Name: diffuse reflectance spectroscopy: getting the capillary refill test under one's thumb
Uploaded: 2017-12-02T14:00:00
Description: Watch this Scientific Journal Video about Diffuse Reflectance Spectroscopy: Getting the Capillary Refill Test Under One's Thumb at JoVE.com

我们谨向瑞典国防部 (信息) 和灾难医学和创伤治疗中心 (KMC) 的林雪平工作人员表示谢意, 感谢他们的亲切支持。

这里描述的研究遵循了当地的道德准则, 并得到了林雪平地区伦理审查委员会的批准 (许可证编号 2015/99-31)。
1. 知情同意和甄别
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	<li>根据包含/排除标准进行筛选。 注: 纳入标准为: (一) 健康成人 > 18 岁, (二) 能够理解书面和口头信息, (三) 提供口头和书面同意。排除标准是: (一) 无法或不愿意提供知情同意, (二) 持续的皮肤状况, (iii) 心?...

<ol>
	<li>Strehlow, M. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Early+identification+of+shock+in+critically+ill+patients.">Early identification of shock in critically ill patients.</a> Emerg Med Clin North Am. 28 (1), 57-66 (2010).</li><li>Advanced Life Support, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Acute Medical Emergencies. , 67-84 (2010).</li><li>Brasel, K. J., Guse, C., Gentilello, L. M., Nirula, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Heart+rate:+is+it+truly+a+vital+sign?.">Heart rate: is it truly a vital sign?.</a> J Trauma. 62 (4), 812-817 (2007).</li><li>De Backer, D., Ortiz, J. A., Salgado, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Coupling+microcirculation+to+systemic+hemodynamics.">Coupling microcirculation to systemic hemodynamics.</a> Curr Opin Crit Care. 16 (3), 250-254 (2010).</li><li>Mrgan, M., Rytter, D., Brabrand, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capillary+refill+time+is+a+predictor+of+short-term+mortality+for+adult+patients+admitted+to+a+medical+department:+an+observational+cohort+study.">Capillary refill time is a predictor of short-term mortality for adult patients admitted to a medical department: an observational cohort study.</a> Emerg Med J. 31 (12), 954-958 (2014).</li><li>Advanced Life Support, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Acute Medical Emergencies. , 55-65 (2010).</li><li>Lewin, J., Maconochie, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capillary+refill+time+in+adults.">Capillary refill time in adults.</a> Emerg Med J. 25 (6), 325-326 (2008).</li><li>Lobos, A. T., Menon, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+multidisciplinary+survey+on+capillary+refill+time:+Inconsistent+performance+and+interpretation+of+a+common+clinical+test.">A multidisciplinary survey on capillary refill time: Inconsistent performance and interpretation of a common clinical test.</a> Pediatr Crit Care Med. 9 (4), 386-391 (2008).</li><li>Otieno, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Are+bedside+features+of+shock+reproducible+between+different+observers?.">Are bedside features of shock reproducible between different observers?.</a> Arch Dis Child. 89 (10), 977-979 (2004).</li><li>Raju, N. V., Maisels, M. J., Kring, E., Schwarz-Warner, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capillary+refill+time+in+the+hands+and+feet+of+normal+newborn+infants.">Capillary refill time in the hands and feet of normal newborn infants.</a> Clin Pediatr (Phila). 38 (3), 139-144 (1999).</li><li>Klupp, N. L., Keenan, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+evaluation+of+the+reliability+and+validity+of+capillary+refill+time+test.">An evaluation of the reliability and validity of capillary refill time test.</a> The Foot. 17, 15-20 (2007).</li><li>Gorelick, M. H., Shaw, K. N., Baker, M. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+ambient+temperature+on+capillary+refill+in+healthy+children.">Effect of ambient temperature on capillary refill in healthy children.</a> Pediatrics. 92 (5), 699-702 (1993).</li><li>Schriger, D. L., Baraff, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Defining+normal+capillary+refill:+variation+with+age,+sex,+and+temperature.">Defining normal capillary refill: variation with age, sex, and temperature.</a> Ann Emerg Med. 17 (9), 932-935 (1988).</li><li>Pandey, A., John, B. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capillary+refill+time.+Is+it+time+to+fill+the+gaps?.">Capillary refill time. Is it time to fill the gaps?.</a> Med J Armed Forces India. 69 (1), 97-98 (2013).</li><li>Strozik, K. S., Pieper, C. H., Roller, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capillary+refilling+time+in+newborn+babies:+normal+values.">Capillary refilling time in newborn babies: normal values.</a> Arch Dis Child Fetal Neonatal Ed. 76 (3), F193-F196 (1997).</li><li>Doherty, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sub-epidermal+imaging+using+polarized+light+spectroscopy+for+assessment+of+skin+microcirculation.">Sub-epidermal imaging using polarized light spectroscopy for assessment of skin microcirculation.</a> Skin Res Technol. 13 (4), 472-484 (2007).</li><li>Noguchi, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+caffeine+contained+in+a+cup+of+coffee+on+microvascular+function+in+healthy+subjects.">Effect of caffeine contained in a cup of coffee on microvascular function in healthy subjects.</a> J Pharmacol Sci. 127 (2), 217-222 (2015).</li><li>Reus, W. F., Robson, M. C., Zachary, L., Heggers, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acute+effects+of+tobacco+smoking+on+blood+flow+in+the+cutaneous+micro-circulation.">Acute effects of tobacco smoking on blood flow in the cutaneous micro-circulation.</a> Br J Plast Surg. 37 (2), 213-215 (1984).</li><li>Lenasi, H., Strucl, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+regular+physical+training+on+cutaneous+microvascular+reactivity.">Effect of regular physical training on cutaneous microvascular reactivity.</a> Med Sci Sports Exerc. 36 (4), 606-612 (2004).</li><li>Anderson, B., Kelly, A. M., Kerr, D., Clooney, M., Jolley, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+patient+and+environmental+factors+on+capillary+refill+time+in+adults.">Impact of patient and environmental factors on capillary refill time in adults.</a> Am J Emerg Med. 26 (1), 62-65 (2008).</li><li>John, R. T., Henricson, J., Nilsson, G. E., Wilhelms, D., Anderson, C. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reflectance+spectroscopy:+to+shed+new+light+on+the+capillary+refill+test.">Reflectance spectroscopy: to shed new light on the capillary refill test.</a> J Biophotonics. , (2017).</li><li>Blaxter, L. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+automated+quasi-continuous+capillary+refill+timing+device.">An automated quasi-continuous capillary refill timing device.</a> Physiological measurement. 37, 83-99 (2016).</li><li>Bordoley, A., Irwin, R., Kalyani, V., MacDonald, C., Standish, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> D1GIT: Automated, temperature-calibrated measurement of capillary refill time. , (2012).</li><li>Kviesis-Kipge, E., Curkste, E., Spigulis, J., Eihvalde, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+analysis+of+skin+capillary-refill+processes+using+blue+LED.">Real-time analysis of skin capillary-refill processes using blue LED.</a> Proc. of SPIE. 771523, (2010).</li><li>Shavit, I., Brant, R., Nijssen-Jordan, C., Galbraith, R., Johnson, D. 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为了使系统得到最佳的结果, 必须控制环境因素造成的变化。所有的环境光必须关闭。照相机必须与测量区域垂直对齐。为了保证一个恒定的测量区域, 对象不应该移动或谈话在测量期间。出于同样的原因, 相机最好安装在一个立场, 以避免移动和保持一个恒定的距离测量区域。测试对象应避免咖啡因的17, 烟草18, 和硬练习19至少两个 h 之前的测?...

