Len'kin P I, Smetkin A A, Husseyn A, Fot E V, Len'kin A I, Paromov K V, Ushakov A A, Krygina M A, Kirov M Yu
Anesteziol Reanimatol. 2016 Sep;61(5):329-334.
To assess the accuracy ofcontinuous hemoglobin monitoring using pulse co-oximetry and revealfactors affecting the results of the measurements during early postoperative period in cardiac surgery.
27 patients undergoing off-pump CABG and 16patients after elective complex (repair or replacement of two or more valves) or combined (valve and coronary artery) cardiac surgery requiring CPB were enrolled into a prospective observational study. Both groups received continuous hemoglobin monitoring using pulse co-oximetry (SpHb). During early postoperative period SpHb was compared with hemoglobin concentration in the arterial blood (Hbart).
Wefoundpositive correlation between SpHb and Hb in both groups (rho =0,29, p < 0,05 u rho=0,34; p<0.005 respectively). The Bland-Altman analysis showed a bias ? limits of agreement (?I.96 SD) between the continuously measured hemoglobin and reference arterial blood hemoglobin concentration of -6,0 ? 41,0 g/l in the off-pump group and 7,7 k 31,0 g/l in the CPB group.
Hemoglobin measurement using pulse co-oximetry does not provide acceptable accuracy during early postoperative period in cardiac surgery. Applicability of this technology is influenced by vascular tone, systemic and regional tissue hypoperfusion.
评估使用脉搏血氧饱和度仪进行连续血红蛋白监测的准确性，并揭示心脏手术后早期影响测量结果的因素。
27例行非体外循环冠状动脉搭桥术的患者和16例接受择期复杂（修复或置换两个或更多瓣膜）或联合（瓣膜和冠状动脉）心脏手术且需要体外循环的患者被纳入一项前瞻性观察性研究。两组均使用脉搏血氧饱和度仪（SpHb）进行连续血红蛋白监测。在术后早期，将SpHb与动脉血中的血红蛋白浓度（Hbart）进行比较。
我们发现两组中SpHb与Hb之间均呈正相关（分别为rho = 0.29，p < 0.05和rho = 0.34；p < 0.005）。Bland-Altman分析显示，非体外循环组中连续测量的血红蛋白与参考动脉血血红蛋白浓度之间的偏差 - 一致性界限（±1.96 SD）为-6.0 ± 41.0 g/l，体外循环组为7.7 ± 31.0 g/l。
在心脏手术后早期，使用脉搏血氧饱和度仪测量血红蛋白不能提供可接受的准确性。该技术的适用性受血管张力、全身和局部组织灌注不足的影响。
