动脉血气分析检测ICU患者的电解质及阴离子间隙结果准确性探讨

The accuracy of arterial blood gas analysis in detecting electrolytes and anionic gap in ICU patients

目的 床旁动脉血气分析仪对ICU患者电解质及阴离子间隙结果与生化仪准确性比较.方法 回顾性分析376例ICU成年患者入ICU时的动脉血气分析仪和生化仪检测的血钠、钾、氯和碳酸氢根及计算的阴离子间隙（AG）结果.以生化仪检测结果为金标准,对两种检测方法进行比较.结果 生化仪检测的血钠、钾、氯及计算AG分别为121~183 mmol/L、2.13~6.77 mmol/L、86~146 mmol/L、1~62 mmol/L;动脉血气分析仪检测的血钠、钾、氯及计算AG分别为114~180 mmol/L、1.78~6.36 mmol/L、94~150 mmol/L、-7~40 mmol/L.动脉血气分析仪检测的血钠、钾、AG均低于生化仪结果,而血氯则高于生化仪.低、正常、高电解质及AG间两种检测方法的差值比较差异有统计学意义（P〈0.01）.结论 动脉血气分析仪检测的电解质及AG结果与生化仪明显不同,动脉血气分析仪测量的电解质结果不能用于AG的计算.

Objective To explore the accuracy of bedside arterial blood gas analyzer in detecting electrolytes and anionic gap （AG） in ICU patients, and compare it with auto-analyzer. Methods Results of blood sodium, potassium, chlorine, bicarbonate ions and AG measured by arterial blood gas analyzer and auto- analyzer of 376 ICU adult patients admitted to ICU were retrospectively analyzed. With the outcomes of auto-analyzer as standard, the correlation and difference of electrolytes and AG measured by 2 methods were analyzed. Results The sodium, potassium, chlorine and AG measured by auto-analyzer were 121 - 183 mmol/L, 2.13 - 6.77 mmol/L, 86 - 146 mmol/L and 1 - 62 mmol/L. The blood sodium, potassium, chlorine and AG measured by arterial blood gas analyzer were 114 - 180 mmol/L, 1.78 - 6.36 mmol/L, 94 - 150 mmol/L, -7 - 40 mmol/L. The blood sodium, potassium and AG measured by arterial blood gas analyzer were lower than those measured by auto-analyzer, but the blood chlorine was higher than that measured by auto- analyzer. There were statistical differences in the difference of low, normal and high electrolytes and AG between 2 methods （P〈0.01）. Conclusions The electrolytes and AG measured by arterial blood gas analyzer and auto-analyzer are significantly different, and the electrolytes measured by arterial blood gas analyzer are unreliable to calculate AG.