Name: measurement of tissue oxygenation using near-infrared spectroscopy in patients undergoing hemodialysis
Uploaded: 2020-10-02T13:00:00
Description: Watch this Scientific Journal Video about Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis at JoVE.com

自治医科大学埼玉医療センターの透析スタッフと腎臓内科の方々に感謝します。英語の編集をしてくださったエディテージ(www.editage.com)に感謝します。

すべての参加者は書面によるインフォームドコンセントを提供しました。この研究は、自治医科大学埼玉医療センターの治験審査委員会(RIN 15–104)によって承認されました。
1. rSO2の監視装置
<ol><li>組織の酸素化を測定するためのNIRS装置を準備します。このデバイスには4つのチャンネルがあり、最大4つの臓器で同時に測定を実行できます。</li>
	<li>NIRSモニタリ?...

<ol>
	<li>Nishiyama, 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=Regional+cerebral+oxygen+saturation+monitoring+for+predicting+interventional+outcomes+in+patients+following+out-of-hospital+cardiac+arrest+of+presumed+cardiac+cause:+A+prospective,+observational,+multicentre+study.">Regional cerebral oxygen saturation monitoring for predicting interventional outcomes in patients following out-of-hospital cardiac arrest of presumed cardiac cause: A prospective, observational, multicentre study.</a> Resuscitation. 96, 135-141 (2015).</li><li>Kobayashi, 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=Factors+associated+with+a+low+initial+cerebral+oxygen+saturation+value+in+patients+undergoing+cardiac+surgery.">Factors associated with a low initial cerebral oxygen saturation value in patients undergoing cardiac surgery.</a> Journal of Artificial Organs. 20 (2), 110-116 (2017).</li><li>Cruz, S. M., 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=A+novel+multimodal+computational+system+using+near-infrared+spectroscopy+predicts+the+need+for+ECMO+initiation+in+neonates+with+congenital+diaphragmatic+hernia.">A novel multimodal computational system using near-infrared spectroscopy predicts the need for ECMO initiation in neonates with congenital diaphragmatic hernia.</a> Journal of Pediatric Surgery. 53 (1), 152-158 (2018).</li><li>MacEwen, C., Sutherland, S., Daly, J., Pugh, C., Tarassenko, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relationship+between+Hypotension+and+Cerebral+Ischemia+during+Hemodialysis.">Relationship between Hypotension and Cerebral Ischemia during Hemodialysis.</a> Journal of the American Socociety of Nephrology. 28 (8), 2511-2520 (2017).</li><li>Polinder-Bos, H. A., 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=Changes+in+cerebral+oxygenation+and+cerebral+blood+flow+during+hemodialysis+-+A+simultaneous+near-infrared+spectroscopy+and+positron+emission+tomography+study.">Changes in cerebral oxygenation and cerebral blood flow during hemodialysis - A simultaneous near-infrared spectroscopy and positron emission tomography study.</a> Journal of Cerebral Blood Flow &amp; Metablism. 40 (2), 328-340 (2020).</li><li>Ookawara, S., 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=Differences+in+tissue+oxygenation+and+changes+in+total+hemoglobin+signal+strength+in+the+brain,+liver,+and+lower-limb+muscle+during+hemodialysis.">Differences in tissue oxygenation and changes in total hemoglobin signal strength in the brain, liver, and lower-limb muscle during hemodialysis.</a> Journal of Artificial Organs. 21 (1), 86-93 (2018).</li><li>Malik, 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=Tissue+ischemia+worsens+during+hemodialysis+in+end-stage+renal+disease+patients.">Tissue ischemia worsens during hemodialysis in end-stage renal disease patients.