CAJ | 학술논문

目的评价目前重症监护室(intensive care unit,ICU)常用的4种血糖测量方法与静脉血/血生化仪法的一致性,并分析可能的影响因素.方法前瞻性序贯纳入2007年11月至2008年1月期间收入北京协和医院内科ICU病房且预期ICU住院时间＞48 h的患者49例,共检测血糖130组,每组均采用毛细血管血/血糖仪法、动脉血/血糖仪法、动脉血/血气分析仪法和动脉血/血生化仪法测量血糖,分别计算上述4种方法与静脉血/血生化仪法(标准法)所测血糖值的差值、相关系数、偏倚校正因子及不一致率,并采用Logistic回归分析影响一致性的因素.结果毛细血管血/血糖仪法、动脉血/血糖仪法、动脉血/血气分析仪法、动脉血/血生化仪法所测血糖值与标准法所测血糖值的差值分别为:(1.7±1.4)mmol/L,(1.6±1.4)mmol/L,(1.1±1.2)mmol/L,(0.5±1.2)mmol/L,不一致率分别为66.9%,63.8%,40.0%,23.8%.相关系数分别为0.844,0.845,0.895和0.896,偏倚校正因子分别为0.821,0.831,0.914和0.979.红细胞比积减低是毛细血管血/血糖仪法(OR=0.923,P=0.03)和动脉血/血糖仪法(OR=0.921,P=0.014)血糖测量值与标准法不一致的独立危险因素.结论在重症监护病房,采用血糖仪测量血糖的方法与标准法的一致性均较差,而血气分析仪法则是一致性较好的床旁血糖检测方法.红细胞比积减低可影响血糖仪测量的准确性.
목적 평개목전중증감호실(intensive care unit,ICU)상용적4충혈당측량방법여정맥혈/혈생화의법적일치성,병분석가능적영향인소.방법 전첨성서관납입2007년11월지2008년1월기간수입북경협화의원내과ICU병방차예기ICU주원시간＞48 h적환자49례,공검측혈당130조,매조균채용모세혈관혈/혈당의법、동맥혈/혈당의법、동맥혈/혈기분석의법화동맥혈/혈생화의법측량혈당,분별계산상술4충방법여정맥혈/혈생화의법(표준법)소측혈당치적차치、상관계수、편의교정인자급불일치솔,병채용Logistic회귀분석영향일치성적인소.결과 모세혈관혈/혈당의법、동맥혈/혈당의법、동맥혈/혈기분석의법、동맥혈/혈생화의법소측혈당치여표준법소측혈당치적차치분별위:(1.7±1.4)mmol/L,(1.6±1.4)mmol/L,(1.1±1.2)mmol/L,(0.5±1.2)mmol/L,불일치솔분별위66.9%,63.8%,40.0%,23.8%.상관계수분별위0.844,0.845,0.895화0.896,편의교정인자분별위0.821,0.831,0.914화0.979.홍세포비적감저시모세혈관혈/혈당의법(OR=0.923,P=0.03)화동맥혈/혈당의법(OR=0.921,P=0.014)혈당측량치여표준법불일치적독립위험인소.결론 재중증감호병방,채용혈당의측량혈당적방법여표준법적일치성균교차,이혈기분석의법칙시일치성교호적상방혈당검측방법.홍세포비적감저가영향혈당의측량적준학성.
Objective To evaluate the accuracy of five blood glucose measurements commonly used in ICU and to determine the potential factors interfering the accuracy. Method This prospective study carried out in consecutively enrolled 49 patients stayed more than 48 hours in the medical ICU of Peking Union Medical College Hospital from November 2007 to January 2008. A total of 130 blood samples were measured to determine blood glucose with five different methods, and the biochemistry analyzer in central laboratory was regarded as reference method for comparison with other four methods, ( 1 ) capillary blood/glucometer;(2) arterial blood/glucometer; (3) arterial blood/blood gas analyzer; and (4) arterial blood/biochemistry analyzer. The accuracy of a method tested was judged by the difference in level of blood glucose between it and reference method, correlation coefficient, bias correction factor and discrepancy. The independent factors for the discrepancies were identified by multivariate logistic regression. Results The values of differences in level of blood glucose between above four methods and the reference were ( 1.7 ± 1.4) mmol/L,( 1.6 ± 1.4 ) mmol/L, ( 1.1 ± 1.2) mmol/L, and (0.5 ± 1.2 ) mmol/L, respectively. The rates of discrepancy were 66.9%, 63.8%, 40.0% and 23.8%. The correlation coefficients were 0. 844, 0. 845, 0. 895and 0. 896. The bias correction factors were 0. 821,0.831,0.914 and 0. 979. Decrease in hematocrit was statistically associated with the discrepancy between glucometer analysis methods and the reference, with OR of 0.923 for capillary blood ( P = 0.03 ) and 0. 912 for arterial blood( P = 0.014), respectively. Conclusions Glucometer analysis poorly correlated with reference method and blood gas analysis in ICU patients. Decrease in hematocrit significantly increased the degree of discrepancy in glucose measurements between glucometer analysis and the reference.