动脉血气分析结果可靠的血样放置时限

目的 确定动脉血样采集后得到准确可靠血气分析检测结果 的标本放置时限.方法 选择择期行口腔颌面外科手术患者40例,全麻诱导后气管插管,进行机械通气后30min,采集桡动脉血液,进行血气分析,红细胞压积、血红蛋白、血糖、乳酸、电解质测定.检测时点分别为采血后即刻(T0)、采血后15min(T1)、采血后30min(T2)、采血后45min(T3)、采血后60min(T4)、采血后90min(T5)、采血后120min(T6)、采血后180min(T7)和采血后240min (T8).结果 从T4开始pH和PaO2比T0明显降低,PaCO2明显增高,P＜0.05.HCO3-、TCO2和BE在T7和T8时刻显著降低.SaO2在各时点无明显变化.从T4开始红细胞压积、血红蛋白和乳酸比T0明显增高,P＜0.05.从T4开始血糖比T0明显降低,P＜0.05.Na+浓度略降低,K+浓度略增高,但均无统计学意义,P＞0.05.Ca2+浓度在各时点无明显差异.结论 动脉血采集常温放置45min后血气分析结果 仍然准确可靠,具有临床指导意义.     

动脉血气标本放置时间对检验结果影响的研究

目的研究动脉血气分析标本放置时间对检验结果的影响,确定标本送检的最佳时间,以提高检验的准确性、可靠性。方法对40例患的桡动脉血样分别于采样后5,10,20,30,40,50,60,70,80和90min测量其结果,并与即刻测定值相比较。结果抽取血标本后于30min内必须送检并检测。结论血气分析是判断危重患病情的重要检测指标,采集和送检标本都有严格的要求,准确采集、及时送检,血气分析的结果才能对临床诊治提供可靠依据。     

不同保存方式对动脉血气标本分析结果的影响

目的探讨3种不同的保存和处理方法对动脉血气标本检测值的影响,以指导临床医护人员正确处理和保存动脉血气标本。方法选择年龄18～60岁行气管内插管的全身麻醉患者35例,抽取不含肝素盐水的动脉血液5ml,分别置于3个一次性动脉血气针中:即刻组立刻进行血气分析;揉搓组搓管10min后进行测定;静置组静置10min后测定,比较各组的血气分析指标。结果静置组动脉血气标本的红细胞压积和血红蛋白含量高于即刻组及揉搓组,差异有统计学意义(P<0.01);三组间pH值、氧分压及CO2分压差异无统计学意义。结论搓管后进行测定可使动脉血气标本中的有形成分(红细胞、血红蛋白)及酸碱度在短时间(10min)内近似于真实值。     

慢性阻塞性肺病患者动脉血气分析与血浆D-二聚体的相关性研究

目的探讨慢性阻塞性肺病（COPD）患者动脉血氧分压（PaO2）及二氧化碳分压（PaCO2）与血浆D．二聚体关系。方法测定38例COPD患者治疗前、后Pa02、PaC02、D．二聚体水平,并作比较。结果治疗前、后及与健康对照组比较,D-二聚体差异均有显著性（P〈0．01）,Pa02、PaC02与D．二聚体水平分别呈中度负相关及中度正相关。结论COPD患者急性加重期及好转期均存在不同程度高凝及纤溶亢进状态,早期使用抗凝剂可能对改善预后有益。     

肺源性心脏病患者缺氧的量化判定与动脉血气分析的相关性研究

目的寻找一种判定肺源性心脏病(简称肺心病)患者缺氧程度的方法,为无条件进行血气分析的医务人员提供诊治、护理参考。方法(1)以急性生理功能和慢性健康状况评分系统II为框架,自行设计肺心病患者缺氧的量化评分表,对67例肺心病患者缺氧状况进行评分;(2)将评分结果与动脉血气分析进行对比分析,找出其相关性。结果该量表的缺氧评分与pH、PaO2、SaO2有负相关性,与PaCO2有高度正相关性,P均<0.01。结论缺氧量表为临床和基层医疗单位提供了一种简便有效的诊治、护理参考依据,基本反映了肺心病患者缺氧的临床症状和缺氧程度。     

Improving the Validity of Peripheral Venous Blood Gas Analysis as an Estimate of Arterial Blood Gas by Correcting the Venous Values with SvO2

Background

Peripheral venous blood gas (pVBG) analysis in replacement of arterial blood gas (ABG) is limited by the unpredictable differences between arterial and venous values, especially for PCO₂ and pH (ΔPCO₂ and ΔpH).

Objectives

We hypothesized that, using the theoretical relationship linking SvO₂ and blood flow, we could diminish the effect of local circulatory conditions on ΔPCO₂ and ΔpH and thereby increase pVBG validity.

