatment Pulse Oximetry in Acute Childhood Asthma

Objectives : To evaluate the utility of pre- and posttreatment O₂ saturation (SpO₂) for prediction of admission or relapse after ED release in acute asthma exacerbations using a standardized treatment protocol.
Design : A prospective, double-blind, observational study was performed at a pediatric ED. Children with acute asthma were enrolled upon ED presentation. SpO₂ was measured prior to treatment and after disposition decision. Two experienced physicians determined disposition based on history and physical examination alone, while blinded to SpO₂. Relapse of released patients was determined by telephone follow-up.
Results : A pretreatment room-air SpO₂ of ≤91% had a sensitivity of 0.24, a specificity of 0.86, and a likelihood ratio of 1.77 to predict admission/relapse. A posttreatment room-air SpO₂ of ≤91% had a sensitivity of 0.34, a specificity of 0.98, and a likelihood ratio of 16.43 to predict admission/relapse.
Conclusions : As opposed to some previous studies, this study found pretreatment SpO₂ to be a relatively poor predictor of admission. A posttreatment SpO₂ of ≤91% occurred in a minority (32%) of patients, but increased the odds of admission 16-fold and may be used as an adjunct to objectively confirm the need for admission.     

Pulse oximetry,capnography, and blood gas measurements: reducing cost and improving the quality of care with technology

Pulse oximetry appears to improve quality of care by the early detection of hypoxia noninvasively. We tested the hypothesis that the widespread use of pulse oximetry over a 5-year period in the operating rooms at our institution had resulted in a reduction in blood gas measurements and in departmental operating costs. The total number of blood gas determinations per hour of anesthetic time at our institution decreased by 44%, from 7.64 to 4.26 measurements per 100 operating room hours. The number of capnography units in the operating rooms increased from 8 to 14, the number of pulse oximeters increased from 0 to 22, and oximeter use increased from 0 to 100% for all anesthetics. The total cost to provide oximetry, capnography, and blood gas measurements in 1989–1990 was less than the cost to provide blood gas measurements alone in 1985–1986. The introduction of these technologies was accomplished without an increase in cost: $76,880 in 1985–1986 versus $71,025 in 1989–1990.     

产前超声对比经皮血氧饱和度对胎儿结构畸形筛查的价值

目的：超声筛查对比经皮血氧饱和度筛查(POX)在胎儿先天性结构畸形中的价值。方法：回顾分析有出生结局的胎儿10133例,对比出生后不同结构畸形超声筛查与血氧饱和度筛查间的差异。结果：1.消化系统畸形、神经系统畸形、泌尿系统畸形、室间隔缺损、房间隔缺损和/或卵圆孔未闭、动脉导管未闭中,产前超声筛查结果与血氧饱和度筛查结果比较P＜0.05,超声筛查阳性率较高,血氧饱和度筛查阳性率较低。2.生殖系统畸形、骨骼系统畸形、复杂先心病中,超声筛查结果与血氧饱和度筛查结果比较P＞0.05,在复杂先心病中两种筛查方法阳性率均较高,其余系统畸形中超声能够筛查出较为明显的畸形,但存在漏诊不在产前筛查范围之内的异常,血氧饱和度对以上畸形筛查阳性率均较低。结论：经皮血氧饱和度在复杂先心病中具有提示价值,对其他结构畸形时无明显诊断价值,经皮血氧饱和度对胎儿畸形产前超声筛查有补充价值。