Blood gas analysis as a surrogate for microhemodynamic monitoring in sepsis

BACKGROUND:Emergency patients with sepsis or septic shock are at high risk of death.Despite increasing attention to microhemodynamics,the clinical use of advanced microcirculatory assessment is limited due to its shortcomings.Since blood gas analysis is a widely used technique reflecting global oxygen supply and consumption,it may serve as a surrogate for microcirculation monitoring in septic treatment.METHODS:We performed a search using PubMed,Web of Science,and Google scholar.The studies and reviews that were most relevant to septic microcirculatory dysfunctions and blood gas parameters were identified and included.RESULTS:Based on the pathophysiology of oxygen metabolism,the included articles provided a general overview of employing blood gas analysis and its derived set of indicators for microhemodynamic monitoring in septic care.Notwithstanding flaws,several parameters are linked to changes in the microcirculation.A comprehensive interpretation of blood gas parameters can be used in order to achieve hemodynamic optimization in septic patients.CONCLUSION:Blood gas analysis in combination with clinical performance is a reliable alternative for microcirculatory assessments.A deep understanding of oxygen metabolism in septic settings may help emergency physicians to better use blood gas analysis in the evaluation and treatment of sepsis and septic shock.

An investigation of the effects of dust storms on rat lung using HRCT and blood gas analysis

The increasing intensity and frequency of sand-dust storms in China has led to greater prominence of associated environmentaland health issues. Many studies have focused on the health effects of air particulate contaminants, but fewformal investigations have studied the effects of sand-dust storms on human and animal health. The aim of this study wasto investigate the effects of dust storms on rat lung by using high resolution computed tomography （HRCT） and blood gasanalysis through a wind tunnel simulating. We found that the rat lung damage effects can be detected by the HRCT imagingafter exposure to sand-dust storm environments, but had no obvious result through blood gas analysis. Exposure durationspositively correlated with the damage degree to lung tissue. These will provide some evidence for clinical diagnosis ofnon-occupational pneumoconiosis.

Effects of Hyperventilation on Venous-Arterial Bicarbonate Concentration Difference: A Possible Pitfall in Venous Blood Gas Analysis

Objectives: Recent reports on venous blood gas analysis have shown that venous bicarbonate concentration is useful in the evaluation of the body acid-base status. Most of these reports have been based on the Bland-Altman analysis comparing arterial and venous blood gas values. We intended to elucidate any factors that decrease the agreement between venous and arterial bicarbonate concentrations, which might impair the usefulness of venous blood gas analysis. Methods: Healthy volunteers and patients with various diseases (n = 141) were evaluated by simultaneous arterial and venous blood sampling and Bland-Altman analysis. The venous-arterial bicarbonate concentration difference was compared between healthy volunteers and untreated respiratory alkalosis patients. Intentional hyperventilation (30 or 60 breaths/min, for 3 min) was also performed on 6 healthy volunteers and the venous-arterial bicarbonate concentration difference was evaluated. Results: The relative average bias in bicarbonate concentration was 2.00 mEq/l with venous bicarbonate higher than arterial bicarbonate with 95% limits of agreement of ±4.15 mEq/l. Hyperventilation challenges increased the venous-arterial bicarbonate concentration difference in an intensity-dependent manner. The venous-arterial bicarbonate concentration difference was higher in untreated respiratory alkalosis patients than in healthy volunteers (P Conclusion: Although venous bicarbonate may be useful to evaluate the body acid-base status, hyperventilation increases the venous-arterial bicarbonate concentration difference. Physicians should keep this phenomenon in mind.

Effects of Suhuang Zhike Capsule on Pulmonary Function, Blood Gas Analysis Index, Serum PCT and CRP Expression in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

