Kim Sang-Hyun, Lilot Marc, Murphy Linda Suk-Ling, Sidhu Kulraj S, Yu Zhaoxia, Rinehart Joseph, Cannesson Maxime
From the Departments of Anesthesiology & Perioperative Care, Science Library Reference, and Statistics, University of California Irvine, Orange, California.
Anesth Analg. 2014 Aug;119(2):332-346. doi: 10.1213/ANE.0000000000000272.
Noninvasive hemoglobin (Hb) monitoring devices are available in the clinical setting, but their accuracy and precision against central laboratory Hb measurements have not been evaluated in a systematic review and meta-analysis.
We conducted a comprehensive search of the literature (2005 to August 2013) with PubMed, Web of Science and the Cochrane Library, reviewed references of retrieved articles, and contacted manufactures to identify studies assessing the accuracy of noninvasive Hb monitoring against central laboratory Hb measurements. Two independent reviewers assessed the quality of studies using recommendations for reporting guidelines and quality criteria for method comparison studies. Pooled mean difference and standard deviation (SD) (95% limits of agreement) across studies were calculated using the random-effects model. Heterogeneity was assessed using the I statistic.
A total of 32 studies (4425 subjects, median sample size of 44, ranged from 10 to 569 patients per study) were included in this meta-analysis. The overall pooled random-effects mean difference (noninvasive-central laboratory) and SD were 0.10 ± 1.37 g/dL (-2.59 to 2.80 g/dL, I = 95.9% for mean difference and 95.0% for SD). In subgroup analysis, pooled mean difference and SD were 0.39 ± 1.32 g/dL (-2.21 to 2.98 g/dL, I = 93.0%, 71.4%) in 13 studies conducted in the perioperative setting and were -0.51 ± 1.59 g/dL (-3.63 to 2.62 g/dL, I = 83.7%, 96.4%) in 5 studies performed in the intensive care unit setting.
Although the mean difference between noninvasive Hb and central laboratory measurements was small, the wide limits of agreement mean clinicians should be cautious when making clinical decisions based on these devices.
临床中已有非侵入性血红蛋白（Hb）监测设备，但尚未通过系统评价和荟萃分析评估其相对于中心实验室Hb测量的准确性和精密度。
我们利用PubMed、科学网和考克兰图书馆对文献（2005年至2013年8月）进行了全面检索，查阅了检索文章的参考文献，并联系制造商以确定评估非侵入性Hb监测相对于中心实验室Hb测量准确性的研究。两名独立的评审员根据报告指南建议和方法比较研究的质量标准评估研究质量。使用随机效应模型计算各研究的合并平均差异和标准差（SD）（95%一致性界限）。使用I统计量评估异质性。
本荟萃分析共纳入32项研究（4425名受试者，样本量中位数为44，每项研究的患者人数范围为10至569）。总体合并随机效应平均差异（非侵入性测量值-中心实验室测量值）和SD分别为0.10±1.37 g/dL（-2.59至2.80 g/dL，平均差异的I²=95.9%，SD的I²=95.0%）。在亚组分析中，围手术期进行的13项研究中，合并平均差异和SD分别为0.39±1.32 g/dL（-2.21至2.98 g/dL，I²=93.0%，71.4%）；重症监护病房进行的5项研究中，合并平均差异和SD分别为-0.51±1.59 g/dL（-3.63至2.62 g/dL，I²=83.7%，96.4%）。
尽管非侵入性Hb测量值与中心实验室测量值之间的平均差异较小，但一致性界限较宽，这意味着临床医生在基于这些设备做出临床决策时应谨慎。
