不同动脉采集血气分析标本的临床效果比较

ICU收治的多为伴有呼吸衰竭使用机械通气的急危重病人,常需要血气分析结果来判断机体是否存在缺氧和缺氧的程度,是否存在酸碱失衡,调整呼吸机参数及做预后判断.及时正确采集动脉血气分析标本是血气分析结果是否准确的标准之一.我科2007年1月-2008年2月为280例危重病人分别采用足背动脉和股动脉采血,对两组的采血成功率、误穿静脉的发生率、血肿发生率、疼痛反应、按压时间做了比较.现报道如下.     

Determination of amino acids by ion-exchange chromatography on filter paper spotted blood samples stored at different temperatures and for different periods: comparison with capillary and venous blood

OBJECTIVE: To determine whether the well-established filter paper spotted blood method used for the determination of some amino acids could be reliably used to measure all amino acids and whether amino acid results thus obtained are reproducible and comparable to the results obtained by measuring plasma amino acids in either capillary or venous blood. METHODS: This is a prospective study in which blood samples from a finger-prick were collected in capillary tubes and at the same time blotted on filter papers; another sample was taken from a vein, from 19 healthy volunteers aged between 18 and 24 yr after a strict 12-h overnight fast. Another 9 healthy adult volunteers provided blood samples on filter papers for the storage study; 9 samples were analyzed immediately; 9, 8 and 4 samples were stored at -20 degrees C, -4 degrees C and room temperature respectively and analyzed after 14 days; 8 samples stored at -20 degrees C were analyzed after 4 weeks. RESULTS: Intra-sample reproducibility in the filter paper blood from the same individual was found to be mostly less than 20%, while for the capillary blood was less than 5%. The greatest variability was in cystine and methionine. There was no significant difference between results obtained from capillary blood and from venous blood, but there was a significant difference between amino acid concentrations in venous and capillary blood on the one hand and filter paper blood on the other. Storage at different temperatures and for a varied period of time showed little change except in serine, glutamate, ornithine, histidine, cystine and methionine. There was a 30% decrease in concentrations of most amino acids in filter paper blood when compared to capillary or venous blood probably because of loss in the extraction process. CONCLUSION: A new set of values for amino acids in filter paper blood in normal individuals is presented. Blood spotted filter paper could be used to screen practically all inborn errors of amino acid metabolism.     

不同储存方式和时间对动脉血气分析结果的影响

目的：探讨不同储存方式和时间对动脉血气分析结果的影响。方法采用随机对照重复测量的方法,将120例患者的动脉血标本随机分成两组,每组60例,研究组1血标本存放于4℃冰箱中,研究组2血标本存放于0℃冰盒中,各标本均于采血后即刻,0．5,1,1．5,2 h 分别进行结果检测。结果4℃冰箱组和0℃冰盒组两组间pH、PaCO2、PaO2、SaO2检测结果差异无统计学意义（P＞0．05）;但不同时间点的测试结果差异有统计学意义（P＜0．01）,随样本搁置时间的延长,pH、PaO2与SaO2值呈逐渐下降趋势,而PaCO2值逐渐升高。结论血气分析标本放于4℃冰箱或0℃冰盒中其检测结果差异不大,应在采血后30 min内完成检测,否则影响其血气分析结果。     

新生儿不同监测部位脉搏血氧饱和度与血气分析的比较研究

[目的]通过对新生儿手、足、前额、耳垂部位监测脉搏血氧饱和度(SpO2)与动脉血气分析比较,寻找新生儿经皮血氧饱和度的最佳监测部位。[方法]选取住院新生儿肺炎患儿66例,采用迈瑞手握式脉搏血氧饱和度仪、雅培便捷式床旁血气分析仪,分别在手、足、前额、耳垂部位监测脉搏血氧饱和度,并与桡动脉血血气分析值动脉血氧分压(SaO2)进行等效性分析。[结果]手、足监测脉搏血氧饱和度值与动脉血气分析血氧饱和度值比较差异无统计学意义(P>0.05),且手、足监测部位的SpO2与SaO2均数之差绝对值均小于对应的等效界值。[结论]新生儿经皮血氧饱和度最佳监测部位为手心与手背、足心与足背。     

