GEM Premier 3000血气分析仪非传统检测项目实用价值的探讨

doi:10.3969/j.issn.1673-8640.2016.01.006

摘要/Abstract

摘要： 目的探讨GEM Premier 3000血气分析仪（简称Premier 3000）血钾（K⁺）、血钠（Na⁺）、血糖（Glu）、总二氧化碳（TCO₂）、血红蛋白（Hb）和红细胞压积（Hct）项目与日立7600全自动生化分析仪（简称日立7600）、Sysmex XN-1000血液分析仪（简称XN-1000）相同项目的可比性以及呼吸指数（RI）对Premier 3000以上指标检测结果的影响。方法同时采集193例患者的动、静脉血,采用Premier 3000检测动脉全血K⁺、Na⁺、Glu、TCO₂、Hb、Hct和RI,采用日立7600检测动脉血浆及静脉血浆K⁺、Na⁺、Glu和TCO₂,采用XN-1000检测静脉全血Hb和Hct,分析不同仪器、不同标本类型相同项目的差异。按RI结果将193例患者分为Ⅰ组（30例,RI<0）、Ⅱ组（45例,0≤RI≤1）、Ⅲ组（118例,RI>1）,比较各组上述各项指标的差异。结果Premier 3000动脉全血与日立7600动脉血浆K⁺、Na⁺、TCO₂结果差异均有统计学意义（P均<0.05）,而Glu结果差异无统计学意义（P>0.05）。以日立7600动脉血浆数据为因变量（Y）、Premier 3000动脉全血数据为自变量（X）做相关分析和线性回归分析,K⁺、Na⁺、Glu、TCO₂的回归方程分别为Y=0.868X+0.561,r=0.959;Y=0.993X+5.998,r=0.831;Y=1.080X+0.594,r=0.992;Y=0.857X+0.755,r=0.956。日立7600检测动脉血浆K⁺、Glu、TCO₂结果与静脉血浆结果比较差异均有统计学意义（P均<0.05）,而Na⁺结果差异无统计学意义（P>0.05）。Premier 3000动脉全血K⁺、Na⁺和Hb结果低于日立7600静脉血浆K⁺、Na⁺结果和XN-1000静脉全血Hb结果（P均<0.05）,而Glu、TCO₂、Hct结果差异均无统计学意义（P均>0.05）。不同RI组间动脉全血K⁺浓度差异有统计学意义（P<0.05）,而Na⁺、Glu、TCO₂、Hb和Hct差异均无统计学意义（P均>0.05）。结论动脉全血Glu、TCO₂、Hct检测结果可分别用于Glu水平、呼吸功能及临床输血、输液的评估,而动脉全血K⁺、Na⁺、Hb仅有参考价值。

关键词: 血气分析仪, 电解质, 血糖, 红细胞压积, 呼吸指数

Abstract:

Objective To investigate the comparability of serum potassium（K⁺）,serum sodium（Na⁺）,glucose（Glu） and total carbon dioxide（TCO₂） determined by GEM Premier 3000 blood gas analyzer （Premier 3000） and Hitachi 7600 biochemical analyzer （Hitachi 7600） and hemoglobin（Hb）and hematocrit（Hct） determined by Premier 3000 and Sysmex XN-1000 hematology analyzer （XN-1000）,and to investigate the influence of respiratory index（RI） on the above results. Methods K⁺,Na⁺,Glu,TCO₂,Hb,Hct and RI of arterial and venous blood in 193 patients were determined by Premier 3000,K⁺,Na⁺,Glu and TCO₂ of arterial and venous plasma were determined by Hitachi 7600,and Hb and Hct of venous blood were determined by XN-1000. The differences of same test items in different analyzers and specimen types were analyzed. According to RI,193 patients were classified into 3 groups,Ⅰ group（30 cases,RI<0）,Ⅱ group （45 cases,0≤RI≤1） and Ⅲ group（118 cases,RI>1）,and the differences of above indices were compared among different groups. Results The differences of K⁺,Na⁺ and TCO₂ between arterial blood by Premier 3000 and arterial plasma by Hitachi 7600 were statistically significant（P<0.05）,but there was no statistical significance for Glu（P>0.05）. With arterial plasma data by Hitachi 7600 as dependent variable（Y） and arterial blood data by Premier 3000 as independent variable（X）,the correlation analysis and linear regression analysis were performed,and the regression equations of K⁺,Na⁺,Glu and TCO₂ were Y=0.868X+0.561（r=0.959）,Y=0.993X+5.998（r=0.831）,Y=1.080X+0.594（r=0.992） and Y=0.857X+0.755（r=0.956）,respectively. The differences of K⁺,Glu and TCO₂ by Hitachi 7600 between arterial plasma and venous plasma were statistically significant（P<0.05）,but there was no statistical significance for Na⁺ （P>0.05）. The results of K⁺,Na⁺ and Hb in arterial blood by Premier 3000 were lower than those in venous plasma by Hitachi 7600 and in venous blood by XN-1000（P<0.05）,but there was no statistical significance for Glu,TCO₂ and Hct（P>0.05）. There was statistical significance for K⁺（P<0.05）,with no statistical significance for Na⁺,Glu,TCO₂,Hb and Hct（P>0.05）by Premier 3000 in arterial blood by RI. Conclusions Glu,TCO₂and Hct in arterial blood can be used for evaluating Glu level,respiratory function and clinical transfusion,and K⁺,Na⁺ and Hb in arterial blood only have reference significance.

