ICU危重患者两种血糖检测结果可靠性的比较

Comparison of reliabilities of two types of blood glucose measurements for critical patients in ICU

目的比较ICU危重患者的动脉血气分析快速末梢血糖检测结果的可靠性。方法选取ICU危重患者152例,晨间同时检测患者的静脉血生化、动脉血气和快速末梢血糖。以静脉血生化检测的血糖值为标准对照,对快速末梢血糖和动脉血气分析中的血糖检测结果进行一致性比较分析。结果动脉血气分析和快速末梢血糖检测的血糖值与静脉血生化中的血糖值均高度相关（r分别为0.927和0.861,P〈0.001）。动脉血糖值与静脉血糖值一致性好（Kappa=0.895,P〈0.05）。末梢血糖值与静脉血糖值一致性比较的均值差距为0.3 mmol/L（〈4.4 mmol/L）;低血糖组末梢血糖值与静脉血糖值一致性较差（Kappa分别为0.229,P〈0.05）;目标血糖组（4.4～10.0mmol/L）和高血糖组（〉10.0mmol/L）,末梢血糖值与静脉血糖值之间的一致性较高（Kappa分别为0.872和0.765,P〈0.05）。结论当危重患者的静脉血糖水平高于4.4 mmol/L时,临床采用动脉血气分析中的血糖检测值和快速末梢血糖检测结果作为指导血糖控制治疗策略的参考依据较为可靠。当静脉血的血糖水平低于4.4 mmol/L时,动脉血气分析结果中的血糖值较可靠,而快速末梢血糖检测结果则不能准确反映患者的血糖水平,此时不应单纯依据末梢血糖检测结果指导临床治疗。

Objective To compare the reliability of blood glucose values in arterial blood by using a blood gas analyzer and in capillary blood by using a glucometer in ICU critical patients.Methods One hundred fifty-five ICU critical patients were selected.In the morning,three kinds of blood samples,i.e.venous blood,arterial blood and capillary blood,were collected and tested at the same time.Compared with reference standard of central laboratory,the agreement between arterial and capillary blood glucose measurement was analyzed.Results Arterial blood glucose and capillary blood glucose showed a strong correlation with venous blood glucose（r =0.927 and 0.861,respectively,P〈 0.001）.The mean difference（bias） was 0 mmol/L for arterial blood glucose and venous blood glucose that showed a good consistency（Kappa = 0.895,P〈0.05）.The mean difference between capillary blood glucose and venous blood glucose was 0.3 mmol/L.In patients with hypoglycemia,the bias was 0.73 mmol/L for capillary blood glucose and venous blood glucose（Kappa = 0.229,P〈0.05）.In patients with target blood glucose and hyperglycemia,the bias was 0.2 mmol/L and 0.22 mmol/L that also had a high consistency（Kappa = 0.872 and 0.765,respectively,P〈0.05）.Conclusion When blood glucose values are higher than 4.4 mmol/L,the blood glucose values of arterial blood and capillary blood are reliable in critical patients.When blood glucose levels are below 4.4 mmol/L,blood glucose values measured by gas analysis are more reliable than that by glucometer.In this case,we should not merely base on the test results to guide clinical treatment.