Accuracy and stability evaluation of different blood sampling methods in blood gas analysis in emergency patients: A retrospective study

BackgroundTo evaluate the accuracy and stability of arterial blood gas (ABG) results by comparison with venous measurements from routine blood tests, and to compare the accuracy and performance of two sampling syringes, pre‐heparinized syringe (PHS) and disposable arterial blood syringe (DABS), in ABG analysis.MethodsWe retrospectively analyzed the practical use of PHS and DABS in collecting ABG samples, involving 500 and 400 patients, respectively. For each patient, in addition to the ABG sample, a venous blood sample was also collected using a venous blood collection tube (VBCT) and used for routine blood tests. Accordingly, patients were referred to as the PHS + VBCT group and DABS + VBCT group. The correlation between arterial and venous values of each blood parameter in each group was evaluated using the interclass correlation coefficient (ICC). Bland–Altman was performed to evaluate the agreement between arterial and venous values and compare the performance of PHS and DABS in ABG sample collection.ResultsIn the PHS + VBCT group, arterial K⁺, Na⁺, hemoglobin (Hb), and hematocrit (HCT) were 0.32 mmol/L, 2.90 mmol/L, 2.21 g/L, and 1.27% significantly lower their corresponding venous values while arterial Cl⁻ was 7.60 mmol/L significantly higher than venous Cl⁻. In the DABS + VBCT group, arterial K⁺ and Na⁺ were 0.20 mmol/L and 1.19 mmol/L significantly lower while Cl⁻ and HCT in arterial blood were 5.34 mmol/L and 0.66% significantly higher than their corresponding venous values. In both groups, arterial K⁺, Na⁺, Hb, and HCT values were highly consistent with their corresponding venous values, with all ICCs greater than 0.70, especially Hb and HCT. Bland–Altman analysis demonstrated that arterial K⁺ and Na⁺ were more consistent with venous counterparts in the DABS + VBCT group, with a narrower 95% limits of agreement than the PHS + VBCT group (K⁺, −0.7‐0.3 mmol/L vs. −1.1 to 0.5 mmol/L; Na⁺, −5.8 to 3.4 mmol/L vs. −8.2 to 2.4 mmol/L).ConclusionArterial blood gas analysis of K⁺, Na⁺, Hb, and HCT using PHS or DABS for blood sampling is accurate and stable, especially DABS, which can provide clinicians with fast and reliable blood gas results.     

新生儿两种采集动脉血气分析标本方法的效果比较

[目的]比较经桡动脉与股动脉采集新生儿血气分析标本的优缺点。[方法]将110例新入院危重新生儿随机分为桡动脉采血组和股动脉采血组，每组55例。统计两组采血一次穿刺成功率、穿刺部位损伤及操作所需时间。[结果]经桡动脉采血比经股动脉采血一次穿刺成功率高、所需操作时间短、损伤小。[结论]桡动脉采血优于股动脉采血。     

用小儿头皮针经头皮动脉采集血气分析标本的研究

[目的]为小儿血气分析检测采集动脉血寻找更好的方法.[方法]对35例需查血气分析的昏迷患儿,同时应用注射器股动脉采血和小儿头皮针经头皮动脉采血,同时送检,并对两种不同采血方法从采血所用时间、采血副反应及采血成功率方面进行比较.[结果]两种采血方法血气分析检测值差异无统计学意义(P＞0.05),但应用小儿头皮针经头皮动脉采血所用时间短,无一例发生血肿或淤斑,采血成功率高.[结论]应用小儿头皮针经头皮动脉采血气分析标本检测数据准确、方法简便、成功率高.     

