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

Clinical application of artery blood electrolytes among the mechanical ventilation patients

目的 探讨机械通气患者不同pH情况下动脉全血和静脉血清电解质的变化.方法 77例急性呼吸衰竭机械通气患者在ICU治疗期间共508次同步抽取动脉抗凝全血进行血气分析与血钾、钠浓度测定及静脉全血检测血清钾、钠浓度.按pH值不同分为：Ⅰ组（n=207）,pH 7.35～7.45;Ⅱ组（n=164）,pH＜7.35;Ⅲ组（n=137）,pH＞7.45;分组计算动静脉血钾、钠浓度,以及动静脉钾、钠浓度的差值,并进行直线相关分析,探讨不同pH情况下动静脉钾、钠浓度的变化.结果 静脉血清钾、钠浓度均高于动脉全血钾、钠浓度.动静脉钾、钠浓度呈线性相关.不同pH情况下,动静脉血钾浓度同步变化,血钠浓度不随pH的变化.结论 动静脉电解质浓度变化呈线性相关,临床上可用动脉全血电解质替代静脉血清电解质,但应注意动静脉电解质检测值的差异.

Objective To study the difference of electrolytes between artery blood and vein blood in mechanical ventilation patients under different pH. Methods 77 patients admitted to the ICU due to acute respiratory failure and treated with mechanical ventilation were included in this study. The study were conducted in 508 paired venous and arterial samples from 77 patients, which were analyzed for electrolytes on the blood gas analyzer （Gem PREMIER 3000, America） and the laboratory automated blood biochemistry analyzer （ Hitachi7600 - 010, Japan ）. The 508 matched samples were divided into three groups by pH, pH 7.35 - 7.45 in group I （ n = 207 ）, pH 〈 7.35 in group 11 （ n = 164） and pH 〉 7.45 group HI （ n = 137 ） , the difference between arterial and venous values for potassium and sodium were calculated respectively and made for linear correlation analysis. The changes of potassium and sodium values were investigated under different pH. Results Arterial values of potassium and sodium in artery blood were lower than those in vein blood. The change of the potassium values in artery and vein were all the similar under different pH. Conclusion Arterial potassium and sodium values show a high correlation with the respective venous values. These results suggest that arterial values may be an acceptable substitute for venous measurement in this clinical setting, but attention should be paid to the difference of values between artery blood and vein blood.