无创血红蛋白监测在肾癌手术中的应用  

Non-invasive measurement of hemoglobin in patients undergoing radical nephrectomy

作　　者：李强[1] 马伟[1] 于布为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院麻醉科,上海200025

出　　处：《上海医学》2013年第2期98-101,共4页Shanghai Medical Journal

摘　　要：目的探讨在肾癌根治术的稳定期与动态期,晶体液或胶体液填充时无创血红蛋白(SpHb)与有创血红蛋白(Hbsatlab)的相关性。方法将46例行肾癌根治术的患者随机分入晶体液组和胶体液组,每组23例。手术稳定期(从麻醉诱导开始至病灶切除完成)按照4-2-1法则补充乳酸钠林格注射液,动态期(液体填充期)晶体液组和胶体液组分别静脉滴注乳酸钠林格注射液和4%琥珀酰明胶注射液,剂量均为15mL/kg,静脉输注时间持续30min。分别于麻醉诱导前、麻醉诱导后即刻、稳定期每30min、动态期每5min、手术结束即刻、气管导管拔除后即刻,记录患者的SpHb(应用美国Masimo公司MasimoRadical7脉搏血氧仪检测)和Hbsatlab(应用丹麦Radiometer公司ABL100血气分析仪检测)以及心率、平均动脉压、中心静脉压;记录患者的输液总量、出血量及尿量。结果两组间输液总量、尿量、出血量的差异均无统计学意义(P值均>0.05)。两组在麻醉诱导后即刻、稳定期、动态期各时间点的心率和平均动脉压均显著低于同组麻醉诱导前(P值均<0.05),于手术结束即刻恢复至麻醉诱导前水平(P>0.05)。两组在麻醉诱导后各时间点的中心静脉压均显著高于同组麻醉诱导前(P值均<0.05)。两组在围术期各时间点的SpHb与Hbsatlab值均呈正相关(r=0.761,P值均<0.05)。所有患者的中位SpHb值为112(84,141)g/L,中位Hbsatlab值为115(86,145)g/L,两者间差异无统计学意义(P>0.05)。输注胶体液后SpHb的准确性下降(r=0.562)。结论 SpHb与Hbsatlab存在良好的相关性,输注胶体液后相关性有所下降。Objective To explore the correlation between non-invasively measured hemoglobin concentration （SpHb） with invasive satellite-lab hemoglobin monitoring （Hbab） under steady state and dynamic state after fluid administration of crystalloid and colloid solutions during radical nephrectomy. Methods Totally 46 patients for radical nephrectomy were randomly divided into crystalloid group and colloid group （n=23）. During the steady-state phase （from the induction of anesthesia to the completion of nephrectomy）, all the patients received sodium lactate ringer＇s injection according to the 4-2-1 rule. During the dynamic phase （fluid administration）, the patients received a fluid administration of 15 mL/kg sodium lactate ringer＇s injection or 4% succinylated gelatin injection for over 30 min. SpHb was calculated by the Masimo Radical 7 （Masimo Corp., Irvine, CA, USA） and Hbsatlab was measured by the ABL 800 （Radiometer GmbH, Copenhagen, Denmark） before induction, after induction, every 30 min during the steady-state phase, every 5 min during the dynamic phase, at the end of surgery and after the extubation. Heart rate （HR）, mean arterial pressure （MAP）, central venous pressure （CVP）, total fluid administration, urinary volume and hemorrhage volume were recorded perioperatively. Results There were no significant differences in total fluid administration, urinary volume or hemorrhage volume between two groups （P〈0.05）. HR and MAP were significantly decreased after induction, during the steady-state phase and dynamic phase （P〈0.05）, and returned to the basic level at the end of surgery （P〉0.05）. CVP was significantly higher than the basic level during the surgery （P〈0.05）. Pearson correlation test showed that SpHb was positively correlated with Hbab （r = 0. 761, P〈0. 05）. Median SpHb was 112 （84,141 ） g/L and median Hbsatwas 115 （86,145） g/L there was no significant difference between the two values （P〈0.05）. However, SpHb accuracy decrease

关 键 词：血红蛋白 肾癌根治术 液体填充 

分 类 号：R614[医药卫生—麻醉学]