Saito Junichi, Kitayama Masato, Oishi Masafumi, Kudo Tomoyuki, Sawada Masahiro, Hashimoto Hiroshi, Hirota Kazuyoshi
Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan,
J Anesth. 2015 Feb;29(1):29-34. doi: 10.1007/s00540-014-1863-1. Epub 2014 Jun 28.
Non-invasively continuous total hemoglobin (SpHb) measurement has not been assessed adequately in acute bleeding and rapid blood transfusion during surgery. Thus, we have assessed the efficacy of SpHb during both acute normovolemic hemodilution (ANH) and autologous blood transfusion (ABT).
Twenty-four patients undergoing urological and gynecological surgery were enrolled. ANH was induced by withdrawing blood of 800 g with simultaneous fluid administration. When surgical hemostasis was completed, collected blood was reinfused. Measurement of SpHb, perfusion index (PI) and real total Hb (tHb) were done before and after each 400 ml blood removal (-0, -400, -800 ml) and reinfusion (+0, +400, +800 ml).
A Bland-Altman analysis for repeated measurements showed a bias (precision) g/dl of 1.12 (1.25), 1.43 (1.24) and 1.10 (1.23) for all data, during ANH and during ABT, respectively. Additionally, a bias (precision) increased with a reduction in tHb (g/dl): ≥10.0; 0.74 (1.30), 8.0-10.0; 1.15 (1.12) and <8.0; 1.60 (1.28). Although the difference between SpHb and tHb was almost zero before anesthesia induction, it became significant just before ANH and did not change further by ANH and ABT. Significant correlations between SpHb and tHb for all data (r = 0.75, n = 228, p < 0.001) were observed. PI slightly correlated with the difference between SpHb and tHb (r = 0.38, n = 216, p < 0.001). Furthermore, before and after induction of anesthesia, PI also correlated with the difference between SpHb and tHb (r = 0.42, n = 23, p = 0.048 and r = 0.51, n = 22, p = 0.016, respectively).
The present data suggest that SpHb may overestimate tHb during ANH and ABT. In addition, PI and tHb levels had an impact on the accuracy of SpHb measurements.
在手术期间的急性出血和快速输血过程中，尚未对无创连续总血红蛋白（SpHb）测量进行充分评估。因此，我们评估了SpHb在急性等容血液稀释（ANH）和自体输血（ABT）过程中的有效性。
纳入24例行泌尿外科和妇科手术的患者。通过抽取800克血液并同时补液来诱导ANH。手术止血完成后，将采集的血液回输。在每次抽取400毫升血液（-0、-400、-800毫升）和回输（+0、+400、+800毫升）前后，测量SpHb、灌注指数（PI）和实际总血红蛋白（tHb）。
重复测量的Bland-Altman分析显示，所有数据在ANH期间和ABT期间的偏差（精密度）分别为1.12（1.25）、1.43（1.24）和1.10（1.23）克/分升。此外，偏差（精密度）随着tHb（克/分升）的降低而增加：≥10.0；0.74（1.30），8.0 - 10.0；1.15（1.12），<8.0；1.60（1.28）。虽然在麻醉诱导前SpHb和tHb之间的差异几乎为零，但在ANH前差异变得显著，并且在ANH和ABT过程中没有进一步变化。观察到所有数据的SpHb和tHb之间存在显著相关性（r = 0.75，n = 228，p < 0.001）。PI与SpHb和tHb之间的差异略有相关（r = 0.38，n = 216，p < 0.001）。此外，在麻醉诱导前后，PI也与SpHb和tHb之间的差异相关（分别为r = 0.42，n = 23，p = 0.048和r = 0.51，n = 22，p = 0.016）。
目前的数据表明，在ANH和ABT期间，SpHb可能高估tHb。此外，PI和tHb水平对SpHb测量的准确性有影响。
