Yamada Hiroshi, Saeki Minako, Ito Junko, Kawada Kazuhiro, Higurashi Aya, Funakoshi Hiromi, Takeda Kohji
Critical Care Division, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa, Kanagawa, 251-8550, Japan,
J Clin Monit Comput. 2015 Feb;29(1):107-12. doi: 10.1007/s10877-014-9574-6. Epub 2014 May 3.
The pulse CO-Oximeter (Radical-7; Masimo Corp., Irvine, CA) is a multi-wavelength spectrophotometric method for noninvasive continuous monitoring of hemoglobin (SpHb). Because evaluating the relative change in blood volume (ΔBV) is crucial to avoid hypovolemia and hypotension during hemodialysis, it would be of great clinical benefit if ΔBV could be estimated by measurement of SpHb during hemodialysis. The capability of the pulse CO-Oximeter to monitor ΔBV depends on the relative trending accuracy of SpHb. The purpose of the current study was to evaluate the relative trending accuracy of SpHb by the pulse CO-Oximeter using Crit-Line as a reference device. In 12 patients who received hemodialysis (total 22 sessions) in the intensive care unit, ΔBV was determined from SpHb. Relative changes in blood volume determined from SpHb were calculated according to the equation: ΔBV(SpHb)=[starting SpHb]/[current SpHb] - 1. The absolute values of SpHb and hematocrit measured by Crit-Line (CL-Hct) showed poor correlation. On the contrary, linear regression analysis showed good correlation between ΔBV(SpHb) and the relative change in blood volume measured by Crit-Line [ΔBV(CL-Hct)] (r=0.83; P≤0.001). Bland-Altman analysis also revealed good agreement between ΔBV(SpHb) and ΔBV(CL-Hct) (bias, -0.77%; precision, 3.41%). Polar plot analysis revealed good relative trending accuracy of SpHb with an angular bias of 4.1° and radial limits of agreement of 24.4° (upper) and -16.2° (lower). The results of the current study indicate that SpHb measurement with the pulse CO-Oximeter has good relative trending accuracy.
脉搏碳氧血红蛋白仪（Radical-7；Masimo公司，加利福尼亚州欧文市）是一种用于无创连续监测血红蛋白（SpHb）的多波长分光光度法。由于评估血容量的相对变化（ΔBV）对于避免血液透析期间的血容量不足和低血压至关重要，因此如果能通过血液透析期间SpHb的测量来估计ΔBV，将具有很大的临床益处。脉搏碳氧血红蛋白仪监测ΔBV的能力取决于SpHb的相对趋势准确性。本研究的目的是使用Crit-Line作为参考设备，评估脉搏碳氧血红蛋白仪对SpHb的相对趋势准确性。在重症监护病房接受血液透析的12例患者（共22个疗程）中，根据SpHb确定ΔBV。根据以下公式计算由SpHb确定的血容量相对变化：ΔBV(SpHb)=[起始SpHb]/[当前SpHb] - 1。Crit-Line测量的SpHb和血细胞比容（CL-Hct）的绝对值相关性较差。相反，线性回归分析显示ΔBV(SpHb)与Crit-Line测量的血容量相对变化[ΔBV(CL-Hct)]之间具有良好的相关性（r=0.83；P≤0.001）。Bland-Altman分析还显示ΔBV(SpHb)与ΔBV(CL-Hct)之间具有良好的一致性（偏差，-0.77%；精密度，3.41%）。极坐标图分析显示SpHb具有良好的相对趋势准确性，角度偏差为4.1°，一致性的径向界限为24.4°（上限）和-16.2°（下限）。本研究结果表明，使用脉搏碳氧血红蛋白仪测量SpHb具有良好的相对趋势准确性。
