休克的光学无创监护技术及监测指标研究

Shock is the most common complication of severe diseases in various clinical departments, which is highly fatal and usually causes other severe complications. Real-time monitoring of shock severity allows seizing best time window for operation and guiding treatments, which may increase patients' chance to survive and life quality after treatment. However, currently the diagnosis of shock mainly relies on some blood-oxygen indices from blood sampling and blood analysis, such as the shock gold standard central venous oxygen saturation, which are invasive and discontinuous. Based on the breakthrough in our preliminary work, this study attempts to explore novel blood oxygen indictors sensitive to shock, to establish approaches to monitor them noninvasively and continuously based on near-infrared spectroscopy, to develop a noninvasive optical shock monitor capable of simultaneously monitoring multiple shock indicators in multiple shock-sensitive region of body, to conduct clinical trial to test the reliability and sensitivity of our technology, and to build a reference diagnosis standard for shock disease with clinical data statistical analysis. This project will provide a powerful tool for both clinical monitoring and research of shock, supply the expand application of NIRS in clinics, and offer ideas for researches on noninvasive monitoring of severe illness, which accordingly has important scientific value and social economy significance.

休克是临床各科严重疾病最常见的并发症，死亡率高，治疗后易患严重后遗症。实时监测休克病情，可赢取较佳抢救窗口，指导复苏治疗，提高存活几率和疗后生活品质。然而，目前休克检测主要依赖于采血+血气分析所得的血氧指标，例如休克金标准——中央静脉氧饱和度，具有有创、不能实时连续监测的缺点。本研究拟基于近红外光谱术（NIRS），在前期预研的突破性进展基础上，探索对休克灵敏的各种血氧指标，建立光学无创检测方法，研制多部位多个休克灵敏血氧指标同步监测的无创光学休克实时监护仪，开展临床实验研究，检验本技术的可靠性和灵敏度，并基于临床数据分析，尝试建立休克病情诊断的参考标准。本项目将为休克临床监护和休克疾病研究提供有力的工具，为NIRS的临床应用拓展奠定基础，为重症无创监护提供研究思路，具有重要的科学价值和社会经济意义。

休克的实时监测对临床及时治疗和降低患者生命危险有重要意义。实时往往要求无创。休克金标准——中央静脉氧饱和度，具有有创、不能实时连续监测的缺点。本研究基于近红外光谱术(NIRS)，建立光学无创检测方法，并通过临床实验建立参考标准。在精准仿真光在颈内中部静脉组织周围的通量分布后，我们证实了可在颈内中部静脉部位实施休克的无创监控。本研究研制的近红外多参数休克监护能够检测多项人体生理参数，临床实验数据验证了血样参量之间显著的医学统计分析可替代性，其诊断结果达到了休克黄金指标参数标准，基于临床实验数据我们建立了休克病情诊断的参考标准。本团队在基于光学无创方法监测人体深层组织的血氧输送方面的研究成果贡献还获得了Melvin H. Kniseley Awardee的认可，成为了自1983年来中国该奖项的唯一获得者。该技术在脊柱血液动力和激光诊疗监测中稳定的表现为无创中医机制提供了新的探索角度。我们证明了NIRS和吸入氧协议的创新结合能够实现对脑死亡进行无创、可靠的评估。石墨烯在生物传感器表现良好属性为探头材料的使用提供了新思路。通过该技术将NIRS与脑电谱图相结合，利用实时脑机接口可实现将NIRS应用于神经康复和脑功能研究，能够实现从时间分辨率、空间定位、信息传输率和分类准确率上提升脑机接口的性能。