CAJ | 학술논문

目的：通过开发血气酸碱失衡分析软件计算机辅助诊断系统，快速准确地自动判断患者酸碱失衡类型，并进行临床应用评价。方法用VBA语言编写程序，开发一种判断血气酸碱平衡的计算机辅助诊断软件。回顾性分析广州医科大学附属第二医院收治的220例患者的临床资料，收集患者的动脉血气数据〔pH值、碳酸氢根（HCO3-）、动脉血二氧化碳分压（PaCO2）〕和电解质数据（Na＋、Cl-），将数据录入计算机软件自动进行酸碱失衡判断；同时用手工法将数据代入改良H-H代偿公式，通过计算结果判断酸碱失衡类型。用Kappa检验评价计算机软件判断结果和手工法判断结果的一致性，并对其判断所需时间进行比较。结果临床诊断220例患者的酸碱失衡类型为：正常65例，单纯型90例，混合型41例，三重型24例。计算机软件判断和手工法判断正常及三重型的准确率均为100%，判断单纯型的准确率为98.9%，判断混合型的准确率为78.0%，总准确率为95.5%。计算机软件判断结果和手工法判断结果的Kappa值为0.935，P＝0.000，说明一致性非常好。计算机软件判断酸碱失衡所需时间明显短于手工法判断（s：18.14±3.80比43.79±23.86，t＝7.466，P＝0.000），说明计算机软件判断所需时间远远快于手工法。结论开发的血气酸碱失衡分析软件判断结果可以代替手工法判断，具有快速、准确和方便等特点，能提高临床医生的工作效率和质量，具有较大的临床应用推广价值。
목적：통과개발혈기산감실형분석연건계산궤보조진단계통，쾌속준학지자동판단환자산감실형류형，병진행림상응용평개。방법용VBA어언편사정서，개발일충판단혈기산감평형적계산궤보조진단연건。회고성분석엄주의과대학부속제이의원수치적220례환자적림상자료，수집환자적동맥혈기수거〔pH치、탄산경근（HCO3-）、동맥혈이양화탄분압（PaCO2）〕화전해질수거（Na＋、Cl-），장수거록입계산궤연건자동진행산감실형판단；동시용수공법장수거대입개량H-H대상공식，통과계산결과판단산감실형류형。용Kappa검험평개계산궤연건판단결과화수공법판단결과적일치성，병대기판단소수시간진행비교。결과림상진단220례환자적산감실형류형위：정상65례，단순형90례，혼합형41례，삼중형24례。계산궤연건판단화수공법판단정상급삼중형적준학솔균위100%，판단단순형적준학솔위98.9%，판단혼합형적준학솔위78.0%，총준학솔위95.5%。계산궤연건판단결과화수공법판단결과적Kappa치위0.935，P＝0.000，설명일치성비상호。계산궤연건판단산감실형소수시간명현단우수공법판단（s：18.14±3.80비43.79±23.86，t＝7.466，P＝0.000），설명계산궤연건판단소수시간원원쾌우수공법。결론개발적혈기산감실형분석연건판단결과가이대체수공법판단，구유쾌속、준학화방편등특점，능제고림상의생적공작효솔화질량，구유교대적림상응용추엄개치。
Objective To develop a blood gas,acid-base imbalance analysis computer software to diagnose systematically,rapidly,accurately and automatically determine acid-base imbalance type,and evaluate the clinical application. Methods Using VBA programming language,a computer aided diagnostic software for the judgment of acid-base balance was developed. The clinical data of 220 patients admitted to the Second Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. The arterial blood gas〔pH value,HCO3-,arterial partial pressure of carbon dioxide(PaCO2)〕and electrolytes included data(Na+and Cl-)were collected. Data were entered into the software for acid-base imbalances judgment. At the same time the data generation was calculated manually by H-H compensation formula for determining the type of acid-base imbalance. The consistency of judgment results from software and manual calculation was evaluated,and the judgment time of two methods was compared. Results The clinical diagnosis of the types of acid-base imbalance for the 220 patients:65 cases were normal,90 cases with simple type,mixed type in 41 cases,and triplex type in 24 cases. The accuracy of the judgment results of the normal and triplex types from computer software compared with which were calculated manually was 100%,the accuracy of the simple type judgment was 98.9% and 78.0% for the mixed type,and the total accuracy was 95.5%. The Kappa value of judgment result from software and manual judgment was 0.935,P=0.000. It was demonstrated that the consistency was very good. The time for software to determine acid-base imbalances was significantly shorter than the manual judgment(seconds:18.14±3.80 vs. 43.79±23.86,t=7.466,P=0.000),so the method of software was much faster than the manual method. Conclusion Software judgment can replace manual judgment with the characteristics of rapid,accurate and convenient,can improve work efficiency and quality of clinical doctors and has great clinical application promotion value.