中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2013年
1期
58-61
,共4页
冯涛%何丽娟%曹相原%闫红
馮濤%何麗娟%曹相原%閆紅
풍도%하려연%조상원%염홍
危重病%血糖%床旁诊断化验信息系统
危重病%血糖%床徬診斷化驗信息繫統
위중병%혈당%상방진단화험신식계통
Critical illness%Blood glucose%Point-of-care systems
目的 评价葡萄糖氧化酶法(GOD法)和葡萄糖脱氢酶法(GDH法)检测重症患者床旁即时血糖的准确性.方法 危重症患者240例,年龄20～ 88岁,性别不限,急性生理学与慢性健康状况评分系统Ⅱ评分1～45分.床旁同步采集患者静脉血、动脉血、指端血,分别采用GOD法和GDH法检测即时血糖,同时以中心实验室己糖激酶法测定血糖作为标准水平,即时血糖检测水平与标准水平进行Clarke误差表格分析和Bland-Altman一致性检验,并评价位于Bland-Altmen一致性界限内的即时血糖检测水平的准确性.结果 Clarke误差表格分析显示:静脉血、动脉血、指端血样即时血糖检测水平与标准水平的差异率分别有98.7％、98.3％、98.3％(GDH法)及96.2％、96.6％、96.7％ (GOD法)位于临床准确区(A区)与临床可接受区(B区),1.2％、1.7％、1.7％(GDH法)及2.9％、3.3％、3.3％(GOD法)位于数据错误区(D区),GDH法没有位于数据误差区(C区)和严重错误区(E区)的情况,GOD法0.8％静脉血即时血糖检测水平与标准水平的差异率位于数据误差区(C区),没有位于严重错误区(E区)的情况.Bland-Altman一致性检验结果:标准水平与静脉血、动脉血、指端血即时血糖检测水平的差值依次为-0.1、-0.3和-0.2 mmol/L(GDH法)及-0.9、-1.0和-0.9 mmol/L(GOD法),超上、下限范围发生率为4.6％、6.7％、6.6％(GDH法)及4.5％、5.0％、7.1％(GOD法).位于BlandAltman一致性界限内的静脉血、动脉血、指端血样即时血糖检测水平的准确率分别为94.3％、92.1％、93.7％(GOD法)和96.6％、95.1％、95.5％(GDH法).结论 GOD法和GDH法检测重症患者床旁即时血糖总体上具有良好的准确性,但有高估实际血糖水平的可能.
目的 評價葡萄糖氧化酶法(GOD法)和葡萄糖脫氫酶法(GDH法)檢測重癥患者床徬即時血糖的準確性.方法 危重癥患者240例,年齡20～ 88歲,性彆不限,急性生理學與慢性健康狀況評分繫統Ⅱ評分1～45分.床徬同步採集患者靜脈血、動脈血、指耑血,分彆採用GOD法和GDH法檢測即時血糖,同時以中心實驗室己糖激酶法測定血糖作為標準水平,即時血糖檢測水平與標準水平進行Clarke誤差錶格分析和Bland-Altman一緻性檢驗,併評價位于Bland-Altmen一緻性界限內的即時血糖檢測水平的準確性.結果 Clarke誤差錶格分析顯示:靜脈血、動脈血、指耑血樣即時血糖檢測水平與標準水平的差異率分彆有98.7％、98.3％、98.3％(GDH法)及96.2％、96.6％、96.7％ (GOD法)位于臨床準確區(A區)與臨床可接受區(B區),1.2％、1.7％、1.7％(GDH法)及2.9％、3.3％、3.3％(GOD法)位于數據錯誤區(D區),GDH法沒有位于數據誤差區(C區)和嚴重錯誤區(E區)的情況,GOD法0.8％靜脈血即時血糖檢測水平與標準水平的差異率位于數據誤差區(C區),沒有位于嚴重錯誤區(E區)的情況.Bland-Altman一緻性檢驗結果:標準水平與靜脈血、動脈血、指耑血即時血糖檢測水平的差值依次為-0.1、-0.3和-0.2 mmol/L(GDH法)及-0.9、-1.0和-0.9 mmol/L(GOD法),超上、下限範圍髮生率為4.6％、6.7％、6.6％(GDH法)及4.5％、5.0％、7.1％(GOD法).位于BlandAltman一緻性界限內的靜脈血、動脈血、指耑血樣即時血糖檢測水平的準確率分彆為94.3％、92.1％、93.7％(GOD法)和96.6％、95.1％、95.5％(GDH法).結論 GOD法和GDH法檢測重癥患者床徬即時血糖總體上具有良好的準確性,但有高估實際血糖水平的可能.