Methods

This was a prospective cross-sectional study performed in emergency patients requiring a blood gas analysis in which ABG and pVBG were performed simultaneously. The data of 50 randomly selected patients (model group) were used for developing two equations to correct PvCO₂ and pHv according to the peripheral SvO₂ (SpvO₂) level. The formulas derived were PvCO_2cor = PvCO₂ − 0.30 × (75 − SpvO₂), and pHv_cor = pHv + 0.001 × (75 − SpvO₂). The validity of the corrected values was then tested on the remaining population (validation group).

Results

There were 281 patients included in the study, mainly for dyspnea. ΔPCO₂ and ΔpH were strongly correlated with SpvO₂ (r² = 0.62 and r² = 0.53, respectively, p < 0.001). Using the data of the model group, we developed equations that we applied on the validation group. We found that the corrected values were more valid than the raw values for detecting a PaCO₂ > 45 mm Hg (AUC ROC = 0.96 ± 0.01 vs. 0.89 ± 0.02, p < 0.001), a PaCO₂ < 35 mm Hg (AUC = 0.95 ± 0.02 vs. 0.84 ± 0.03, p < 0.001), a pHa < 7.35 (AUC = 0.97 ± 0.01 vs. 0.95 ± 0.02, p < 0.05), or a pHa > 7.45 (AUC = 0.91 ± 0.02 vs. 0.81 ± 0.04, p < 0.001).

Conclusions

The variability of ΔPCO₂ and ΔpH is significantly lowered when the venous values are corrected according to the SpvO₂ value, and pVBG is therefore more accurate and valid for detecting an arterial abnormality.     

妊娠期肝内胆汁淤积症患者血脂水平与新生儿血气分析值的相关性分析

目的:探讨妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)患者血脂水平与围生儿预后的关系。方法:选择ICP晚期妊娠60例,正常晚期妊娠25例,测定母体血总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)浓度及围生儿出生即刻脐动脉血气分析值[pH值、血氧分压(PO2)、二氧化碳分压(PCO2)],并进行相关性分析。结果:ICP孕妇血TC、TG、LDL值明显升高,HDL值明显降低,ICP孕妇TC、TG、LDL值与PCO2呈正相关,与pH值及PO2呈负相关,HDL值与pH值及PO2呈正相关,与PCO2呈负相关。结论:ICP孕妇血脂水平与围生儿预后具有相关性,血脂检测应列为ICP的常规。     

新冠肺炎疫情期间负压病房动脉血气分析流程优化策略

基于新冠肺炎疫情期间临床护理工作的实际需求,文章总结了中南大学湘雅医院感染科对原有动脉血气的采集、送检、分析流程优化及护理工作调整的相关做法。具体措施包括统筹人员安排、设置血气分析检测区、调整血气分析结果的传递方式、加强人员培训等。动脉血气采集流程经优化后,2020年1月20日—4月5日医院感染科负压病房共收治留观患者241例(包括新冠肺炎确诊患者31例),动脉血气分析采集与检测702次。动脉血气采集期间,护士均未发生职业暴露,患者均未出现院内感染。     

Arterial Blood Gas Results Rarely Influence Emergency Physician Management of Patients with Suspected Diabetic Ketoacidosis

OBJECTIVES: To test the hypothesis that arterial blood gas (ABG) results for patients with suspected diabetic ketoacidosis (DKA) do not influence emergency physicians' management decisions and to assess correlation and precision between venous pH and arterial pH. METHODS: Prospective, observational study of emergency physicians' decision making for consecutive ED patients with suspected DKA. Inclusion criteria were capillary blood glucose equal to or greater than 200 mg/dL, ketonuria, and clinical signs and symptoms of DKA. Venous pH, chemistry panel, and ABGs were drawn before treatment. Attending emergency physicians indicated planned management and disposition on a standardized form before and after reviewing ABG and venous pH results. This study was powered to detect a 10% difference in management decisions (n = 195). Pearson's correlation and Bland-Altman bias plot were used to compare venous pH and arterial pH. RESULTS: ABG analysis changed the emergency physicians' diagnosis in 2/200 cases (1.0%; 95% confidence interval [95% CI] = 0.3% to 3.6%), altered treatment in 7/200 cases (3.5%; 95% CI = 1.7% to 7.1%), and changed disposition in 2/200 cases (1.0%; 95% CI = 0.3% to 3.6%). The pH value of the ABGs changed the treatment or disposition in 5/200 patients (2.5%; 95% CI = 1.1% to 5.7%). The Po(2) and Pco(2) results of the ABGs altered treatment and disposition in 2/200 patients (1.0%; 95% CI = 0.3% to 3.6%). Venous pH correlated well with arterial pH (r = 0.951), and bias plotting yielded a bias value of -0.015 (+/- 0.006 pH units). CONCLUSIONS: ABG results rarely influenced emergency physicians' decisions on diagnosis, treatment, or disposition in suspected DKA patients. Venous pH correlated well and was precise enough with arterial pH to serve as a substitute.     

