不同血红蛋白测定方法在产后出血救治中的效果比较

摘要

目的 探讨产后出血患者无创血红蛋白(SPHb)、快速血红蛋白(Hb201)与静脉血血红蛋白(VHb)之间的关系及其在产后出血救治中意义,为产后出血救治提供参考依据.方法 采用Masimo Radical 7 Pulse Co-Oximeter、HEMOCUE Hb201+及Syemex XS-500i同时检测37例产后出血患者入科时、输血结束时、产后24h的血红蛋白值,将获得的113对数据进行分析,评估其准确性、相关性及一致性.结果 37例产后出血患者SPHb与VHb的差异有统计学意义(P=0.009);Hb201与VHb的差异无统计学意义(P=0.031).Peason相关分析显示:SPHb与VHb相关系数为0.909(P<0.001);Hb201与VHb相关系数为0.963(P<0.001).直线回归分析显示:SPHb和VHb的直线回归拟合公式为y=0.9412x+3.2074,R2=0.8261;Hb201和VHb的直线回归拟合公式为y=0.9710x+1.5368,R2=0.927.用Bland-Altman分析显示:SPHb与VHb的差值,平均偏倚为5.95g/L,95％的一致性界限中的最大差值15.3g/L为该两方式测定结果均值83.00g/L的18.43％;Hb201与VHb的差值,平均偏倚为3.88g/L,95％的一致性界限中的最大差值9.4g/L为该两方式测定结果均值82.56g/L的11.39％.结论 在产后出血患者中SPHb与VHb一致性存在差异,但相关性较好,以VHb为参照标准,通过设备自带的系统较准功能,减少误差;Hb201与VHb具有较好的一致性和相关性.临床可根据不同的使用环境,准确选择三种检测方法,通过优势互补,更好地为产后出血救治提供及时、可靠的血红蛋白测定值.%Objective To explore the relation among the noninvasive hemoglobin(SPHb),fast hemoglobin(Hb201)and venous hemoglobin(VHb),as well as the significance in the postpartum hemorrhage treatment and to provide reference basis for postpartum hemorrhage patients. Methods Masimo Radical 7 Pulse Co-Oximeter,HEMOCUE Hb201+ and Syemex XS-500i were used to detect the hemoglobin of 37 postpartum hemorrhage patients when section entrance,at the end of blood transfusion and 24 hours postpartum at the same time,the 113 pairs of data were analysed to evaluate the accuracy,correlation and consistency. Results There was a significant difference between SPHb and VHb(P=0.009), while no statistical significance between Hb201 and VHb(P=0.031)of the 37 postpartum hemorrhage patients. Person correlation analysis showed that the correlation coefficient of SPHb and VHb was 0.909(P<0.001);and 0.963 for Hb201 and VHb(P<0.001). Linear regression analysis indicated that linear regression fitting formula of SPHb and VHb were y=0.9412x+3.2074,R2=0.8261;and y=0.9710x+1.5368,R2=0.927 for Hb201 and VHb. The difference value between SPHb and VHb were found using the Bland-Altman analysis,the average bias was 5.95g/L,the biggest difference value 15.3g/L in 95％ conformance limit was 18.43％ of the mean value 83.00g/L;while for the difference value between Hb201 and VHb,the average bias was 3.88g/L,the biggest difference value 9.4g/L in 95％ conformance limit was 11.39％ of the mean value 82.56g/L. Conclusions The consistency between SPHb and VHb exists differences in postpartum hemorrhage patients,but with good correlation,VHb as reference standard,through the equipment's own system calibration function to reduce error;Hb201 and VHb has good consistency and correlation. We can accurately choose the three detection methods according different service environment,by means of complementary advantages,better for postpartum hemorrhage treatment to provide timely and reliable hemoglobin estimated value.