三种检测血红蛋白水平的方法在行脊柱手术患者中的比较

背景测定血红蛋白（hemoglobin，Hb）值有助于围术期输血管理。目前可以通过有创抽取血标本经实验室Co-血氧计法（mb）测定血红蛋白，或是实时现场检验HemoCue法（HCue）。最近临床上采用了一种新型的无创连续分光光度传感器法（MasimoSpHb）。我们对tHb、SpHb和HCue三种方法的准确性进行了比较研究。方法选择20例、年龄40—80岁、全麻在俯卧位下行脊柱手术的患者。所有血标本均采自桡动脉导管。在诱导后即刻、手术开始前及此点后大约每小时分别测定一次SpHb、tHb和HCue。主要评定结果的依据是SpHb和tHb或HCue和tHb的差值。所有患者的每次检测均有3-5个观察数据。为评估精确度采用几种技术去分析它们的差异值与绝对差异值。我们还同时调查了所得数据的偏差和下列变量：tHb水平、手术持续时间、年龄、体重和灌注指数之间的关系。结果数据由20例患者的SpHb、tHb和HCue的78组测量值构成。结果中SpHb和tHb之间绝对差值〈1．5g／dI的占61％；在1．6—2．0g／dI之间的占16％；〉2．og／dI的占22％。随着手术时间的延长和灌注指数增加，差值显著下降。与年龄或体重之间无系统相关性。除一个数值外，所有的HCue值均比tHb低1．Og／DI。结论虽然HCue始终是精确的，但是我们的数据证实SpHb与tHb值之间的相关性通常是良好的。不过，在某些病例，本研究显示SpHb可能还未达到临床需要的精确性。通过对诸如SpHb此类无创连续监测技术的不断改进，将可以达到临床必需的要求。

Abstract BACKGROUND： Hemoglobin vahes （Hb） can facilia decisions regarding perioperative transfusion man- agement. Currently, Hb can be determined invasively by analyzing blood via laboratory Co - Oximetry （tHb） or by point-of- care HemoCue （HCue）. Recently, a new noninvasive, continuous spectrophotometric sensor （Masimo SpHb） was introduced into clinical practice, We compared the accuracy of the SpHb and HCue with tHb. METHODS： Twenty patients, ages 40 to 80 years, were studied. They received general anesthesia and underwent spine surgery in the prone position. All blood sam- ples were obtained from a radial artery catheter. SpHb, tHb, and HCue were determined immediately after induction of anes- thesia, but before the start of surgery and approximatelv every hou thereafter Primary outcomes were defined on the basisof the following differences between measures： SpHb - tHb or HCue - tHb. All patients had 3 to 5 observations taken on each measure. Differences and absolute differences were analyzed by several techniques to assess accuracy. We also investigated the relationship between observed differences and the following variables： tHb level, duration of surgery, age, weight, and perfu- sion index. RESULTS： Data consisted of 78 measurements of SpHb, tHb, and HCue made on the 20 patients. Absolutedifferences between SpHb and tHb were 〈1.5 g/dL for 61% of observations, between 1.6 to 2.0 g/dL for 16% and 〉2.0 g/dL for 22% of the observations. Observed differences displayed significant decreases with time and higher perfusion index values. No systematic relationships were observed with age or weight. Except for 1 value, all of the HCue values were 〈1.0 g/ dL of tHb. CONCLUSIONS： Although HCue was consistently accurate, our data confirm that SpHb often correlated well with tHb values. Yet our study indicates that SpHb may not be as accurate as clinically necessary in some patients. Improved refinement of continuous, noninvasive technology, such as SpHb, could address important dinical requirements.