</a> The Journal of Vascular Access. 18 (1), 47-51 (2017).</li><li>Ito, 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=Cerebral+oxygenation+improvement+is+associated+with+hemoglobin+increase+after+hemodialysis+initiation.">Cerebral oxygenation improvement is associated with hemoglobin increase after hemodialysis initiation.</a> TheInternational Journal of Artificial Organs. , (2020).</li><li>Valerianova, A., 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=Factors+responsible+for+cerebral+hypoxia+in+hemodialysis+population.">Factors responsible for cerebral hypoxia in hemodialysis population.</a> Physiological Research. 68 (4), 651-658 (2019).</li><li>Ookawara, S., 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=Associations+of+cerebral+oxygenation+with+hemoglobin+levels+evaluated+by+near-infrared+spectroscopy+in+hemodialysis+patients.">Associations of cerebral oxygenation with hemoglobin levels evaluated by near-infrared spectroscopy in hemodialysis patients.</a> PLoS One. 15 (8), 0236720 (2020).</li><li>Kovarova, L., 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=Low+Cerebral+Oxygenation+Is+Associated+with+Cognitive+Impairment+in+Chronic+Hemodialysis+Patients.">Low Cerebral Oxygenation Is Associated with Cognitive Impairment in Chronic Hemodialysis Patients.</a> Nephron. 139 (2), 113-119 (2018).</li><li>Miyazawa, 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=Association+of+cerebral+oxygenation+with+estimated+glomerular+filtration+rate+and+cognitive+function+in+chronic+kidney+disease+patients+without+dialysis+therapy.">Association of cerebral oxygenation with estimated glomerular filtration rate and cognitive function in chronic kidney disease patients without dialysis therapy.</a> PLoS One. 13 (6), 0199366 (2018).</li><li>Locatelli, F., 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=Haemodialysis+with+on-line+monitoring+equipment:+tools+or+toys.">Haemodialysis with on-line monitoring equipment: tools or toys.</a> Nephrology Dialysis Transplantation. 20 (1), 22-33 (2005).</li><li>Cordtz, J., Olde, B., Solem, K., Ladefoged, S. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Central+venous+oxygen+saturation+and+thoracic+admittance+during+dialysis:+new+approaches+to+hemodynamic+monitoring.">Central venous oxygen saturation and thoracic admittance during dialysis: new approaches to hemodynamic monitoring.</a> Hemodialysis International. 12 (3), 369-377 (2008).</li><li>Kamijo, Y., 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=Continuous+monitoring+of+blood+pressure+by+analyzing+the+blood+flow+sound+of+arteriovenous+fistula+in+hemodialysis+patients.">Continuous monitoring of blood pressure by analyzing the blood flow sound of arteriovenous fistula in hemodialysis patients.</a> Clinical and Experimental Nephrology. 22 (3), 677-683 (2018).</li><li>Ito, 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=Factors+affecting+cerebral+oxygenation+in+hemodialysis+patients:+cerebral+oxygenation+associates+with+pH,+hemodialysis+duration,+serum+albumin+concentration,+and+diabetes+mellitus.">Factors affecting cerebral oxygenation in hemodialysis patients: cerebral oxygenation associates with pH, hemodialysis duration, serum albumin concentration, and diabetes mellitus.</a> PLoS One. 10 (2), 0117474 (2015).