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目的 一直以来,围手术期血红蛋白监测依赖于测量血浆红细胞比容 (Hct) 的血气分析设备计算饱和度.测量总血红蛋白量 (t Hb) 的碳氧-血氧定量法,可获得对血液稀释更全面的评估.本研究旨在评估施行大心脏手术的住院患者中用碳氧-血氧定量法检测的t Hb和用电导率检测的Hct,与红细胞 (red blood cell,RBC) 输注、住院时间 (length of stay,LOS) 和住院费用的相关性.方法 回顾性分析2014年1月至2016年6月行冠状动脉旁路移植术 (CABG) 和/或瓣膜置换 (VR) 术患者的临床资料,使用Med Assets出院数据.患者按照检测方式 (t Hb和Hct) 进行分组,采用详细的账单记录和当代操作术语编码.根据医院特定的成本费用比来计算住院费用.采用多变量logistic回归法来确定RBC输注和资源利用的重要驱动因素.结果 本研究纳入18 169例心血管手术患者.其中Hct监测患者占66％,并更有可能进行CABG+VR双重手术 (10.4％vs.8.9％,P=0.006 9).在控制了患者和医院特征及患者合并症后,Hct组较t Hb组有明显更高的RBC输注风险 (OR=1.26,95％CI 1.15～1.38,P＜0.000 1),更长的LOS (IRR=1.08,P＜0.000 1) 和更高的费用 (IRR=1.15,P＜0.000 1).结论 与Hct监测相比,在心血管手术期间进行t Hb监测可以显著减少RBC输注和住院费用、缩短住院时间.“,”Objective Historically, perioperative hemoglobin monitoring has relied on calculated saturation, using blood gas devices that measure plasma hematocrit (Hct). Co-oximetry, which measures total hemoglobin (t Hb), yields a more comprehensive assessment of hemodilution. The purpose of this study was to examine the association of t Hb measurement by co-oximetry and Hct, using conductivity with red blood cell (RBC) transfusion, length of stay (LOS) and inpatient costs in patients having major cardiac surgery. Methods A retrospective study was conducted on patients who underwent coronary artery bypass graft (CABG) and/or valve replacement (VR) procedures from January 2014 to June2016, using Med Assets discharge data. The patient population was sub-divided by the measurement modality (t Hb and Hct), using detailed billing records and Current Procedural Terminology coding. Cost was calculated using hospitalspecific cost-to-charge ratios. Multivariable logistic regression was performed to identify significant drivers of RBC transfusion and resource utilization. Results The study population included 18 169 cardiovascular surgery patients. Hctmonitored patients accounted for 66％ of the population and were more likely to have dual CABG and VR procedures (10.4％ vs. 8.9％, P=0.006 9). After controlling for patient and hospital characteristics, as well as patient comorbidities, Hctmonitored patients had significantly higher RBC transfusion risk (OR=1.26, 95％CI 1.15-1.38, P＜0.000 1), longer LOS (IRR=1.08, P＜0.000 1) and higher costs (IRR=1.15, P＜0.000 1) than t Hb-monitored patients. RBC transfusions were a significant driver of LOS (IRR=1.25, P＜0.000 1) and cost (IRR=1.22, P＜0.000 1). Conclusion t Hb monitoring during cardiovascular surgery could offer a significant reduction in RBC transfusion, length of stay and hospital cost compared to Hct monitoring.