OBJECTIVE: To observe the effects of Suhuang Zhike Capsule on pulmonary function, blood gas analysis index, serum PCT and CRP expression in patients with acute exacerbation of chronic obstructive pulmonary disease. METHODS: A total of 88 patients with acute exacerbation of chronic obstructive pulmonary disease admitted to the Department of Respiratory Medicine, Xuancheng People's Hospital of Anhui Province from December 2014 to December 2016 were randomly divided into the observation group and the control group, with 44 cases in each group. The control group was given routine clinical treatment, and the observation group was given Suhuang Zhike Capsule on the basis of the treatment method of the control group. After 7 days' treatment, the improvement of lung function indexes were observed and evaluated before and after treatment(forced expiratory volume in one second(FEV_1), forced expiratory volume occupancy in the 1^(st) second percentage of vital capacity(FEVl/FVC), peak expiatory flow(PEF)), blood gas analysis index(Arterial oxygen partial pressure(PaO_2) and arterial blood carbon dioxide partial pressure(PaCO_2), oxygenation index(OI)) and serum cytokine levels(procalcitonin(PCT) and C reactive protein(CRP). RESULTS: The total effective rate of the observation group was significantly higher than that of the control group(P < 0.05). The FEV_1, FEV_1/FVC and PEF in 2 groups were significantly increased after the treatment(P < 0.05), and the above lung function indexes in the observation group were significantly higher than the control group(P < 0.05). PaO_2 and OI were significantly increased after the treatment(P < 0.05), PaCO_2 was significantly decreased after the treatment(P < 0.05), and the improvement of above blood gas analysis indexes were significantly superior of the observation group than the control group(P < 0.05). The serum PCT and CRP levels in 2 groups were significantly decreased after the treatment(P < 0.05), and the improvement in the observation group were more significant than that in the control group(P < 0.05). CONCLUSION: Suhuang Zhike Capsule can inhibit serum inflammatory cytokine levels in patients with acute exacerbation of chronic obstructive pulmonary disease, improve blood gas analysis indicators, and improve lung functions.

Clinical significance of coagulation function combined with blood gas analysis and serum NT-proBNP detection in COPD patients

Objective:To investigate the clinical significance of coagulation function, blood gas analysis and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level detection in patients with chronic obstructive pulmonary disease (COPD).Methods: A total of 98 cases of COPD patients were selected and divided per different disease courses. For COPD acute exacerbation (AECOPD) stage, 53 patients were selected and set as group A. 45 cases of COPD patients in COPD stable stage were set as group B, and 50 cases of healthy people who received physical examination in our hospital in the corresponding period were collected and set as healthy controls (group C). Levels of PT, APTT, TT, Fbg, D-D, PaCO2, PaO2 and serum NT-proBNP in the whole 3 groups of patients were detected. Differences of index levels among the 3 groups and between before and after treatment in AECOPD patients were compared separately. The correlations of NT-proBNP, coagulation relevant indexes and arterial blood gas relevant indexes were analyzed.Results: (1) PT, APTT in group A and PT, APTT in group B were obviously longer than which in group C, and group A showed more significant variations. (2) Fbg, D-D, PaCO2, NT-proBNP in group A and Fbg, D-D, PaCO2, NT-proBNP in group B were obviously higher than which in group C;But PaO2 in group A and PaO2 in group B were significantly lower than which in group C;Group A showed more significant variations. (3) After treatment, PT and APTT in AECOPD patients were shorter than which before treatment, Fbg, D-D, PaCO2 and NT-proBNP were lower than before treatment, but PaO2 was higher than before treatment. (4) TT in group A were significantly longer than in group C, and differences showed no significance on comparison of TT between patients of group A and B, B and C and within A before and after treatment. (5) NT-proBNP in COPD patients showed significantly positive correlation separately with APTT, Fbg, D-D and PaCO2, showed significantly negative correlation with PaO2, but showed no obvious correlation with PT.Conclusion: Coagulation function and blood gas analysis combined with serum NT-proBNP level detection could better judge the severity of COPD. It shows significant reference value on clinical diagnosis, disease monitoring and evaluation for COPD patients.

The influence of ganglioside on the blood gas analysis and serum inflammatory cytokines in newborns with anoxic ischemic encephalopathy