</li><li>Imai, S., 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=Deterioration+of+Hepatic+Oxygenation+Precedes+an+Onset+of+Intradialytic+Hypotension+with+Little+Change+in+Blood+Volume+during+Hemodialysis.">Deterioration of Hepatic Oxygenation Precedes an Onset of Intradialytic Hypotension with Little Change in Blood Volume during Hemodialysis.</a> Blood Purification. 45 (4), 345-346 (2018).</li><li>Cho, A. R., Kwon, J. Y., Kim, C., Hong, J. M., Kang, C. <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+sensor+location+on+regional+cerebral+oxygen+saturation+measured+by+INVOS+5100+in+on-pump+cardiac+surgery.">Effect of sensor location on regional cerebral oxygen saturation measured by INVOS 5100 in on-pump cardiac surgery.</a> Journal of Anesthesia. 31 (2), 178-184 (2017).</li><li>Ito, 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=Deterioration+of+cerebral+oxygenation+by+aortic+arch+calcification+progression+in+patients+undergoing+hemodialysis:+A+cross-sectional+study.">Deterioration of cerebral oxygenation by aortic arch calcification progression in patients undergoing hemodialysis: A cross-sectional study.</a> BioMed Research International. , 2852514 (2017).</li><li>Ito, 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=Blood+transfusion+during+haemodialysis+improves+systemic+tissue+oxygenation:+A+case+report.">Blood transfusion during haemodialysis improves systemic tissue oxygenation: A case report.</a> Nefrologia. 37 (4), 435-437 (2017).</li><li>Ito, 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=Improvement+of+bilateral+lower-limb+muscle+oxygenation+by+low-density+lipoprotein+apheresis+in+a+patient+with+peripheral+artery+disease+undergoing+hemodialysis.">Improvement of bilateral lower-limb muscle oxygenation by low-density lipoprotein apheresis in a patient with peripheral artery disease undergoing hemodialysis.</a> Nefrologia. 39 (1), 90-92 (2019).</li><li>Kitano, T., 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=Changes+in+tissue+oxygenation+in+response+to+sudden+intradialytic+hypotension.">Changes in tissue oxygenation in response to sudden intradialytic hypotension.</a> Journal of Artificial Organs. 23 (2), 187-190 (2020).</li><li>Lemmers, P. M. A., Toet, M. C., van Bel, F. <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+patent+ductus+arteriosus+and+subsequent+therapy+with+indomethacin+on+cerebral+oxygenation+in+preterm+infants.">Impact of patent ductus arteriosus and subsequent therapy with indomethacin on cerebral oxygenation in preterm infants.</a> Pediatrics. 121, 142-147 (2008).</li><li>Ito, 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=Sleep+apnea+syndrome+caused+lowering+of+cerebral+oxygenation+in+a+hemodialysis+patient:+a+case+report+and+literature+review.">Sleep apnea syndrome caused lowering of cerebral oxygenation in a hemodialysis patient: a case report and literature review.</a> Renal Replacement Therapy. 4, 54 (2018).</li><li>Minato, S., 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=Continuous+monitoring+of+changes+in+cerebral+oxygenation+during+hemodialysis+in+a+patient+with+acute+congestive+heart+failure.">Continuous monitoring of changes in cerebral oxygenation during hemodialysis in a patient with acute congestive heart failure.</a> Journal of Artificial Organs. , (2019).</li></ol>