用小儿头皮针经头皮动脉采集血气分析标本的研究

[目的]为小儿血气分析检测采集动脉血寻找更好的方法。[方法]对35例需查血气分析的昏迷患儿，同时应用注射器股动脉采血和小儿头皮针经头皮动脉采血，同时送检，并对两种不同采血方法从采血所用时间、采血副反应及采血成功率方面进行比较。[结果]两种采血方法血气分析检测值差异无统计学意义（P〉0．05），但应用小儿头皮针经头皮动脉采血所用时间短，无一例发生血肿或淤斑，采血成功率高。[结论]应用小儿头皮针经头皮动脉采血气分析标本检测数据准确、方法简便、成功率高。     

血液标本不同条件下检测对血细胞分析结果的影响

目的：分析血液标本在室温和冰箱两种放置条件下不同时间段的血细胞检测结果。方法随机选择南京医科大学附属南京第一医院门诊40份血标本,每份标本稀释2管,第1管20℃室温放置（20℃组）,第2管4℃冰箱放置（4℃组）,分别在即刻,0．5、1．5、3．0h后用仪器对两组标本进行分析测定,取平均值。结果随放置时间的不同,两组各检测值与即刻值比较,差异有统计学意义（ P＜0．05）。血细胞分析20℃组与4℃组比较中,中间细胞、淋巴细胞和血小板计比较,差异有统计学意义（P＜0．05）,红细胞、平均红细胞体积、白细胞、中性粒细胞和平均血小板体积比较,差异无统计学意义（ P＞0．05）。结论标本放置在室温（20℃）条件下应在1 h内检测完毕,置于冰箱保存,可适当延长测定时间,但不适宜超过2h,这样才能保证检验结果的准确性。     

Influence of sodium fluoride on the stability of human blood samples and blood gas measurements

OBJECTIVE: This study aimed to reduce the analytical error associated with measuring oxygen and carbon dioxide partial pressures as well as the pH in arterial blood samples an hour after sample collection. The standard blood sample preparation procedure involving sample cooling down to 0 degrees C is known to have several drawbacks. Therefore, another approach using NaF at room temperature as an inhibitor of metabolic reactions was introduced. DESIGN AND METHODS: Arterial heparin blood samples from six volunteers were distributed over 104 single capillaries prepared with different concentrations of NaF. The capillaries were filled simultaneously and under the same conditions with blood samples, and the blood gas parameters of each sample were measured. Changes in pO2, pCO2, and pH during storage were evaluated with the aid of t test statistics. RESULTS: During the storage period under investigation, fluctuations of the carbon dioxide partial pressure and the pH were low, whereas there was a significant (P < 0.01) decrease of the oxygen partial pressure. This was observed at all NaF concentrations. Depending on the addition of NaF, a significant baseline shift for the time-resolved pH and pCO2 values could be observed. Whereas the partial pressure of carbon dioxide and the pH could be kept stable by adding a defined amount of NaF, the partial pressure of oxygen decreased significantly over 70 min. CONCLUSIONS: The proposed new method can be practically applied to a comparative blood gas study, significantly reducing the blood sample volume required. The application of analytical grade NaF is an improvement compared to previous work because a pH decrease could not be observed.     

血管介入术后病人不同卧床制动时间的对比研究

[目的]探讨经皮股动脉穿刺介入治疗术后病人早期下床活动时间及对机体恢复的影响。[方法]将224例行股动脉穿刺介入治疗病人随机分为两组。实验组112例，拔鞘管后6h即开始下床活动；对照组112例，术后24h开始活动。对两组病人术后不同下床活动时间与穿刺部位出血及血肿发生率、腰背酸痛、术肢麻木、排尿困难、食欲下降的关系进行研究。[结果]股动脉穿刺介入治疗术后不同下床活动时间，两组病人的股动脉穿刺点出血发生率比较差异无统计学意义（P〉0．05）；而两组病人在腰背酸痛、术肢麻木、排尿困难、食欲下降等方面的差异有统计学意义（P〈0．05）。[结论]经股动脉穿刺介入治疗术后6h开始下床活动是安全可行的，并且可减少术后并发症的发生。     

