胫骨近端骨髓腔内通路与外周血管通路血液标本用于实验室检查的研究比较

Proximal tibial intramedullary access vs peripheral access of blood sample collection for laboratory investigation:a comparative study

目的分析胫骨近端骨髓腔内血液标本用于指导急危重症患者救治的可行性。方法选择2018年6月至2019年6月山西医科大学第二医院急诊科收治的危重症患者68例,每例患者同时采集胫骨近端骨髓腔内血液标本和外周静脉通路血液标本,比较不同采集部位血液标本在血常规、部分生化指标之间的差异。结果骨髓腔内组与外周静脉组血液标本在红细胞、血红蛋白、红细胞压积、尿素氮、肌酐、血糖、钾、钠、氯、钙、总蛋白、白蛋白结果差异无统计学意义(P>0.05),白细胞、血小板结果差异有统计学意义(P<0.05),且骨髓腔内组中白细胞和血小板的检测结果高于外周静脉组。结论对于急危重症患者,当外周静脉采血困难时,可以通过采集胫骨近端骨髓腔内血液标本进行实验室检查。除白细胞、血小板2项指标外,本研究中的其他检测项目可代替外周静脉血液标本,为急危重症患者的救治提供临床数据支持。

Objective To analyze the feasibility of using intramedullary blood specimen of proximal tibia to guide the treatment of critical patients.Methods Included were a total of 68 critically ill patients admitted to the Emergency Department of Second Hospital of Shanxi Medical University,from June 2018 to June 2019.For each patient,blood samples were collected in pairs,both from the marrow cavity of the proximal tibia(study group)and peripheral vein(control group).The findings fo blood routine tests and a set of biochemical parameters were compared between the two groups.Results There were no significant differences between the study group and the control group in levels or counts of red blood cells,hemoglobin,hematocrit,urea nitrogen,creatinine,blood sugar,potassium,sodium,chloride,calcium,total protein and albumin(P>0.05),except for the white blood cells and platelets(P<0.05)which were higher in the study group than those in the control group.Conclusion For critically ill patients,blood samples for laboratory investigation can be obtained via access via the marrow cavity of the proximal tibia,if peripheral vascular access becomes difficult.Apart from white blood cells and platelets,findings of other parameters via this access can substitute for those of peripheral venous blood samples in providing supportive clinical data for the treatment of the critically ill.