Key words: Blood gas analyzer, Electrolyte, Glucose, Hematocrit, Respiratory index

中图分类号:

R446.1

余建洪. GEM Premier 3000血气分析仪非传统检测项目实用价值的探讨[J]. 检验医学, 2016, 31(1): 26-30.

YU Jianhong. Investigation on the practical application significance of non-traditionary test items by GEM Premier 3000 blood gas analyzer[J]. Laboratory Medicine, 2016, 31(1): 26-30.

图/表 6

参考文献 10

1	刘光明,黄小兵,李健茹.血气分析仪与生化分析仪相同检测项目的比较分析[J].海南医学,2010,21(8):102-104.
2	江龙,李鹏.床旁血气分析仪与生化仪测定动静脉血钾浓度差异的检测[J].中国医疗设备,2013,28(3):115-117.
3	Medicare,Medicaid and CLIA programs; regulations implementing the Clinical Laboratory Improvement Amendments of 1988(CLIA)--HCFA. Final rule with comment period[J]. Fed Regist,1992,57(40):7002-7186.
4	郭亚鹏,曾新艳,扶志敏,等.床旁血气分析仪与血液分析仪相同检测项目的比较分析[J].湘南学院学报:医学版,2012,14(3):26-28.
5	杨惠聪,林洁,方春香,等.血气分析仪与全自动生化仪相同检测项目可比性探讨[J].检验医学与临床,2013,10(16):2072-2073.
6	BUDAK YU,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.
7	丁珂.全自动生化分析仪与血气分析仪电解质测定结果比较[J]. 海军医学杂志,2011,32(4):255-256.
8	王建琼,牛华,郑瑞,等.肝素抗凝血浆钾与血清钾测定对比分析[J].国际检验医学杂志,2010,31(5):500-501.
9	DAURES MF,COMBESCURE C,DEMATTEI C,et al. Hematocrit measurement: comparison of conductimetry to microcentrifugation[J].Ann Biol Clin(Paris),2009,67(1):67-72.
10	杨明全,肖国辉. 机械通气患者不同pH情况下动静脉血电解质测定的相关性研究[J]. 中国急救医学,2010,30(10):886-888.

标本类型	K⁺	Na⁺	Glu	TCO₂
动脉全血	3.30±0.62	137.17±10.16	8.14±5.29	27.45±5.90
动脉血浆	3.41±0.57^*	141.08±10.31^*	8.19±5.60	23.75±5.26^*

标本类型	K⁺	Na⁺	Glu	TCO₂
动脉全血	3.30±0.62	137.17±10.16	8.14±5.29	27.45±5.90
动脉血浆	3.41±0.57^*	141.08±10.31^*	8.19±5.60	23.75±5.26^*

项目	回归方程	Xc	SE	1/2TEa	临床评价
K⁺	Y=0.868X+0.561	3.00	0.17	0.25	可接受
		6.00	0.23	0.25	可接受
Na⁺	Y=0.993X+5.998	130.00	5.09	2.00	不可接受
		150.00	4.95	2.00	不可接受
Glu	Y=1.08X+0.594	2.78	0.37	0.17	不可接受
		6.99	0.03	0.35	可接受
		11.00	0.29	0.56	可接受

项目	回归方程	Xc	SE	1/2TEa	临床评价
K⁺	Y=0.868X+0.561	3.00	0.17	0.25	可接受
		6.00	0.23	0.25	可接受
Na⁺	Y=0.993X+5.998	130.00	5.09	2.00	不可接受
		150.00	4.95	2.00	不可接受
Glu	Y=1.08X+0.594	2.78	0.37	0.17	不可接受
		6.99	0.03	0.35	可接受
		11.00	0.29	0.56	可接受

标本类型	K⁺	Na⁺	Glu	TCO₂
动脉血浆	3.62±0.52	142.62±6.52	7.71±4.24	20.55±5.00
静脉血浆	4.02±0.53^*	138.85±4.33	8.04±4.82^*	22.67±4.69^*