Objective:To observe the influence of ganglioside on the blood gas analysis and serum levels of inflammatory cytokines in newborns with anoxic ischemic encephalopathy.Method: A total of 100 newborns with anoxic ischemic encephalopathy in our hospital were selected and randomly divided into 2 groups: the control group and the observation group. Conventional oxygen inhalation, reducing intracranial pressure, controlling eclampsia and neurotrophic drug treatment were given to the observation group. Treatment of ganglioside was given to the control group on the basis of observation group. Blood gas analysis and serum levels of inflammatory cytokines were detected before treatment (T0), 3 d after treatment (T1), and 7 d after treatment (T2).Result: (1) The comparison of pH, PaO2, PaCO2, SaO2 in the two groups in T0 was not statistically significant. The comparison of pH, PaO2, PaCO2, SaO2 in T0, T1, T2 was considered to be statistically significant. Among these, the result of comparision of pH, PaO2, SaO2: T0<T1<T2. comparision of PaCO2: T0>T1>T2. The pH, PaO2, SaO2 in observation group were higher, PaCO2 in observation group was lower compared with that in control group in T1 and T2. The difference was considered to be statistically significant. (2) The comparision of IL-2, IL-6, hs-CRP, TNF-α in the two groups in T0 was not statistically significant. IL-2 in the observation in T1 and T2 was higher than that in the control group, IL-6, hs-CRP, TNF-α in the observation in T1 and T2 was lower than that in the control group. The difference was considered to be statistically significant.Conclusion: Ganglioside can improve blood gas analysis indexes, decrease the serum inflammatory cytokines in newborns with anoxic ischemic encephalopathy.

Effects of terbutaline combined with methylprednisolone on pulmonary function, blood gas analysis and inflammatory factors in patients with chronic obstructive pulmonary disease

Objective: To investigate the effects of terbutaline combined with methylprednisolone on pulmonary function, blood gas analysis and inflammatory factors in patients with chronic obstructive pulmonary disease (COPD). Methods: A total of 100 patients with COPD were randomly divided into control group (n=50) and observation group (n=50) according to the lottery method. Both groups were treated with conventional therapy. On this basis, the control group was given inhalation of terbutaline. The observation group was given terbutaline inhalation and combination therapy with methylprednisolone. The changes of lung function, changes of blood gas analysis and inflammatory factors were measured before and after treatment in both groups. Results: There were no significant differences in lung function between the two groups before treatment. After treatment, the levels of FVC and FEV1 in both groups were significantly higher than those before treatment, and that of the observation group was higher than those of the control group. Before treatment, there was no significant difference between the two groups. After treatment, PaO2 levels in both groups were significantly higher than those before treatment, and that of the observation group was higher than those of the control group. After treatment, PaCO2 levels in both groups were significantly lower than those before treatment, and the observation group was lower than the control group after treatment. There were no significant differences in the levels of inflammatory factors between the two groups before treatment. After treatment, the levels of PCT and TNF-α in both groups were significantly lower than those before treatment, and those of the observation group was lower than those of the control group after treatment. Conclusion: The effect of Terbutaline combined with methylprednisolone treatment of COPD is better, which can significantly improve lung function, stable blood gas analysis, reduce the concentration of inflammatory factors, and be a potential effective treatment programs.

Use of sodium bicarbonate and blood gas monitoring in diabetic ketoacidosis: A review

Diabetic ketoacidosis(DKA) is a severe and toocommon complication of uncontrolled diabetes mellitus. Acidosis is one of the fundamental disruptions stemming from the disease process, the complications of which are potentially lethal. Hydration and insulin administration have been the cornerstones of DKA therapy; however, adjunctive treatments such as the use of sodium bicarbonate and protocols that include serial monitoring with blood gas analysis have been much more controversial. There is substantial literature available regarding the use of exogenous sodium bicarbonate in mild to moderately severe acidosis; the bulk of the data argue against significant benefit in important clinical outcomes and suggest possible adverse effects with the use of bicarbonate. However, there is scant data to support or refute the role of bicarbonate therapy in very severe acidosis. Arterial blood gas(ABG) assessment is an element of some treatment protocols, including society guidelines, for DKA. We review the evidence supporting these recommendations. In addition, we review the data supporting some less cumbersome tests, including venous blood gas assessment and routine chemistries. It remains unclear that measurement of blood gas pH, via arterial or venous sampling, impacts management of the patient substantially enough to warrant the testing, especially if sodium bicarbonate administration is not being considered. There are special circumstances when serial ABG monitoring and/or sodium bicarbonate infusion are necessary, which we also review. Additional studies are needed to determine the utility of these interventions in patients with severe DKA and pH less than 7.0.

