Gupta Namrata, Kulkarni Anita, Bhargava A K, Prakash Aditya, Gupta Nitika
Department of Anesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
Department of Mechanical Engineering, IIT Kharagpur, Kharagpur, West Bengal, India.
Indian J Anaesth. 2017 Jul;61(7):543-548. doi: 10.4103/ija.IJA_707_16.
Oncosurgeries may incur massive blood loss demanding frequent blood sampling to assess blood loss and the need for intraoperative blood transfusions. Accuracy of non-invasive spectrophotometric haemoglobin (hereafter to be referred as SpHb) monitoring has been studied in various perioperative settings. The intraoperative use of Radical-7, Masimo Corp., (Radical-7) for SpHb monitoring may be useful during cancer surgery. The aim of this study is to evaluate the intraoperative utility of SpHb monitoring by the Radical-7 to guide intraoperative transfusion in oncosurgeries.
Fifty adult patients, undergoing oncosurgery with anticipated blood loss of more than 20% of blood volume, were selected. Continuous SpHb monitoring was performed intraoperatively and blood transfusion was based on SpHb values. Simultaneous laboratory haemoglobin (LabHb) samples were taken for validation. The accuracy of intraoperative blood transfusions based on SpHb was analysed using Error Grid Analysis. Paired measurements of SpHb and LabHb were compared using Bland-Altman plot analysis.
There were 66 paired data points for blood transfusion from fifty patients with a correlation of 73% ( < 0.001) between SpHb and LabHb. In the Bland-Altman analysis, the bias was - 0.313 g/dl with ~ 95% of values within the limits of agreement of 1.81 g/dl to -2.44 g/dl. In the Error Grid Analysis, most data points were in the least error zone (Zone A).
The Radical-7 has the advantage of providing SpHb value continuously to take prompt decision regarding blood transfusion intraoperatively.
肿瘤手术可能导致大量失血，需要频繁采血以评估失血量及术中输血需求。在各种围手术期环境中，已对无创分光光度法血红蛋白（以下简称SpHb）监测的准确性进行了研究。术中使用美赛尼公司的Radical-7进行SpHb监测在癌症手术中可能有用。本研究的目的是评估Radical-7进行SpHb监测在肿瘤手术中指导术中输血的实用性。
选取50例预计失血量超过血容量20%的成年肿瘤手术患者。术中进行连续SpHb监测，并根据SpHb值进行输血。同时采集实验室血红蛋白（LabHb）样本进行验证。使用误差网格分析评估基于SpHb的术中输血准确性。采用Bland-Altman图分析比较SpHb和LabHb的配对测量值。
50例患者共有66对输血数据点，SpHb与LabHb的相关性为73%（<0.001）。在Bland-Altman分析中，偏差为-0.313 g/dl，约95%的值在1.81 g/dl至-2.44 g/dl的一致性界限内。在误差网格分析中，大多数数据点位于误差最小区域（A区）。
Radical-7具有连续提供SpHb值的优势，有助于术中就输血问题迅速做出决策。
