陈光强;达瓦;孙秀梅;徐明;周建新;

• 1:首都医科大学附属北京天坛医院
• 2:拉萨市人民医院

摘要(Abstract)：

目的评价血气分析仪与自动生化分析仪检测开颅术后患儿血钠和血钾水平的一致性。方法前瞻性连续收集2019-09—2020-08首都医科大学附属北京坛医院重症医学科收治的开颅术后同时进行动脉血气分析和生化分析仪检测的100例患儿的血钠和血钾水平,应用Pearson相关和Bland-Altman分析法评价两种方法的一致性和相关性。结果两种不同方法检测的血钠和血钾水平具有明显的相关性(r=0.996和r=0.859);二者血钠的差异(95%的可信区间)为2.2mmol/L(6.7～2.2 mmol/L),血钾的差异(95%的可信区间)为0.2 mmol/L(0.6～0.2 mmol/L)。结论血气分析仪检测血钠和血钾的水平与自动生化分析仪呈明显正相关,但二者之间仍存在一定差异,尤其对于血钠水平,无法完全互相替代检测结果。

关键词(KeyWords)： 开颅术;血气分析仪;生化分析仪;电解质;一致性;相关性

Abstract:

Keywords:

基金项目(Foundation): 西藏自治区自然科学基金组团式医学援藏项目（编号：拉医发[2017]145号）;西藏自治区自然科学基金组团式医学援藏项目（编号：XZ2019ZR-ZY37(Z)）

作者(Authors): 陈光强;达瓦;孙秀梅;徐明;周建新;