Algorithm-based arterial blood sampling recognition increasing safety in point-of-care diagnostics

AIM To detect blood withdrawal for patients with arterial blood pressure monitoring to increase patient safety and provide better sample dating.METHODS Blood pressure information obtained from a patient monitor was fed as a real-time data stream to an experimental medical framework. This framework was connected to an analytical application which observes changes in systolic, diastolic and mean pressure to determine anomalies in the continuous data stream. Detection was based on an increased mean blood pressure caused by the closing of the withdrawal three-way tap and an absence of systolic and diastolic measurements during this manipulation. For evaluation of the proposed algorithm, measured data from animal studies in healthy pigs were used.RESULTS Using this novel approach for processing real-time measurement data of arterial pressure monitoring, the exact time of blood withdrawal could be successfully detected retrospectively and in real-time. The algorithm was able to detect 422 of 434(97%) blood withdrawals for blood gas analysis in the retrospective analysis of 7 study trials. Additionally, 64 sampling events for other procedures like laboratory and activated clotting time analyses were detected. The proposed algorithm achieved a sensitivity of 0.97, a precision of 0.96 and an F1 score of 0.97.CONCLUSION Arterial blood pressure monitoring data can be used toperform an accurate identification of individual blood samplings in order to reduce sample mix-ups and thereby increase patient safety.

60例假性血小板减少原因分析

目的探讨与全血细胞分析仪有关造成假性血小板(PLT)减少的影响因素,以提高检验结果的准确性。方法采用手工计数血小板和血涂片复检法对全血细胞分析仪检测血小板直方图异常且部分血小板减少的60例全血标本进行复检。结果电阻抗法PLT直方图正常组结果与手工计数和血涂片法相比差异无统计学意义(P>0.05);电阻抗法PLT直方图异常组结果与手工计数和血涂片法相比差异有统计学意义(P<0.05)。结论在日常工作中,大批量样本检测时可选用成本低廉的电阻抗法,而当出现PLT直方图和计数结果减少时必须用手工计数和血涂片复检核对,以保证检验结果的准确性。

血细胞分析仪白细胞分类功能评价

目的评价Sysmex XE-2100血细胞分析仪白细胞分类功能。方法仪器检测338例非白血病标本共4组,其中WBC减少组86例,WBC正常组127例,WBC增高组125例,嗜酸性粒细胞增高组39例;同时进行血涂片人工分类。结果仪器与人工镜检白细胞分类,在WBC正常、增高或减低各组,中性粒细胞和淋巴细胞两者相关性良好(r>0.900),而单核细胞与嗜碱性粒细胞两者相关性较差(r<0.700);嗜酸性粒细胞在WBC正常、增高及嗜酸性粒细胞增高组,两者有较好的相关性(r>0.900)。在WBC正常、增高或减低各组,中性粒细胞和淋巴细胞镜检法明显高于仪器法(P均<0.001);而单核细胞与嗜酸性粒细胞则镜检法明显低于仪器法(P均<0.001)。结论Sysmex XE-2100血细胞分析仪可准确分类中性粒细胞、淋巴细胞及嗜酸性粒细胞,并且可在嗜酸性粒细胞增高的标本中准确分类嗜酸性粒细胞。而单核细胞分类两者结果差异较大,且仪器对有异常细胞存在的标本又可能不分类,说明高档次的血细胞分析仪也仅可作为全血细胞分析的一种过筛手段,其异常细胞的检测能力仍然存在缺陷。

对BC-3000plus全自动血液分析仪测定结果的影响因素分析及对策

目的:研究"机房环境、吸样针、管道清洁度、试剂、采血、抗凝剂和异常物质"等7个影响因素,避免因测定结果不准确而导致临床医生的错误诊断和治疗行为。方法:应用相应的规范性操作和探讨性方法。结果:在实际工作中,如果注意了以上7个环节,就能较好地避免不利情况的发生,保证计数或分类结果的准确性,降低各种指标假性增高或假性降低的情况,减少手工复片的工作量,避免漏诊和误诊。结论:BC-3000plus全自动血液分析仪及其功能相似的血液分析仪不仅能够完全满足大型综合性医院门、急诊检验工作的需要,也是基层医院和基层部队卫生队的首选检验仪器。

