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无创血红蛋白监测在肾癌患者手术中的应用
Non-invasive measurement of hemoglobin in patients undergoing radical nephrectomy

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DOI:
作者:
李强，马伟，于布为
LI Qiang, MA Wei, YU Buwei
作者单位:
上海交通大学医学院附属瑞金医院
Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
关键词:
血红蛋白；肾癌根治术；液体填充
hemoglobin; radical nephrectomy; fluid administration
摘要:
【摘要】 目的 观察比较在肾癌根治术的稳定期与动态期，晶体或胶体液体填充时无创血红蛋白（SpHb）与有创血红蛋白（Hbsatlab）的相关性。 方法 46例行肾癌根治术患者纳入该项研究，并随机分为两组：15ml/kg胶体输注组（n=23）及15ml/kg晶体输注组（n=23），输注时间持续30min。在手术稳定期（从诱导开始至病灶切除完成）和动态期（液体填充期），使用美国Masimo公司Masimo Radical 7连续监测记录SpHb以及丹麦Radiometer公司血气分析仪ABL100检测动脉Hbsatlab。 结果 SpHb监测值为112 g l-1（84-141 g l-1），与动脉Hbsatlab检测水平115 g dl-1（86-145 g l-1）的差异无统计学意义（P＞0.05）；Pearson相关检验显示，SpHb与Hbsatlab呈正相关（R=0.761，P＜0.05）。输注胶体后SpHb准确性则会下降（R=0.562）。 结论 SpHb与Hbsatlab存在良好的相关性，输注胶体后相关性则有所下降。有必要进一步深入研究，以提高Masimo Radical 7在上述条件下的精确性，以便SpHb能够成为临床上实时监测血红蛋白的敏感指标。
【Abstract】 Objective We compared non-invasively measured hemoglobin concentration (SpHb) with invasive satellite-lab hemoglobin monitoring (Hbsatlab) both under steady-state conditions and dynamic-state conditions with fluid administration of crystalloid and colloid solutions during radical nephrectomy. Methods Totally 46 patients undergoing radical nephrectomy were enrolled in this study and randomized to receive a fluid administration of 15 ml kg-1 colloid (n=23) or crystalloid (n=23) solution over 30 min. During both the steady-state phase (from induction until completion of nephrectomy) and the dynamic phase (during fluid administration), SpHb was continuously calculated by the Masimo Radical 7 (Masimo Corp., Irvine, CA, USA) and also Hbsatlab was measured using the ABL 800 (Radiometer GmbH, Copenhagen, Denmark). Results SpHb value was 112 g l-1 (84-141 g l-1), which had no significant difference between Hbsatlab value 115 g l-1 (86-145 g l-1) (P＞0.05). Pearson correlation test showed that the correlation was significant between SpHb and Hbsatlab (R=0.761, P＜0.05). However, SpHb accuracy decreased after colloid administration (R=0.562). Conclusions SpHb correlated significantly with Hbsatlab in patients undergoing radical nephrectomy. Accuracy decreased in the circumstance of colloid solution. Further improvements are necessary to improve device accuracy under these conditions, in order that SpHb might become sensitive hemoglobin evaluation for clinical use.

 

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