参考文献(References)：

• [1]PICOZZI T C.Volume and electrolyte management[J].Best Pract Res Clin Anaesthesiol,2007,21(4):497-516.DOI:10.1016/j.bpa.2007.07.002.
• [2]CASTLE-KIRSZBAUM M,KYI M,WRIGHT C,et al.Hyponatraemia and hypernatraemia:Disorders of Water Balance in Neurosurgery[J].Neurosurg Rev,2021:1-26.DOI:10.1007/s10143-020-01450-9.
• [3]VIERA A J,WOUK N.Potassium Disorders:Hypokalemia and Hyperkalemia[J].Am Fam Physician,2015,92(6):487-495.
• [4]REFARDT J,SAILER C O,CHIFU I,et al.The challenges of sodium measurements:indirect versus direct ion-selective method[J].Eur J Endocrinol,2019,181(2):193-199.DOI:10.1530/EJE-19-0101.
• [5]MEYERHOFF M E,OPDYCKE W N.Ion-selective electrodes[J].Adv Clin Chem,1986,25:1-47.DOI:10.1016/s0065-2423(08)60123-7.
• [6]PRICE C,ST JOHN A.Point-of-Care Testing.Making innovation work for patient-centred care[M].Washington,USA:AACC Press,2012.
• [7]USTUNDA?Y,HUYSAL K,OZGUNAY?E,et al.Interchangeability of Sodium and Potassium Result Values of Arterial Blood Gas with Laboratory Analyzer:Narrative Review[J].Indian J Crit Care Med,2019,23(1):35-42.DOI:10.5005/jp-journals-10071-23110.
• [8]PRAKASH S,BIHARI S,LIM Z Y,et al.Concordance between point-of-care blood gas analysis and laboratory autoanalyzer in measurement of hemoglobin and electrolytes in critically ill patients[J].J Clin Lab Anal,2018,32(6):e22425.DOI:10.1002/jcla.22425.
• [9]KIM H,KIM J K,CHO S C.Comparison of sodium ion levels between an arterial blood gas analyzer and an autoanalyzer in preterm infants admitted to the neonatal intensive care unit:a retrospective study[J].BMC Pediatr,2016,16(1):101.DOI:10.1186/s12887-016-0636-4.
• [10]SOLAK Y.Comparison of serum sodium levels measured by blood gas analyzer and biochemistry autoanalyzer in patients with hyponatremia,eunatremia,and hypernatremia[J].Am J Emerg Med,2016,34(8):1473-1479.DOI:10.1016/j.ajem.2016.04.037.
• [11]UYSAL E,ACAR Y A,KUTUR A,et al.How reliable are electrolyte and metabolite results measured by a blood gas analyzer in the emergency department?[J].The Am J Emerg Med,2015,34(3):419-424.DOI:10.1016/j.ajem.2015.11.025.
• [12]BUDAK Y U,HUYSAL K,POLAT M.Use of a blood gas analyzer and a laboratory autoanalyzer in routine practice to measure electrolytes in intensive care unit patients[J].BMC Anesthesiol,2012,12(17).DOI:10.1186/1471-2253-12-17.
• [13]YILMAZ S,UYSAL H B,AVCIL M,et al.Comparison of different methods for measurement of electrolytes in patients admitted to the intensive care unit[J].Saudi Med J,2016,37(3):262-267.DOI:10.15537/smj.2016.3.13539.
• [14]KING R,CAMPBELL A.Performance of the radiometer OSM3 and ABL505 blood gas analysers for determination of sodium,potassium and haemoglobin concentrations[J].Anaesthesia,2000,55(1):65-69.DOI:10.1046/j.1365-2044.2000.01166.x.
• [15]CHACKO B,PETER J V,PATOLE S,et al.Electrolytes assessed by point-of-care testing-Are the valuescomparable with results obtained from the central laboratory?[J].Indian J Crit Care Med,2011,15(1):24-29.DOI:10.4103/0972-5229.78219.
• [16]CHHAPOLA V,KANWAL S K,SHARMA R.A Comparative Study on Reliability of Point of Care Sodium and Potassium Estimation in a Pediatric Intensive Care Unit[J].Indian J Pediatr,2013,80(9):731-735.DOI:10.1007/s12098-013-0977-z.
• [17]ALLARDET-SERVENT J,LEBSIR M,DUBROCA C,et al.Point-of-Care versus central laboratory measurements of hemoglobin,hematocrit,glucose,bicarbonate and electrolytes:A prospective observational study in critically ill patients[J].PLo S One,2017,12(1):e0169593.DOI:10.1371/journal.pone.0169593.
• [18]AUVET A,ESPITALIER F,GRAMMATICO-GUIL-LON L,et al.Preanalytical conditions of point-ofcare testing in the intensive care unit are decisive for analysis reliability[J].Ann Intensive Care,2016,6(1):57.DOI:10.1186/s13613-016-0152-6.
• [19]MICHAEL G,SHARON K,ARTHUR M,et al.How closely do blood gas electrolytes and haemoglobin agree with serum values in adult emergency department patients:An observational study[J].Emerg Med Australas,2018,1(2):241-246.DOI:10.1111/1742-6723.13133.
• [20]MIRZAZADEH M,MOROVAT A,JAMES T,et al.Point-of-care testing of electrolytes and calcium using blood gas analysers:it is time we trusted the results[J].Emerg Med J,2016,33(3):181-1816.DOI:10.1136/emermed-2015-204669.
• [21]BLAND J M,ALTMAN D G.Statistical methods for assessing agreement between two methods of clinical measurement[J].Lancet,1986,327(8476):307-310.
• [22]EHRMEYER S S,LAESSIG R H,LEINWEBER J E,et al.1990 Medicare/CLIA final rules for proficiency testing:minimum intralaboratory performance characteristics(CV and bias) needed to pass[J].Clin Chem,1990,36(10):1736-1740.
• [23]BANSAL L R,ZINKUS T.Osmotic Demyelination Syndrome in Children[J].Pediatric Neurol,2019,97:12-17.DOI:10.1016/j.pediatrneurol.2019.03.018.
• [24]SCOTT M G,LEGRYS V A,KLUFTS J C.Electrolytes and Blood Gases.Ch.27[M]//Tietz Textbook of Clinical Chemistry.4th edition.BURTIS C A,ASH-WOOD E,BRUNS D E.Missouri USA:Elsevier,2006:985.
• [25]WEAVER D K,MILLER D,LEVENTHAL E A,et al.Evaluation of a computer-directed pneumatic-tube system for pneumatic transport of blood specimens[J].Am J Clin Pathol,1978,70(3):400-405.DOI:10.1093/ajcp/70.3.400.
• [26]STORY D A,MORIMATSU H,EGI M,et al.The effect of albumin concentration on plasma sodium and chloride measurements in critically ill patients[J].Anesth Analg,2007,104(4):893-897.DOI:10.1213/01.ane.0000258015.87381.61.
• [27]CHOPRA P,DATTA S K.Discrepancies in Electrolyte Measurements by Direct and Indirect Ion Selective Electrodes due to Interferences by Proteins and Lipids[J].JLab Physicians,2020,12(2):84-91.DOI:10.1055/s-0040-1713690.
• [28]HIN C S,CHANG C H,KIM J H.Liquid Heparin Anticoagulant Produces More Negative Bias in the Determination of Ionized Magnesium than Ionized Calcium[J].Yonsei Med J,2006,47(2):191-195.DOI:10.3349/ymj.2006.47.2.191.