Department of Surgery, University of Arizona, Tucson, AZ, USA.
World J Surg. 2013 Mar;37(3):525-9. doi: 10.1007/s00268-012-1871-y.
Advances in technology have allowed for continuous noninvasive hemoglobin monitoring (SpHb), which may enable earlier detection of hemorrhage and more efficient surgical and/or blood transfusion management. The use of SpHb has not been described in the trauma population. The purpose of the present study was to evaluate the accuracy of a SpHb measurement device in severely injured trauma patients.
We performed a prospective cohort analysis of severely injured trauma patients admitted to the intensive care unit (ICU) at our level I trauma center over a 6 month period. Serial IHb (invasive hemoglobin) levels and SpHb for the first 72 h were measured. Each SpHb measurement was matched with a corresponding IHb measurement. We defined normal Hgb as >8 mg/dL and low Hgb as <8 mg/dL. Data were then grouped based on Hgb level. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Spearman correlation coefficient plot were calculated.
A total of 23 trauma patients with 89 data pairs were reviewed. Eighty-six percent of the patients were male with a mean age of 32 years and a mean injury severity score (ISS) of 21.1 ± 14. Invasive hemoglobin had a range of 7.2-16.9 and SpHb had a range of 3.3-15.2. The average mean and difference between IHb and SpHb were 10.7 and 1, respectively. Continuous noninvasive hemoglobin measurement did not record data points 13.5% of the time. The Spearman correlation plot revealed a correlation of R = 0.670 (p < 0.001). After dichotomization with Hgb > 8, SpHb was found to have a sensitivity of 91%, PPV 96%, specificity 40%, NPV 20%, and an accuracy of 88%.
The continuous noninvasive hemoglobin monitor does not appear to represent serum hemoglobin levels accurately in severely injured trauma patients. However, we were able to identify utility for this noninvasive tool when Hgb was dichotomized into normal or low levels.
技术的进步使得连续无创血红蛋白监测（SpHb）成为可能，这可能有助于更早地发现出血，并更有效地进行手术和/或输血管理。SpHb 在创伤人群中的应用尚未得到描述。本研究的目的是评估 SpHb 测量设备在严重创伤患者中的准确性。
我们对在我们的一级创伤中心重症监护病房（ICU）接受治疗的严重创伤患者进行了前瞻性队列分析。在最初的 72 小时内，连续测量了 IHb（侵入性血红蛋白）水平和 SpHb。每一次 SpHb 测量都与相应的 IHb 测量相匹配。我们将正常 Hgb 定义为>8mg/dL，低 Hgb 定义为<8mg/dL。然后根据 Hgb 水平对数据进行分组。计算了敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、准确性和斯皮尔曼相关系数图。
共回顾了 23 例创伤患者的 89 对数据。86%的患者为男性，平均年龄为 32 岁，平均损伤严重程度评分（ISS）为 21.1±14。侵入性血红蛋白的范围为 7.2-16.9，SpHb 的范围为 3.3-15.2。IHb 和 SpHb 的平均差值分别为 10.7 和 1。连续无创血红蛋白测量有 13.5%的时间未记录数据点。斯皮尔曼相关图显示相关系数 R=0.670（p<0.001）。将 Hgb>8 进行二分类后，SpHb 的敏感性为 91%，PPV 为 96%，特异性为 40%，NPV 为 20%，准确性为 88%。
连续无创血红蛋白监测在严重创伤患者中似乎不能准确反映血清血红蛋白水平。然而，当 Hgb 分为正常或低值时，我们能够识别出这种无创工具的实用性。
