分光光度法（SpHb）和 HemoCue®无创血红蛋白监测与自动化实验室血红蛋白测量的准确性比较。
Comparison of the accuracy of noninvasive hemoglobin monitoring by spectrophotometry (SpHb) and HemoCue® with automated laboratory hemoglobin measurement.
机构信息
Department of Anesthesiology and Intensive Care, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, France.
出版信息
Anesthesiology. 2011 Sep;115(3):548-54. doi: 10.1097/ALN.0b013e3182270c22.
BACKGROUND
The reference method for hemoglobin concentration measurement remains automated analysis in the laboratory. Although point-of-care devices such as the HemoCue® 201+ (HemoCue, Ängelholm, Sweden) provide immediate hemoglobin values, a noninvasive, spectrophotometry-based technology (Radical-7®; Masimo Corp., Irvine, CA) that provides continuous online hemoglobin (SpHb) measurements has been introduced. This clinical study aimed to test the hypothesis that SpHb monitoring was equivalent to that of HemoCue® (the automated hemoglobin measurement in the laboratory taken as a reference method) during acute surgical hemorrhage.
METHODS
Blood for laboratory analysis was sampled after induction of anesthesia, during surgery according to the requirements of the anesthesiologist, and finally after the transfer of the patient to the recovery room. When each blood sample was taken, capillary samples were obtained for analysis with HemoCue®. SpHb monitoring was performed continuously during surgery. Using the automated hemoglobin measurement in the laboratory as a reference method, the authors tested the hypothesis that SpHb monitoring is equivalent to that of HemoCue®. The agreement between two methods was evaluated by linear regression and Bland and Altman analysis.
RESULTS
Eighty-five simultaneous measurements from SpHb, HemoCue®, and the laboratory were obtained from 44 patients. Bland and Altman comparison of SpHb and HemoCue® with the laboratory measurement showed, respectively, bias of -0.02 ± 1.39 g · dl(-1) and -0.17 ± 1.05 g · dl(-1), and a precision of 1.11 ± 0.83 g · dl(-1) and 0.67 ± 0.83 g · dl(-1). Considering an acceptable difference of ± 1.0 g · dl(-1) with the laboratory measurement, the percentage of outliers was significantly higher for SpHb than for HemoCue® (46% vs. 16%, P < 0.05).
CONCLUSIONS
Taking automated laboratory hemoglobin measurement as a reference, the study shows that SpHb monitoring with Radical-7® gives lower readings than does the HemoCue® for assessment of hemoglobin concentration during hemorrhagic surgery.
背景
血红蛋白浓度测量的参考方法仍然是实验室中的自动化分析。虽然即时检测设备，如 HemoCue® 201+（HemoCue，Ängelholm，瑞典）可以提供即时的血红蛋白值，但一种非侵入性、基于分光光度法的技术（Radical-7®；Masimo 公司，欧文，加利福尼亚州）已经被引入，可以提供连续在线血红蛋白（SpHb）测量。这项临床研究旨在检验这样一个假设，即在急性外科出血期间，SpHb 监测与 HemoCue®（实验室中的自动化血红蛋白测量作为参考方法）等效。
方法
在麻醉诱导后、根据麻醉师的要求进行手术期间以及最后将患者转移到恢复室时，采集实验室分析用血液样本。在每次采血时，同时采集毛细血管样本，用 HemoCue®进行分析。在手术过程中连续进行 SpHb 监测。作者使用实验室中的自动化血红蛋白测量作为参考方法，检验了 SpHb 监测与 HemoCue®等效的假设。通过线性回归和 Bland 和 Altman 分析评估两种方法之间的一致性。
结果
从 44 名患者中获得了 85 次来自 SpHb、HemoCue®和实验室的同步测量值。SpHb 和 HemoCue®与实验室测量值的 Bland 和 Altman 比较显示，分别为 -0.02 ± 1.39 g · dl(-1) 和 -0.17 ± 1.05 g · dl(-1)的偏差，以及 1.11 ± 0.83 g · dl(-1) 和 0.67 ± 0.83 g · dl(-1)的精度。考虑到与实验室测量值的可接受差异为 ± 1.0 g · dl(-1)，SpHb 的离群值百分比明显高于 HemoCue®（46%比 16%，P < 0.05）。
结论
以实验室血红蛋白自动测量为参考，该研究表明，在出血性手术期间评估血红蛋白浓度时，Radical-7® 的 SpHb 监测比 HemoCue®给出的读数更低。
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