脉搏碳氧-血氧仪无创监测肝硬化急性出血者血红蛋白浓度的研究  

Accuracy of noninvasive hemoglobin measurement by pulse co-oximetry masimo radical-7 for esophageal varices bleeding

作　　者：范春蕾[1] 单晶[1] 张剑[1] 丁惠国[1] 张月宁[1] 李国英[1] 魏光华[1] 刘静[1] 李宁[1] 

机构地区：[1]首都医科大学附属北京佑安医院肝病消化科,北京100069

出　　处：《中国急救复苏与灾害医学杂志》2013年第5期423-426,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：北京市卫生系统高层次卫生技术人才学科带头人培养计划（2011-2-19）;北京佑安基金（BJYAH-2011-009）

摘　　要：目的对于消化道出血患者血红蛋白的监测非常重要，但必须通过采血化验，有创、耗时、且非连续性监测。新型MasimoRadical-7脉搏碳氧-血氧仪可以无创连续监测正常人的血红蛋白浓度，本研究旨在评价在肝硬化食管静脉曲张出血患者中该仪器对血红蛋白浓度的判断的价值。方法47例肝硬化食管静脉曲张出血的住院患者被纳入研究，间断采集其静脉血进行血红蛋白（HGB）浓度的检测，同时用MasimoRadical-7脉搏碳氧-血氧仪连续无创检测血红蛋白（SpHb）的浓度。结果分别用两种方法检测47例急性上消化道出血患者的血红蛋白浓度，得到83组配对的检测数据，HGB为（6．76＋1．93）g／dL，SpHb为（8．80＋2．50）g／dL，差值为1．92s／d]（95％CI：-0．43～4．27g／dL），有统计学意义（P=0．000）。对于其中HGB〈4g／dL的6组检测数据，HGB值为（3．22±0．73）g／dL，SpHb的值为（3．67±1．12）g／dL，二者的差值缩小为0．45±0．67g／dL，P=-0．159，提示此时两种检测方法差异无统计学意义。两种检测方法具有很好的相关性（r=0．896，r^2=0．803，P=-0．000），呈直线正相关，直线方程为y=1．18x＋0．712。利用Bland—Altman法分析两种检测方法的一致性，两方法的偏倚为1．92g／dL，两方法差值占均值比为25．1％。用无创法检测血红蛋白，会将37．1％需要输血的患者错误判断为无需输血（输血的界值为7g／dL）。结论MasimoRadical-7脉搏碳氧一血氧仪可以实时无创监测血红蛋白浓度的变化趋势，与传统方法具有很好的相关性，对于极重度贫血患者检测的准确性相对较高。但该方法对于急性失血及中重度贫血患者，精密度较高而精确性不够，存在系统偏倚，可能会误导输血管理。Objective To monitor hemoglobin （HGB） levels of patients with acute gastrointestinal bleeding, and evaluate noninvasive hemoglobin measurement by pulse co-oximetry on its accuracy in esophageal varices bleeding patients. Methods 47 cirrhosis patients undergoing esophageal varices bleeding were enrolled for HGB concentration examination. Masimo Radical-7 pulse co-oximeter was performed to measure SpHb concentration noninvasively and continuously. Statistical analysis was performed to determine the correlation between the noninvasive hemoglobin measurement and the standard laboratory measurement. Results 83 pairs of data were collected by employing the two methods. The value of SpHb was significantly higher than that of HGB （8.80±2.50 g/dL v.s. 6.76±1.93 g/dL, P=-0.000）, with a mean difference of 1.92 g/dL （95% estimated confidence interval [CI]：-0.43-4.27 g/dL, P=-0.000）. There were 6 pairs of data which HGB value was below 4g/dL. In this subgroup, the value of SpHb reflected a difference with no statistical meaning from that of HGB （3.67± 1.12g/dL v.s. 3.22 ± 0.73g/dL, P=-0.159）, while the mean difference value of the two methods reduced to 0.45g/dL （95%CI：-0.86N1.76g/dL,/9=-0.159）. The overall correlation of the Masimo SpHb and the laboratory HGB was 0.896 （r^2=0.803, P=0.000）. Linear relationship could be found between the two measurements, and the equation was y=1.18x±0.712. Bland and Altman Analysis demonstrated the mean bias of the two methods was 1.92 g/dL. The ratio of the mean different value to the mean average value of the two measurements was 25.1%. Therefore, use of the Masimo radical-7 pulse co-oximeter for noninvasive measurement of hemoglobin would lead to 37.1% error in terms of transfusion decisions. Conclusion The Masimo radical-7 pulse co-oximeter is considered a promising tool, providing a continuous noninvasive measure of hemoglobin concentration. For patients undergoing esophageal varices bleeding with very severe anemia （HGB〈 4.0g/dL）, this method refl

关 键 词：血红蛋白 脉搏碳氧-血氧仪 食管静脉曲张破裂出血 输血 

分 类 号：R657.31[医药卫生—外科学]