Bland-Altman 分析法评价 GEM Premier 3000血气分析仪与BC-5800血液细胞分析仪检测血红蛋白及血细胞比容的相关性和一致性

【目的】使用Bland-Altman分析法评价床边血气分析仪检测血红蛋白（Hb）及血细胞比容（HCT ）结果与中心实验室检测结果是否具有相关性及一致性。【方法】对100份动脉血标本分别使用迈瑞BC-5800血液分析仪及GEM Premier 3000血气分析仪行Hb及 HCT检测，并对结果行相关性分析及Bland-Altman分析。【结果】两种方法所测得Hb的相关系数 r ＝0．807，P ＜0．01，回归方程为Y＝24．163＋0．742X ，两组方法所测得 HCT的相关系数 r ＝0．709，P ＜0．01，回归方程为 Y＝8．881＋0．635X ，两组数据均有较好的相关性。但经Bland-Altman法分析，Hb及HCT检测95％的可信区间均在临床可以接受的界限之外，一致性欠佳。【结论】GEM 血气分析仪与BC血液细胞分析仪方法测得指标均有较好的相关性，但一致性欠佳。床边即时检验尚无法完全替代传统检验方法。

自动化仪在胸腹腔积液细胞计数中应用的探讨

目的:探讨能否用自动化仪器替代传统人工计数方法检测胸腹腔积液中的细胞含量。方法:对收集的121例胸腹腔积液标本,采用传统光学显微镜计数方法直接计数细胞总数和白细胞数,同时分别用SysmexUF-100全自动尿沉渣分析仪和 SysmexKx-21 血细胞分析仪进行细胞计数分析,并将所得结果作配对t检验和相关性分析。结果:用UF-100全自动尿沉渣分析仪及KX-21血细胞分析仪检测所得的细胞总数和白细胞数与人工计数方法计数结果相比较,均存在显著性差异(p< 0．05);经回归分析细胞总数的相关系数(γ)分别为:0．560和0．305,白细胞数的相关系数(γ)分别为:0．645和0．482,相关性亦不好。结论:UF-100全自动尿沉渣分析仪和KX-21血细胞分析仪均不能代替人工计数方法用于胸腹腔积液中的细胞计数检测。

不同人群无偿献血者血清学指标分析

目的了解不同人群无偿献血者血清学指标情况,探讨主要血液传播性疾病在人群中的感染趋势。方法采用标准试剂盒,应用酶联免疫吸附试验,在全自动酶免分析仪上进行检测,对不同人群无偿献血者血液进行了初检和确认检测。结果街头无偿献血者和部队军人无偿献血者检出谷丙转氨酶阳性率分别为4.05%和7.384%,乙型肝炎表面抗原阳性率分别为1.33%和0.13%,丙型肝炎抗体阳性率分别为3.93%和0.08%,抗-HIV阳性率分别为0.022%和0.0%,梅毒螺旋体抗体阳性率分别为1.55%和0.027%。结论除谷丙转氨酶之外,所有检测项目阳性率均为街头献血者高于部队献血者。

HemoCue Hb 201+分析仪测定血红蛋白结果的可比性研究

目的：评估便携式HemoCue Hb 201＋分析仪急性失血后输血的指导意义。方法选择2013年6月~2015年5月间深圳市第二人民医院全麻术中因急性失血可能需要输血的患者共208例，血标本采集后，分别采用HemoCue Hb 201＋分析仪及SYSMEX XE-2100型血细胞分析仪测定同一标本的Hb，所测得的数据进行相关分析，并采用Bland-Altman 法评价两种检验方法的一致性。结果 HemoCue Hb 201＋分析仪和中心实验室SYSMEX XE-2100全自动血液分析仪测得的Hb具有良好的相关性（y =15.9297＋0.8086x， r=0.888，P＜0.001）。两种方法检测Hb差值95%的一致性限度超出临床可接受范围。结论 HemoCue Hb 201＋分析仪在急性失血后Hb的检测具有较好的准确性，并且迅捷，对术中输血具有良好的指导意义；但与标准方法的一致性尚有不足，二者不能相互取代。

