Saito Junichi, Kitayama Masato, Amanai Erika, Toyooka Kentaro, Hirota Kazuyoshi
Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
Division of Operating Center, Hirosaki University Medical Hospital, Hirosaki, Japan.
J Anesth. 2017 Apr;31(2):193-197. doi: 10.1007/s00540-017-2306-6. Epub 2017 Jan 9.
Several factors affect the accuracy of non-invasive continuous hemoglobin concentration (SpHb) measurements. We had previously shown an increase in the perfusion index (PI) following induction of anesthesia which was associated with an increase in the difference between SpHb and total hemoglobin (tHb) (SpHb-tHb). We hypothesized that blunting the increase in PI by maintaining blood pressure during induction of anesthesia would improve the agreement between SpHb and tHb measurements.
Twenty-nine adult patients were enrolled. Patients were randomly assigned by use of sequentially numbered, opaque sealed envelopes to a control (group C) or a phenylephrine group (group P). Anesthesia was induced and maintained with propofol, remifentanil, and ketamine. In group P, phenylephrine was infused at 0.5 µg/kg/min during induction of anesthesia. SpHb and PI were monitored with a Radical-7 Pulse CO-Oximeter. tHb and hematocrit were measured with the ABL800 blood gas analyzer.
Following induction of anesthesia, PI increased significantly in both groups (p < 0.001 and p < 0.05 in groups C and P, respectively). However, the increase in PI was significantly smaller in group P than in group C (2.6 ± 1.3 vs 0.8 ± 1.4%, p < 0.001). Similarly, the change in SpHb-tHb was significantly smaller in group P than in group C (0.40 ± 0.78 vs 0.97 ± 0.70 g/dl, p < 0.05). Changes in SpHb-tHb are correlated with changes in PI (r = 0.46, p < 0.05).
The findings suggest that blunting the increase in PI by maintaining arterial pressure during induction of anesthesia improves the agreement between SpHb and tHb values.
多种因素会影响无创连续血红蛋白浓度（SpHb）测量的准确性。我们之前已经表明，麻醉诱导后灌注指数（PI）会升高，这与SpHb和总血红蛋白（tHb）之间的差值（SpHb - tHb）增加有关。我们假设在麻醉诱导期间通过维持血压来抑制PI的升高将改善SpHb和tHb测量值之间的一致性。
纳入29例成年患者。使用顺序编号的不透明密封信封将患者随机分配至对照组（C组）或去氧肾上腺素组（P组）。采用丙泊酚、瑞芬太尼和氯胺酮诱导并维持麻醉。在P组中，麻醉诱导期间以0.5μg/kg/min的速度输注去氧肾上腺素。使用Radical - 7脉搏血氧饱和度仪监测SpHb和PI。使用ABL800血气分析仪测量tHb和血细胞比容。
麻醉诱导后，两组的PI均显著升高（C组和P组分别为p < 0.001和p < 0.05）。然而，P组PI的升高显著小于C组（2.6±1.3 vs 0.8±1.4%，p < 0.001）。同样，P组SpHb - tHb的变化显著小于C组（0.40±0.78 vs 0.97±0.70 g/dl，p < 0.05）。SpHb - tHb的变化与PI的变化相关（r = 0.46，p < 0.05）。
研究结果表明，在麻醉诱导期间通过维持动脉压来抑制PI的升高可改善SpHb和tHb值之间的一致性。
