Nakamori Erisa, Shigematsu Kenji, Higashi Midoriko, Yamaura Ken
Department of Anesthesiology, Fukuoka University Hospital, Fukuoka, Japan.
Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
Geriatr Orthop Surg Rehabil. 2021 Nov 19;12:21514593211060575. doi: 10.1177/21514593211060575. eCollection 2021.
Postoperative nadir hemoglobin (Hb) is related to a longer length of stay for geriatric patients undergoing orthopedic surgery. We investigated whether postoperative pulse Hb (SpHb) measurement is useful for avoiding anemia and inappropriate blood transfusion after total hip arthroplasty and total knee arthroplasty.
This prospective randomized controlled study included 150 patients randomly assigned to receive blood transfusion, either guided by SpHb monitoring (SpHb group) or based on the surgeons' experience (control group). The target laboratory Hb value was set to >8 g/dL at postoperative day 1 (POD1). The primary endpoints were the product of total time and degree of SpHb <8 g/dL (area under SpHb 8 g/dL) during the period up to POD1 and the incidence of laboratory Hb <8 g/dL at POD1. The secondary endpoints were the amount of blood transfusion and inappropriate blood transfusion, which was defined as allogeneic blood transfusion unnecessary in a case of SpHb >12 g/dL or delayed transfusion in a case of SpHb <8 g/dL.
The area under SpHb 8 g/dL was 37.6 ± 44.1 g/dL-min (5 patients) in the control group and none in the SpHb group ( = .0281). There was 1 patient with Hb <8 g/dL at POD1 in the control group. There was no difference in laboratory Hb levels and the amount of blood transfusion. Forty-one patients (19 in the control group and 22 in the SpHb group) received an allogeneic blood transfusion. Among these patients, 7 in the control group and none in the SpHb group received inappropriate blood transfusion ( = .0022).
The SpHb monitoring could reduce unnoticed anemia, which may prevent complications and be useful in avoiding unnecessary and excessive blood transfusion.
Postoperative SpHb monitoring decreased the incidence of transient, unnoticed anemia during the period up to POD1 and inappropriate blood transfusion.
老年骨科手术患者术后血红蛋白最低点（Hb）与住院时间延长有关。我们研究了术后脉搏血红蛋白（SpHb）测量对于避免全髋关节置换术和全膝关节置换术后贫血及不适当输血是否有用。
这项前瞻性随机对照研究纳入了150例患者，这些患者被随机分配接受输血，要么在SpHb监测指导下（SpHb组），要么基于外科医生的经验（对照组）。术后第1天（POD1）的目标实验室Hb值设定为>8 g/dL。主要终点是至POD1期间SpHb<8 g/dL的总时间与程度的乘积（SpHb 8 g/dL曲线下面积）以及POD1时实验室Hb<8 g/dL的发生率。次要终点是输血量和不适当输血，不适当输血定义为SpHb>12 g/dL时不必要的异体输血或SpHb<8 g/dL时延迟输血。
对照组SpHb 8 g/dL曲线下面积为37.6±44.1 g/dL·分钟（5例患者），SpHb组为零（P = 0.0281）。对照组有1例患者在POD1时Hb<8 g/dL。实验室Hb水平和输血量无差异。41例患者（对照组19例，SpHb组22例）接受了异体输血。在这些患者中，对照组7例接受了不适当输血，SpHb组无1例（P = 0.0022）。
SpHb监测可减少未被注意到的贫血，这可能预防并发症，并有助于避免不必要和过度的输血。
术后SpHb监测降低了至POD1期间短暂、未被注意到的贫血发生率和不适当输血的发生率。