목적 평개포도당양화매법(GOD법)화포도당탈경매법(GDH법)검측중증환자상방즉시혈당적준학성.방법 위중증환자240례,년령20～ 88세,성별불한,급성생이학여만성건강상황평분계통Ⅱ평분1～45분.상방동보채집환자정맥혈、동맥혈、지단혈,분별채용GOD법화GDH법검측즉시혈당,동시이중심실험실기당격매법측정혈당작위표준수평,즉시혈당검측수평여표준수평진행Clarke오차표격분석화Bland-Altman일치성검험,병평개위우Bland-Altmen일치성계한내적즉시혈당검측수평적준학성.결과 Clarke오차표격분석현시:정맥혈、동맥혈、지단혈양즉시혈당검측수평여표준수평적차이솔분별유98.7％、98.3％、98.3％(GDH법)급96.2％、96.6％、96.7％ (GOD법)위우림상준학구(A구)여림상가접수구(B구),1.2％、1.7％、1.7％(GDH법)급2.9％、3.3％、3.3％(GOD법)위우수거착오구(D구),GDH법몰유위우수거오차구(C구)화엄중착오구(E구)적정황,GOD법0.8％정맥혈즉시혈당검측수평여표준수평적차이솔위우수거오차구(C구),몰유위우엄중착오구(E구)적정황.Bland-Altman일치성검험결과:표준수평여정맥혈、동맥혈、지단혈즉시혈당검측수평적차치의차위-0.1、-0.3화-0.2 mmol/L(GDH법)급-0.9、-1.0화-0.9 mmol/L(GOD법),초상、하한범위발생솔위4.6％、6.7％、6.6％(GDH법)급4.5％、5.0％、7.1％(GOD법).위우BlandAltman일치성계한내적정맥혈、동맥혈、지단혈양즉시혈당검측수평적준학솔분별위94.3％、92.1％、93.7％(GOD법)화96.6％、95.1％、95.5％(GDH법).결론 GOD법화GDH법검측중증환자상방즉시혈당총체상구유량호적준학성,단유고고실제혈당수평적가능.
Objective To evaluate the accuracy of point-of-care testing (POCT) for blood glucose monitoring in critically ill patients.Methods Two hundred and forty critically ill patients,of both sexes,aged 20-88 yr,with Acute Physiology and Chronic Health Evaluation Ⅱ score of 1-45,were enrolled.The venous,arterial and capillary blood samples were collected to determine the real-time blood glucose level using glucose oxidase (GOD) and glucose dehydrogenase (GDH) methods.The blood glucose level measured by central laboratory hexokinase method simultaneously was served as standard level.Error Grid analysis (EGA) and Bland-Altman analysis were used to determine accuracy and consistency,respectively.The accuracy of real-time blood glucose levels within the consistent limits was evaluated.Results 1.The results of EGA showed that 98.7 ％,98.3 ％,98.3 ％(GDH method) and 96.2％,96.6％,96.7％ (GOD method) of the difference between venous,arterial and capillary blood glucose levels measured and the standard level were located in the A and B zones,respectively,and 1.2％,1.7％,1.7％ (GDH method) and 2.9％,3.3％,3.3％ (GOD method) in the D zone.0.8％ (GOD method) of the difference between venous blood glucose levels and the standard level were located in the C zone.2.Bland-Altman analysis showed that the difference between the standard level and glucose level measured in blood samples from the vein,artery and capillary.was-0.1,-0.3,-0.2 mmol/L (GDH method) and-0.9,-1.0,-0.9 mmol/L (GOD method),respectively,and the incidence beyond the upper and lower limits of consistency zone was 4.5 ％,6.7 ％,6.6 ％ (GDH method) and 4.6 ％,5.0 ％,7.1％ (GOD method),respectively.The accuracy of venous,arterial and capillary blood glucose levels within the consistent limits was 94.3 ％,92.1％,93.7％ (GOD method) and 96.6％,95.1％,95.5％ (GDH method),respetively.Conclusion The accuracy of POCT for blood glucose monitored by GOD and GDH methods is good in critically ill patients,but it is possible to overestimate the patient's real glucose level.