特殊情况下采集动脉血做血常规检查的可行性分析

血常规检查既往多采用毛细血管取血 ,在儿科 ,我们发现毛细血管采血存在以下弊端 :(1)其化验结果往往由于组织液的混入而出现偏差 ;(2 )足跟采血引起的疼痛较静脉采血剧烈 ,对新生儿日后的生长发育产生不利影响 ,对于次数不多的采血 ,采用静脉血为好[1] 。然而 ,婴幼儿外周浅静脉压力低 ,抽血时往往由于血流不畅而致取血失败。而深静脉采血在不明确凝血功能的情况下取血有形成血肿的危险。婴幼儿头皮动脉位于皮下组织内 ,位置表浅 ,容易触到搏动 ,肉眼可见 ,不需暴露病人躯体 ,穿刺及局部按压均简单易行[2 ] 。而且动脉血压较静脉血压高 ,抽…     

Reducing Pain During Emergency Arterial Sampling Using Three Anesthetic Methods: A Randomized Controlled Clinical Trial

BackgroundTaking a sample of arterial blood is widely reported as a cause of significant pain.ObjectivesTo compare three anesthetic methods with standard practice (no anesthesia) to establish which was the most effective in reducing pain caused by radial artery puncture in patients requiring an arterial blood gas test in the emergency department (ED).MethodsA randomized controlled trial was conducted to compare the effectiveness between anesthetic cream, cryoanalgesia, and subcutaneous mepivacaine in reducing pain caused by radial artery puncture in ED patients.ResultsAfter comparing perceived pain during arterial puncture, the lowest median score was obtained in the mepivacaine group (1 interquartile range 0.6–1.3) and the highest median score in the control group (5 interquartile range 4.0–7.0). When comparing the control group with the three intervention groups, the Kruskal-Wallis test showed that mepivacaine (p = 0.023) and cryoanalgesia (p = 0.012) were associated with significantly lower pain scores. The anesthetic cream (p = 0.861) intervention group did not produce a statistically significant median difference compared with the control group.ConclusionsThe results of this study encourage the use of anesthetic methods like cryoanalgesia or mepivacaine for their proven effectiveness in reducing or eliminating pain during arterial puncture.     

Efficacy of IDET for Relief of Leg Pain Associated with Discogenic Low Back Pain

Abstract: Intradiscal electrothermal annuloplasty (IDET) is an effective treatment for chronic discogenic low back pain (LBP). However, efficacy of IDET for the treatment of referred leg pain has not been examined. This study was performed to assess the long‐term efficacy of IDET for the treatment of referred leg pain in chronic discogenic LBP patients. Data were retrospectively analyzed as an IDET case series from January 1999 to December 2000. The IDET procedure was performed at 1–3 symptomatic levels confirmed by pressure‐controlled discography. General pain outcome was evaluated by Visual Analog Scale (VAS). LBP and leg pain were assessed separately using five‐point pain scales (subsets of the North American Spine Society [NASS] LBP outcome assessment instrument: 0 = no pain, 4 = worst pain) at the 18‐month follow‐up. Among 129 patients who underwent IDET, 30 patients underwent subsequent back surgery and were excluded from the study, giving a total of 99 patients. Eighty‐three patients (83.8%) had leg pain without sciatica. Fifty‐two (52.5%), 21 (21.2%), and 8 (8.0%) patients showed LBP > leg pain, LBP = leg pain and LBP < leg pain, respectively. Fifty‐three out of 83 patients (63.9%) showed post‐IDET improvement in pain, with a mean VAS score of 3.28 ± 2.31. Thirty patients (36.1%) showed no improvement. A statistically significant (P < 0.05) improvement in subjective back and referred leg pain was observed. Improvements in back and referred leg pain were well‐correlated (r = 0.721, P < 0.01). A relatively large number of LBP patients who underwent IDET (84%) presented with referred leg pain without sciatica. The IDET procedure afforded improvements in leg pain that correlated well with improvements in back pain (0.75/4 and 0.88/4, respectively). These data suggest that IDET may relieve associated limb pain in chronic discogenic LBP patients.     