血管介入术后病人不同卧床制动时间的对比研究

[目的]探讨经皮股动脉穿刺介入治疗术后病人早期下床活动时间及对机体恢复的影响。[方法]将224例行股动脉穿刺介入治疗病人随机分为两组。实验组112例,拔鞘管后6h即开始下床活动;对照组112例,术后24h开始活动。对两组病人术后不同下床活动时间与穿刺部位出血及血肿发生率、腰背酸痛、术肢麻木、排尿困难、食欲下降的关系进行研究。[结果]股动脉穿刺介入治疗术后不同下床活动时间,两组病人的股动脉穿刺点出血发生率比较差异无统计学意义(P>0.05);而两组病人在腰背酸痛、术肢麻木、排尿困难、食欲下降等方面的差异有统计学意义(P<0.05)。[结论]经股动脉穿刺介入治疗术后6h开始下床活动是安全可行的,并且可减少术后并发症的发生。     

Monitoring stiffness changes in lesions after radiofrequency ablation at different temperatures and durations of ablation

The variations in the stiffness or stiffness contrast of lesions resulting from radiofrequency (RF) ablation of canine liver tissue at different temperatures and for different ablation durations at a specified temperature are analyzed. Tissue stiffness, in general, increases with temperature; however, an anomaly exists around 80 degrees C, where the stiffness of the lesion is lower than that of the lesion ablated at 70 degrees C. On the other hand, the stiffness increases monotonically with the duration of ablation. Plots illustrating the ratio of mean strains in normal canine liver tissue to mean strains in ablated thermal lesions demonstrate the variation in the stiffness contrast of the thermal lesions. The contrast-to-noise ratio (CNRe) of the lesions, which serves as an indicator of the detectability of the lesions under the different experimental imaging conditions described above, is also presented. The results presented in this paper show that the elastographic depiction of stiffer thermal lesions is better, in terms of the CNRe parameter. An important criterion in the elastographic depiction of RF-ablated regions of tissue is the trade-off between ablation temperature and duration of ablation. Tissue necrosis can occur either by ablating tissue to high temperatures for short durations or to lower temperatures for longer durations. In this paper, we attempt to characterize the elastographic depiction of thermal lesions under these different experimental conditions. This paper provides results that may be utilized by practitioners of RF ablation to decide the ablation temperature and duration, on the basis of the strain images of normal liver tissue and ablated thermal lesions discussed in this paper.     

Some problems in the correction for intrinsic light-scattering of samples in specific protein analysis by automated immunoprecipitation.

Heparinised plasma samples have falsely high blank values in the automated immunoprecipitation system when blanks are measured by omitting antiserum from the assay. This is probably due to an interaction of heparin and serum proteins, together with either fibrinogen or polyethylene glycol. A more accurate estimate of the blank of heparinised plasma samples is obtained by measuring it with a solution of nonimmune serum substituted for the antiserum.     

新生儿两种采集动脉血气分析标本方法的效果比较

[目的]比较经桡动脉与股动脉采集新生儿血气分析标本的优缺点.[方法]将110例新入院危重新生儿随机分为桡动脉采血组和股动脉采血组,每组55例.统计两组采血一次穿刺成功率、穿刺部位损伤及操作所需时间.[结果]经桡动脉采血比经股动脉采血一次穿刺成功率高、所需操作时间短、损伤小.[结论]桡动脉采血优于股动脉采血.     

Morphometric analysis of the endocrine pancreas in streptozotocin-diabetic rats kept on different dietary regimens

The effects of different diets on the endocrine pancreas of streptozotocin-diabetic rats were investigated by morphometry. Three dietary regimens were used over a period of 43 weeks: standard diet (SD), low carbohydrate-high protein diet (LC-HP), and low carbohydrate-high fat diet (LC-HF). Nondiabetic controls received standard diet. Volume density of the total endocrine tissue was significantly reduced in streptozotocin-diabetic rats kept on standard diet as compared to control rats. This reduction of endocrine tissue was significantly less in rats kept on LC-HP diet, whereas diabetic rats kept on LC-HF did not differ from diabetic rats on standard diet. In streptozotocin-diabetic rats volume density of B cells was drastically reduced, whereas volume densities of A, D and PP cells did not differ from nondiabetic controls. This decrease of B cells was partially prevented by LC-HP diet, but not by LC-HF diet. In nondiabetic control rats as in diabetic rats on standard diet most of the islets of Langerhans sized 500-6000 microns2. In contrast, diabetic rats on LC-HP diet revealed more endocrine tissue sized from 50 to 560 microns2 consisting of two to four endocrine cells, single cells, and small islets. The results suggest that LC-HP diet may initiate reparation processes in the endocrine pancreas of streptozotocin-diabetic rats.     

