Pringle肝门阻断术对老年患者术中末梢灌注指数及无创血红蛋白准确性的影响  

Effect of hepatic portal occlusion with Pringle maneuver on intraoperative peripheral perfusion index and accuracy of non-invasive hemoglobin in elderly patients

作　　者：方岩[1] 梅伟[1] FANG Yan MEI Wei(Department of Anesthesiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Chin)

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,武汉430030

出　　处：《中华老年多器官疾病杂志》2017年第2期85-88,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：国家自然科学基金面上项目(81571357);湖北省卫生计生委青年人才项目(WJ2015Q008)~~

摘　　要：目的探讨Pringle肝门阻断术对老年患者术中末梢灌注指数(PI)及无创脉搏血红蛋白(SpHb)准确性的影响。方法入选2013年6月至2014年1月期间华中科技大学同济医学院附属同济医院收治的>60岁患者43例,全麻下行择期肝脏手术。于Pringle肝门阻断前后记录同一时间的PI、SpHb和有创血红蛋白(Hb)。Bland-Altman分析和线性回归模型评估Pringle肝门阻断前后的PI和SpHb测量误差(SpHb与有创Hb差值的绝对值)。结果肝门阻断前后分别收集有效试验数据:44对和73对。肝门阻断前PI>1.4的数据占77.3%,SpHb测量误差≤1 g/dl的数据占75.0%,SpHb偏倚值为0.62 g/dl,95%CI为-1.15~2.38 g/dl。肝门阻断后PI>1.4的数据占67.1%,SpHb测量误差≤1 g/dl的数据占35.6%,SpHb偏倚值为1.12 g/dl,95%CI为-0.98~3.23 g/dl。PI与SpHb测量误差呈显著负相关(r=-0.32,P<0.05)。结论 Pringle肝门阻断术通过降低老年患者的PI,增加了SpHb的测量误差;阻断后指导输血应当参考有创Hb的测量值。Objective To determine the effect of hepatic portal occlusion with Pringle maneuver on intraoperative peripheral perfu -sion index （PI） and accuracy of non-invasive hemoglobin （SpHb） in the elderly patients.Methods Forty-three patients （over 60 years old） undergoing elective liver surgery under general anesthesia in our hospital from June 2013 to January 2014 were enrolled in this study.Time-matched PI, non-invasive hemoglobin （SpHb） and invasive hemoglobin （Hb） before and after Pringle maneuver were recorded .Bland-Altman analysis and linear regression model were used to evaluate the change of PI and difference between SpHb and Hb before and after Pringle maneuver .Results Before hepatic portal occlusion , there were 44 pairs valid test data collected .The percentage of data pairs with PI 〉1.4 covered 77.3%, that with difference between SpHb and Hb below 1 g/dl took 75.0%, bias of SpHb was 0.62 g/dl, 95%confidence interval was -1.15 to 2.38 g/dl.After hepatic portal occlusion , there were 73 pairs valid test data collected, the percentage of data pairs with PI 〉1.4 was 67.1%, that with difference between SpHb and Hb below 1 g/dl was 35.6%, bias of SpHb was 1.12 g/dl, 95% confidence interval was -0.98 to 3.23 g/dl.The linear regression showed that the absolute value of difference between SpHb and Hb was negatively correlated with PI （r=-0.32, P〈0.05）.Conclusion Hepatic portal occlusion with Pringle maneuver decreases accuracy of SpHb in elderly patients by reducing peripheral PI .Invasive testing for Hb should be more reliable to guide blood transfusion decisions after hepatic portal occlusion .

关 键 词：Pringle肝门阻断 灌注指数 无创血红蛋白 

分 类 号：R575[医药卫生—消化系统] R592[医药卫生—内科学]