Huang P H, Shih B F, Tsai Y-F, Chung P C H, Liu F C, Yu H P, Lee W C, Chang C J, Lin C C
Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan.
Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.
Transplant Proc. 2016 May;48(4):1067-70. doi: 10.1016/j.transproceed.2015.12.121.
Shift in large fluid volumes and massive blood loss during liver transplantation frequently leads to rapid changes in hemoglobin (Hb) concentration; thus, to ensure adequate tissue oxygenation, accurate and rapid determination of Hb concentration is essential in transplant recipients. The Radical-7 Pulse CO-Oximeter provides a noninvasive and continuous way to monitor Hb concentration (SpHb) in real time and is an ideal candidate for use during liver transplantation. In this study, we assessed the relationship between SpHb and total Hb (tHb) obtained from arterial blood samples during surgery.
Forty patients undergoing liver transplantation were enrolled in this study. tHb and time-matched SpHb were measured at 5 different phases throughout surgery. Paired SpHb and tHb levels were assessed using linear regression, Bland-Altman analysis, and the Critchley polar plot method.
A total of 161 paired measurements with sufficient signal quality were analyzed. The correlation between SpHb and tHb was 0.59 (P < .001). Bland-Altman analysis revealed that a bias between SpHb and tHb was 2.28 g/dL, and limits of agreement (LoA) were from -0.78 to 5.34 g/dL. Trending analysis showed that 87% of data were located within the acceptable trending area, indicating that the trending ability was not satisfied.
The Radical-7 Pulse CO-Oximeter was not sufficient to monitor Hb levels and trends during liver transplantation surgery in our cohort. In particular, in critical patients and in those with low Hb levels, invasive Hb measurement should be used for assessment.
肝移植过程中大量液体转移和大量失血常导致血红蛋白（Hb）浓度迅速变化；因此，为确保足够的组织氧合，准确快速地测定移植受者的Hb浓度至关重要。Radical-7脉搏血氧饱和度仪提供了一种实时无创连续监测Hb浓度（SpHb）的方法，是肝移植期间使用的理想选择。在本研究中，我们评估了手术期间SpHb与动脉血样本中总Hb（tHb）之间的关系。
本研究纳入了40例行肝移植的患者。在手术全程的5个不同阶段测量tHb和时间匹配的SpHb。使用线性回归、Bland-Altman分析和Critchley极坐标图法评估配对的SpHb和tHb水平。
共分析了161对信号质量足够的测量值。SpHb与tHb之间的相关性为0.59（P <.001）。Bland-Altman分析显示，SpHb与tHb之间的偏差为2.28 g/dL，一致性界限（LoA）为-0.78至5.34 g/dL。趋势分析显示，87%的数据位于可接受的趋势区域内，表明趋势能力不令人满意。
在我们的队列中，Radical-7脉搏血氧饱和度仪不足以监测肝移植手术期间的Hb水平和趋势。特别是在重症患者和Hb水平较低的患者中，应使用有创Hb测量进行评估。