危重病人的评估和分诊集中在经典生命体征血压 (BP)、心率 (HR)、呼吸率 (RR)、氧饱和度和体温1。这些参数的变化在循环恶化过程中显得相对较晚。例如, 在出血, 血压下降将不会发生, 直到血液损失变得中度到严重的2, HR 增加也可以是一个不敏感的和不标记3。
毛细管重填试验 (CR 测试) 可以提供早期的循环崩溃的征兆, 因为重填时间在重要征兆之前被相信改变, 并且临床出现冷, 阴湿黏的和斑驳的皮肤1,4,5. 毛细管填充试验通常是由应用, 然后释放一个坚定的漂白压力的皮肤与时间 (以秒计) 的血液返回到脱皮区域。根据指导原则, 重填应该在2秒内发生, 在5秒的牢固的压力 (例如, 由医生的手指) 在正常健康仰卧患者6。测试的基本原理是, 较慢的填充时间将表明皮肤灌注不良, 可能是由许多关键事件之一, 如脓毒症, 失血, 急性心力衰竭, 或体温过低造成的。
目前, 在执行 CR 测试的艺术方法的状态上没有达成一致意见6,7,8,9,10。有争议的问题包括缺乏标准化的实际漂烫机动和依赖主观 (即, 裸眼) 评估的填充端点7,9,11。此外, 有迹象表明, 性别影响 CR 时间12,13。温度, 环境和皮肤, 是已知的影响毛细管填充时间, 但在何种程度上是不清楚的。最后, 使用不同的测量点, 外围或中央, 可能是一个进一步的原因变化的结果, 在这方面的研究很少14,15。
在目前的工作中, 我们使用了一个光学生物工程系统, 以记录血液的返回过程和随后的充血反应, 在 CR 试验中看到。该系统利用漫反射极化光谱学, 更详细地量化和描述, 比可能的肉眼, 毛细管填充的时间和过程。该系统包括一个标准的数码相机, 装有一个外部的光环与92白色 led, 和专门开发的软件。镜头和两个偏振过滤器, 连接正交在前面的 led, 阻挡光, 已直接反映在皮肤表面, 只允许光已成为偏的组织, 以达到相机。这就产生了一个 "亚表皮" 的组织图像, 深度约0.5 毫米。图像分为其颜色平面, 并计算每个像素的红色和绿色内容, 生成一个对应于红细胞组织浓度的值16。在视频模式下, 系统的时间分辨率为0.02 秒。

