Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA 94305, USA.
Int J Obstet Anesth. 2011 Jul;20(3):240-5. doi: 10.1016/j.ijoa.2011.03.009. Epub 2011 Jun 2.
Obstetric patients diagnosed with abnormal placentation (placenta accreta, increta or percreta) are at increased risk of major postpartum hemorrhage and cesarean hysterectomy. Obstetric anesthesiologists are primarily involved in intraoperative transfusion management in these cases. Hemoglobin assessment is invaluable for assisting transfusion decision-making during the acute period of obstetric hemorrhage. However, laboratory and point-of-care tests of hemoglobin concentration are time-dependent and intermittent, and do not provide a real-time assessment of change during the acute phase of blood loss. A new non-invasive hemoglobin monitor has been introduced recently, which provides real-time measurement of hemoglobin values (SpHb) using multi-wavelength pulse co-oximetry. We present a review of five patients with suspected abnormal placentation who received SpHb monitoring during cesarean hysterectomy at our institution. We discuss the potential clinical utility of non-invasive hemoglobin monitoring for pregnant patients at high risk of obstetric hemorrhage, and the potential role of SpHb in guiding transfusion therapy.
产科患者被诊断为异常胎盘（胎盘植入、胎盘侵入或胎盘穿透）时，发生大出血和剖宫产子宫切除术的风险增加。在这些情况下，产科麻醉师主要参与术中输血管理。血红蛋白评估对于协助产科出血急性期的输血决策非常有价值。然而，血红蛋白浓度的实验室和即时检测是时间依赖和间歇性的，无法在急性失血期间实时评估变化。最近引入了一种新的非侵入性血红蛋白监测仪，它使用多波长脉冲血氧计实时测量血红蛋白值（SpHb）。我们回顾了在我们医院接受剖宫产子宫切除术的五例疑似异常胎盘患者的 SpHb 监测情况。我们讨论了非侵入性血红蛋白监测对有产科大出血高危风险的孕妇的潜在临床应用价值，以及 SpHb 在指导输血治疗中的潜在作用。
