Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California 92354, USA.
Anesthesiology. 2012 Jan;116(1):65-72. doi: 10.1097/ALN.0b013e31823d774f.
Intraoperative transfusion decisions generally are guided by blood loss estimation and periodic invasive hemoglobin measurement. Continuous hemoglobin measurement by pulse cooximetry (pulse hemoglobin; Rainbow® SET Pulse CO-Oximeter, Masimo Corporation, Irvine, CA) has good agreement with laboratory hemoglobin in healthy volunteers and could aid transfusion decision-making. Because intraoperative physiology may alter performance of this device, this study investigated pulse hemoglobin during surgery.
Ninety-one adult patients undergoing abdominal or pelvic surgery in which large blood loss was likely were studied. Time-matched pulse hemoglobin measurements were recorded for each intraoperative arterial hemoglobin measurement obtained. Agreement between measurements was assessed by average difference (mean ± SD, g/dl), linear regression, and multiple measures Bland-Altman analysis.
The average difference between 360 time-matched measurements (bias) was 0.50 ± 1.44 g/dl, with wider limits of agreement (-2.3 to 3.3 g/dl) than reported in healthy volunteers. The average difference between 269 paired sequential pulse and arterial hemoglobin changes was 0.10 ± 1.11 g/dl, with half between -0.6 and 0.7 g/dl of each other. The bias was larger in patients with blood loss of more than 1,000 ml; hemoglobin less than 9.0 g/dl; any intraoperative transfusion; or intraoperative decrease in arterial hemoglobin at the time of sampling ≥2 g/dl (all P < 0.001). The range of bias was narrower at deeper anesthesia (P < 0.001).
Evaluation of the sensor and software version tested suggests that although pulse cooximetry may perform well in ambulatory subjects, in patients undergoing surgery in which large blood loss is likely, an invasive measurement should be used in transfusion decision-making.
术中输血决策通常由失血量估计和定期的有创血红蛋白测量来指导。通过脉搏血氧仪（脉搏血红蛋白；Masimo 公司的 Rainbow®SET Pulse CO-Oximeter，加利福尼亚州欧文市）进行连续血红蛋白测量与健康志愿者的实验室血红蛋白值具有良好的一致性，可辅助输血决策。由于术中生理学可能会改变该设备的性能，因此本研究调查了手术过程中的脉搏血红蛋白。
研究纳入 91 名接受腹部或盆腔手术的成年患者，这些手术可能会导致大量失血。为每一次术中动脉血红蛋白测量记录了时间匹配的脉搏血红蛋白测量值。通过平均差异（g/dl，平均值±标准差）、线性回归和多组 Bland-Altman 分析评估测量值之间的一致性。
360 次时间匹配测量值（偏倚）的平均差异为 0.50±1.44 g/dl，与健康志愿者的报道相比，一致性的范围（-2.3 至 3.3 g/dl）更宽。269 对配对的连续脉搏和动脉血红蛋白变化的平均差异为 0.10±1.11 g/dl，彼此之间相差 0.6 至 0.7 g/dl。失血量超过 1000 ml、血红蛋白<9.0 g/dl、术中任何输血或在取样时动脉血红蛋白下降≥2 g/dl 的患者中，偏倚更大（均 P<0.001）。在深度麻醉时，偏倚范围更窄（P<0.001）。
对所测试的传感器和软件版本进行评估表明，尽管脉搏血氧仪在门诊患者中表现良好，但在可能大量失血的手术患者中，输血决策应使用有创测量值。