<table>
	<tbody>
		<tr>
			<td>TiVi701 Camera</td>
			<td>WheelsBridge AB</td>
			<td>TiVi701 Camera, version 1.5.1</td>
			<td>Software</td>
		</tr>
		<tr>
			<td>TiVi700</td>
			<td>WheelsBridge AB</td>
			<td>TiVi700 Analysis, version 1.2.9</td>
			<td>Software</td>
		</tr>
		<tr>
			<td>Canon EOS 700D</td>
			<td>Canon U.S.A., inc.</td>
			<td>Canon EOS 700D</td>
			<td>Digital SLR Camera</td>
		</tr>
		<tr>
			<td>Camera stand</td>
			<td>Manfrotto</td>
			<td>681B</td>
			<td>Modified camera stand to hold the digital camera in position</td>
		</tr>
		<tr>
			<td>Camera stand</td>
			<td>Disa Denmark</td>
			<td>9020B</td>
			<td>Modified camera stand to hold the digital camera in position</td>
		</tr>
	</tbody>
</table>

diffuse reflectance spectroscopy: getting the capillary refill test under one's thumb

毛细管重填试验在1947年引入, 以帮助估计危重病患者的循环系统状况。通常情况下, 在正常健康的仰卧位患者释放5的牢固压力 (如, 由医生的手指) 后, 应在2秒内发生重填。较慢的填充时间表示皮肤灌注不良, 这可能是由于败血症、失血、灌注和体温过低造成的。自其介绍以来, 该试验的临床效用已被争论。倡导者指出它的可行性和简单性, 并声称它可以显示血管状态的变化早于生命体征的变化, 如心率。另一方面, 批评家强调, 在测试中缺乏标准化, 肉眼评估的高度主观性, 以及测试对周围环境因素的敏感性, 明显降低了临床价值。本工作的目的是详细描述重新灌装事件的过程, 并提出了潜在的更客观和准确的终点值的毛细管填充试验使用漫极化光谱学。

拍摄的毛细管重填过程产生了大量的数据不可能获得肉眼评估。我们建议在这里新的端点, 以进一步提高 CR 测试的可用性, 作为早期的指标恶化的循环状态。我们称这些端点为: "基线"、"血零" (或 ")"、"返回基线1的时间" (或 "tRtB1")、"时间到峰值" 或 "Tpk"。"基线" 值是通过计算在 5 s 基线测量期间获得的所有值的平均值来获得的。"血零" 是指在压力释放后立即从脱皮区域的第?...

Watch this Scientific Journal Video about Diffuse Reflectance Spectroscopy: Getting the Capillary Refill Test Under One's Thumb at JoVE.com

Diffuse Reflectance Spectroscopy: Getting the Capillary Refill Test Under One's Thumb

漫反射光谱分析: 在拇指下进行毛细管填充试验

该协议描述了如何使用漫极化光谱学可以提高临床效用的毛细管填充试验。我们建议使用漫反射光谱视频和新的信息端点对健康志愿者毛细血管充盈的过程进行更详细的分析。

The capillary refill test was introduced in 1947 to help estimate circulatory status in critically ill patients. Guidelines commonly state that refill ...

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