Evaluation of Relationship Between Arterial and Venous Blood Gas Values in the Patients with Tricyclic Antidepressant Poisoning

Introduction. Determination of arterial blood gas (ABG) values is essential in the evaluation of patients with TCA poisoning. The relationship between arterial and venous blood gas pH has not been established in TCA poisoning. In TCA poisoning, blood vessels vasodilatation due to antidepressant-induced α-blockade and also metabolic acidosis may lead to arterialization of venous blood, which in turn enhances the relationship between ABG and VBG parameters. Therefore this study was designed to evaluate the relationship between ABG and VBG pH values in TCA poisoned patients. Methods. This prospective study was performed in the Poisoning Emergency Department of Noor Hospital, Isfahan, Iran. Samples for arterial and venous blood gas analysis were obtained during initial evaluation of TCA-poisoned patients and 30 min after treatment with sodium bicarbonate. The venous blood gas samples were collected with samples for other blood tests at the time of intravenous line insertion. Laboratory data were recorded on a database form initiated in the emergency department and analyzed by paired student t-test. The degree of agreement between the arterial and venous pH measurements was evaluated by Bland and Altman method. Results. Data from 50 TCA-poisoned patients were analyzed. There were significant differences between mean differences of ABG and VBG parameter values on the initial evaluation. There was also a relationship between arterial and venous pH on the initial evaluation. Conclusion. In TCA poisoning, the peripheral venous pH measurement is a valid and reliable substitute for arterial pH.     

Celiac Plexus Block for Treatment of Pain Associated with Pancreatic Cancer: A Meta‐Analysis

Pancreatic ductal adenocarcinoma has a high rate of neural invasion (80 to 100%) and can be associated with moderate to severe pain in pancreatic cancer. Treatment of pain with celiac plexus blockage (CPB) combined with the three‐step ladder utilization of pharmaceutical analgesics following WHO guidelines is used, but the evidence in randomized controlled trials is inconsistent. This meta‐analysis identified and compared seven randomized control trials of pain relief from pancreatic cancer, by treatment with medical management alone to celiac plexus blockade with medical management. While no evidence of potential publication bias was detected, group size and statistical power may account for some of the inconsistent conclusions. The combined CPB groups had a significantly lower pain score at 4 weeks, but significance was not maintained at 8 weeks. The combined CPB groups required significantly less drug use compared to the combined control groups treated with pharmaceutical analgesics.     

二氧化碳气腹对患者动脉血气的影响

目的观察二氧化碳（CO2）气腹对患者动脉血气的影响,并分析出现低氧血症的原因。方法选择行腹腔镜胆囊切除术患者180例,于气腹前后各时点采血行动脉血气分析。结果 13例患者在气腹期间出现明显低氧血症,与气腹前5 min比较,脉搏氧饱和度（SaO2）、动脉氧分压（PaO2）显著性降低（P〈0.05）,放气后各项指标均恢复到气腹前水平。结论 CO2气腹期间患者存在低氧血症的危险,主要原因是肺内氧交换减少。     

Methylene Blue for the Treatment of Intractable Pain Associated with Oral Mucositis

Oral mucositis is a common and often debilitating complication among cancer patients receiving radiation therapy to the head and neck or chemotherapy agents, or undergoing hematopoietic stem cell transplantation. Pain and decreased oral function associated with oral mucositis may persist long after the conclusion of therapy. Although most patients respond to conservative management, a subset of patients develops intractable pain with severe consequences. For some, the use of total parenteral nutrition with insertion of percutaneous endoscopic gastrostomy feeding tubes is the only alternative. Current recommendations to treat mucositis and its related pain include basic oral care, bland oral rinses, topical anesthetics, and systemic analgesics. We believe that chemical neurolysis of the affected areas with methylene blue used as an oral rinse is a noninvasive, efficient, safe, and cost‐effective alternative that can provide prolonged analgesia in patients with intractable pain of oral mucositis. The benefits of this therapy are reflected in its improvement of patients’ quality of life by enabling oral feeding and controlling pain. We report a series of 5 consecutive patients with intractable oral mucositis‐related pain despite conventional treatment with systemic opiates. All 5 patients responded well to the use of 0.05% methylene blue as mouth rinse, demonstrating sustained analgesia over 3 weeks. The treatment was tolerated well, and overall patient satisfaction was very high. We also observed that methylene blue rinse significantly reduced the total opioid requirement, as demonstrated by reductions in the patients’ morphine equivalent daily dose scores after its use. Our case series suggests that 0.5% methylene blue oral rinse therapy is an effective and inexpensive modality that can be used safely to palliate intractable oral pain in patients with mucositis associated with cancer treatment. To our knowledge, this is the first report using this therapy to treat pain from oral mucositis.