脑出血及高血压的脑血管动力学检测与临床意义

脑循环动力学参数(CVDI)改变的阳性率脑出血为94.3％,高血压为98.4％。其中高血压动态阻力(DR)升高明显.脑出血临界压力增高,而临界压与舒张压差(DP)降低更明显。脑出血CVDI异常与CT诊断一致占71.4％,不一致者血肿侧仍存在着CVDI的异常.脑出血较之高血压CVDI改变的特点为①外周阻力R(?)、颈动脉血流量(Q_(mean)、CP、DP更易发生变化。②运动学四项指标下降更明显.③微循环障碍更明显.④CP增高DP降低。

Sysmex XS-800i血细胞分析仪血小板计数性能评价

目的评价Sysmex XS-800i血细胞分析仪血小板(PLT)计数性能。方法遵照行业指南验证Sysmex XS-800i血细胞分析仪PLT计数的精密度、线性、携带污染率和正确度;以显微镜计数法为参考方法对仪器低值PLT检测一致性、小红细胞(RBC)和大PLT的干扰性和仪器报警有效性进行评价。结果精密度、线性、携带污染率、正确度均符合行业标准。对于11×109~55×109 L^(-1)范围内的低值PLT,Sysmex XS-800i检测相关性(r=0.923 9)优于ADVIA 2120i(r=0.908 0);平均红细胞体积(MCV)<70fL或MCV<75fL且PLT直方图异常时、平均血小板体积(MPV)>x+2s即MPV>12fL时,仪器检测PLT结果均有显著性差别(P<0.05)。特异性较高的报警为"RBC大小不一"和"小RBC",分别为89.47%和83.87%;阳性预测值较高的报警为"RBC大小不一"(92.00%)。结论 Sysmex XS-800i血细胞分析仪的PLT计数性能符合行业标准要求;对低值PLT计数准确性良好,但抗小RBC、大PLT干扰能力较差。日常使用应结合仪器各相关报警的有效性,建立合适的人工镜检复检规则。

小红细胞对血小板计数结果的影响

目的 分析用血液分析仪作血小板计数时小红细胞对其计数结果的影响。方法 依仪器血小板计数原理 ,将有小红细胞干扰的标本分成 3组 ,A组 :血小板直方图右峰上翘起始处 >2 5fl;B组 :血小板直方图右峰上翘起始处在 2 0～ 2 5fl;C组 :血小板直方图右峰上翘起始处 <2 0fl。用ED TA K2 抗凝的静脉血 ,分别在Cell Dyn 170 0型血液分析仪上作血小板参数分析 (下称仪器法 ) ,并同时用显微镜目测计数法计数其血小板 ,再对各组两法检测结果作配对t检验。结果 用血液分析仪检测 ,A、B、C 3组平均结果分别为 (199±4 3)× 10 9/L、(2 0 1± 75 )× 10 9/L、(2 90± 5 5 )× 10 9/L ,而显微镜目测计数法A、B、C 3组平均结果分别为 (2 0 0± 4 4 )× 10 9/L、(187± 76 )× 10 9/L、(16 9± 5 0 )× 10 9/L ;其中A组两法差异无统计学意义 ,而B、C两组两法检测结果差异有显著性 (P <0 0 0 1)。结论 由小红细胞引起的异常血小板直方图右峰上翘起始处 <2 5fl时 ,对血小板计数结果有明显影响 ,因此必须正确分析血小板直方图和血小板计数结果 ,如有干扰时必须作显微镜计数复检 ,否则会导致错误的结果。

两种血细胞计数仪的性能分析

目的比较分析KX-21和BC-3000两种血细胞计数仪的性能特征。方法分别用KX-21和BC-3000同时检测同一血样,观察WBC、RBC、Hb、PLT等参数的精密度、线性、携带污染率、可比性、WBC分类计数等情况。结果两种仪器的精密度均达到说明书要求,仪器线性良好,携带污染率低,检测结果的相关性良好。在检测健康人时两种仪器的WBC分类计数结果无差异;在检测中性粒细胞增高的炎性反应患者时,KX-21分类结果的准确度高于BC-3000;在检测白血病患者时,KX-21比BC-3000有更高的敏感度和更低的假阴性率,BC-3000的WBC分类结果不可靠。结论检验人员需全面掌握各种仪器的性能特征,尤其要重视仪器在WBC分类时出现的假阴性情况,避免漏诊误诊,为临床提供更准确的检验信息。