Continuous Noninvasive Hemoglobin Monitoring During Complex Spine Surgery
Continuous Noninvasive Hemoglobin Monitoring During Complex Spine Surgery
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DOI：
10.1213/ane.0b013e318230b425
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发表时间：
2011-12-01
影响因子：
5.7
通讯作者：
Mirski, Erin
中科院分区：
文献类型：
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作者：
Berkow, Lauren;Rotolo, Stephanie;Mirski, Erin
背景技术背景：目前，在手术室中监测血红蛋白水平需要重复抽血、几个步骤和可变的时间延迟才能收到结果。因此，输血管理决策可能会延迟或在血红蛋白结果可用之前做出。连续且非侵入性地测量血红蛋白的能力可以使得能够更快速地评估患者的状况和更适当的血液管理。一项新技术，脉搏一氧化碳血氧仪，提供了一个连续的，非侵入性的血红蛋白浓度（SpHb）的估计从传感器放置在手指上。我们评估的准确性SpHb相比，实验室的总血红蛋白（tHb）在复杂的脊柱手术的患者在高风险的bloodloss.METHODS：符合研究条件的患者进行复杂的脊柱手术计划侵入性动脉或中心静脉监测和每小时抽血血红蛋白测量的一氧化碳血氧测定法测量。在每次手术期间，每小时采集一次血样（如果有临床指征，则更频繁），并由中心实验室使用CO血氧测定法（许多医院的标准血红蛋白测量方法）进行分析。tHb测量值进行了比较，SpHb在抽血时获得的。结果：29例患者被纳入本研究。tHb值范围为6.9 - 13.9 g/dL，SpHb值范围为6.9 - 13.4 g/dL。共分析了186个数据对（tHb/SpHb）;去除低信号质量的SpHb读数后，剩余130个数据对的偏倚（定义为SpHb和tHb之间的差异）和精密度（定义为偏倚的1个SD）为-0.1 g/dL +/- 1.0 g/dL。Bland-Altman分析显示SpHb与tHb值在数值范围内具有良好的一致性;一致性限度为-2.0至1.8 g/dL。绝对偏差和精度为0.8 +/- 0.6 g/dL.CONCLUSIONS：连续，非侵入性血红蛋白测量通过脉冲CO-血氧饱和度证明血红蛋白测量的临床可接受的准确性在1.5 g/dL相比，标准的实验室参考设备时，在复杂的脊柱手术。该技术可以提供比间歇性血液样本分析更及时的血红蛋白状态信息，因此有可能改善手术期间的血液管理。（Anesth Analg 2011;113：1396-402）
BACKGROUND: Monitoring hemoglobin levels in the operating room currently requires repeated blood draws, several steps, and a variable time delay to receive results. Consequently, blood transfusion management decisions may be delayed or made before hemoglobin results become available. The ability to measure hemoglobin continuously and noninvasively may enable a more rapid assessment of a patient's condition and more appropriate blood management. A new technology, Pulse CO-Oximetry, provides a continuous, noninvasive estimate of hemoglobin concentration (SpHb) from a sensor placed on the finger. We evaluated the accuracy of SpHb compared with laboratory CO-Oximetry measurements of total hemoglobin (tHb) during complex spine procedures in patients at high risk for blood loss.METHODS: Patients eligible for the study were undergoing complex spine surgery with planned invasive arterial or central venous monitoring and hourly blood draws for hemoglobin measurement. During each surgery, blood samples were obtained hourly (or more often if clinically indicated) and analyzed by the central laboratory with CO-Oximetry, a standard method of hemoglobin measurement in many hospitals. The tHb measurements were compared with SpHb obtained at the time of the blood draw.RESULTS: Twenty-nine patients were included in the study. The tHb values ranged from 6.9 to 13.9 g/dL, and the SpHb values ranged from 6.9 to 13.4 g/dL. A total of 186 data pairs (tHb/SpHb) were analyzed; after removal of SpHb readings with low signal quality, the bias (defined as the difference between SpHb and tHb) and precision (defined as 1 SD of the bias) were -0.1 g/dL +/- 1.0 g/dL for the remaining 130 data pairs. Bland-Altman analysis showed good agreement of SpHb to tHb values over the range of values; limits of agreement were -2.0 to 1.8 g/dL. The absolute bias and precision were 0.8 +/- 0.6 g/dL.CONCLUSIONS: Continuous, noninvasive hemoglobin measurement via Pulse CO-Oximetry demonstrated clinically acceptable accuracy of hemoglobin measurement within 1.5 g/dL compared with a standard laboratory reference device when used during complex spine surgery. This technology may provide more timely information on hemoglobin status than intermittent blood sample analysis and thus has the potential to improve blood management during surgery. (Anesth Analg 2011;113:1396-402)