NIRSモニタリングは、特に体外循環を必要とする心血管または脳血管手術において、主に脳rSO2を評価するために使用されてきました。HD療法を含む体外循環中に、一部の臓器は相対虚血を示す可能性があります7,17,18;しかし、組織の酸素化が低くなるかどうかは不明である。HD中の筋肉のけいれんまたは腹痛は、臓?...

近赤外分光法(NIRS)は、組織の酸素化、特にさまざまな臨床現場での脳酸素化のマーカーである局所酸素飽和度(rSO2)を評価するために使用されており1,2,3、最近、血液透析(HD)を受けている患者に適用されています4,5,6,7,8,9,10、11.脳rSO2は、HDまたは透析されていない慢性腎臓病(CKD)の患者の認知機能に関連していると報告されています11,12。しかし、これまでのところ、CKD患者におけるNIRSモニタリングの使用は限られている。
NIRSモニタリングはリアルタイムかつ非侵襲的であるため、HDを受けている患者のモニタリングデバイスとしての有用性を評価しました。NIRSは主に脳のrSO2の測定に用いられますが、HD中の他の臓器のrSO2値も調査しました。 具体的には、rSO2測定センサーを額、右心気症、下肢に取り付けて、それぞれ脳、肝臓、下肢のrSO2を評価しました。その結果、NIRSモニタリングは、HD時の臓器酸素化の変化やCKD患者の組織酸素化に影響を与える要因を明らかにするための新しいアプローチである可能性があることが示されました。
現在までに、臨床現場でのHD、血液量モニタリング、中心静脈酸素飽和度、胸部アドミタンス、および電子聴診器ガイド推定血圧(BP)中に継続的なモニタリングが実施されました13,14,15;ただし、低血圧の予測やデバイスの幅広い使用には制限があります。対照的に、ここでの新しい非侵襲的アプローチは、個々の臓器における透析内酸素動態に関するリアルタイムの情報を提供する可能性があります。したがって、このモニタリング方法は、透析内低血圧の初期段階における一過性臓器虚血の検出を可能にし、HDの安全な性能も可能にし得る。この記事では、HDを受けている患者に適用される、rSO2で表される組織酸素化を測定するためのプロトコルについて説明します。

<table>
	<tbody>
		<tr>
			<td>DBB-100NX</td>
			<td>Nikkiso</td>
			<td>DBB-100NX</td>
			<td>Dialysis machine</td>
		</tr>
		<tr>
			<td>INVOS 5100c</td>
			<td>Covidien Japan</td>
			<td>INVOSTM 5100c</td>
			<td>tissue oxygenation device</td>
		</tr>
		<tr>
			<td>SOMASENSER</td>
			<td>Covidien Japan</td>
			<td>CV-SAFB-SM/INTL</td>
			<td>NIRS sensor</td>
		</tr>
	</tbody>
</table>

measurement of tissue oxygenation using near-infrared spectroscopy in patients undergoing hemodialysis

近赤外分光法(NIRS)は、心臓血管外科や脳外科、新生児モニタリング、病院前医療などの臨床現場で、組織の酸素化のマーカーである局所酸素飽和度(rSO2)を測定するためのツールとして最近適用されています。NIRSモニタリングデバイスはリアルタイムで非侵襲的であり、主に手術中または集中治療中の重症患者の脳酸素化を評価するために使用されてきました。これまでのところ、血液透析(HD)を含む慢性腎臓病(CKD)患者におけるNIRSモニタリングの使用は制限されています。そこで、HD中の一部の臓器におけるrSO2値を調べた。近赤外光を2波長の付着で透過するNIRS装置を用いてrSO2値をモニターした。HD患者は仰臥位に置かれ、rSO 2測定センサーを額、右心気症、下肢に取り付けて、それぞれ脳、肝臓、下腿の筋肉のrSO2を評価しました。NIRSモニタリングは、HD中の臓器酸素化の変化やCKD患者の組織酸素化に影響を与える要因を明らかにするための新しいアプローチになる可能性があります。この記事では、HD患者に適用されるrSO2で表される組織酸素化を測定するためのプロトコルについて説明します。

HD前の脳rSO2値は健常者よりも低く、糖尿病(DM)のHD患者の脳rSO2はDMのないHD患者の値よりも低かった(図1)16。さらに、HD期間中はBPの低下なしに組織の酸素化が継続しますが、透析内低血圧による脳および肝臓のrSO2の変化が偶発的に観察されました(図2)。継続的なモニタリングにより、組織の酸素化の変化は?...

Watch this Scientific Journal Video about Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis at JoVE.com

Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis

近赤外分光モニターを用いて血液透析(HD)患者の局所酸素飽和度(rSO2)を測定するためのプロトコルを提示する。rSO2値は、組織の酸素化の指標である。この非侵襲的でリアルタイムのモニタリングは、HD中の臓器酸素化の変化を確認するのに役立つ可能性があります。

血液透析患者における近赤外分光法を用いた組織酸素化の測定

Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in ...

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皮膚組織の酸素化と血管機能のデュアルモードイメージング

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期限切れのCO 2</sub救急部から気管挿管または自発呼吸患者の>の測定

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