经皮肾镜碎石术不同手术时间对血流动力学和血气分析的影响

目的观察经皮肾镜碎石取石术不同手术时间对血流动力学和血气分析的影响。方法选择ASA1～3级的经皮肾镜碎石取石术患者27例，其中手术时间小于120min患者15例为A组，手术时间大于120min患者12例为B组，术中监测血压、心率和中心静脉压，选择麻醉前和术中每30分钟为时间点，并记录术毕前最高值，术前、术中每小时和术后动脉血气分析监测血pH、Na^＋、K^＋、和BE值。结果A组患者术中HR的变化与术前相比差异无显著性，B组患者术毕前HR最高值明显高于术前，结果差异有显著性（P〈0．05）；BP、CVP逐渐增高，与术前比差异有显著性（P〈0．05），随手术时间的延长和灌流液量的增加而增高，2组相比B组比A组变化明显（P〈0．05）；血Na^＋的浓度术前术后的变化差异无显著性；血K^＋的浓度和PH值随手术时间的延长和灌流液的增多逐渐下降，2组相比B组比A组下降明显（P〈0．05）；两组患者术后出现代谢性酸中毒，以B组明显（P〈0．05）。结论长时间经皮肾镜碎石取石术由于灌流液的吸收引起血流动力学和血气分析的剧烈变化而出现灌洗液吸收综合征，应进行严密的监测和预防处理，并适当缩短手术时间。     

Hemoglobin screening in prospective blood donors: comparison of different blood samples and different quantitative methods.

Portable photometers are increasingly used for hemoglobin screening in blood centers. In a total of 500 unselected prospective blood donors, venous hemoglobin concentrations were measured using a hematology analyzer, and fingerstick hemoglobin concentrations were measured on both a HemoCue B and a Biotest hemoglobin photometer. In 100 of the donors, earstick hemoglobin levels were also measured on the HemoCue system. The mean hemoglobin levels in the fingerstick samples were slightly higher than those in the venous samples. The deviation exceeded the limit of +/-10g l(-1) in 9% of samples tested by HemoCue and in 20% of those investigated by Biotest. The use of earstick samples led to considerable overestimation of the actual hemoglobin concentration.     

抗凝血不同贮存温度对血凝试验的影响

目的 探讨不同的抗凝血体外贮存条件对凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)的影响.方法 将同一标本分别置于室温(18～25℃)、4℃、-20℃,在不同的时间测不同贮存温度下的PT、APTT,再与初始测定值进行统计学分析.结果 标本贮存在-20℃,对PT、APTT测定72 h无明显影响;而贮存在室温和4℃经过16～24 h,就会使结果产生不同程度的差异.结论 血凝试验前的标本预处理是保证结果可信度的关键.     

气管切开术后不同给氧方式对患者血气影响的临床研究

目的　探讨气管切开术后不同给氧方式对重型颅脑损伤患者血气的影响 ,以选择最佳的气管切开给氧方式 ,提高氧疗的效果。方法　选择重型颅脑损伤患者 2 5例 ,采取自身对照的方式 ,于气管切开后给氧。在气管套管口覆盖双层盐水湿纱布 ,6h后测定血气分析变化 ,然后改用自制气管切开罩给氧 6h ,再次测定其血气分析的变化。结果　 2组比较显示其血气分析 ,在酸碱代谢平衡 (χ2 值 =7.778,P值 =0 .0 2 0 )、氧分压 (t值 =- 5 .6 5 1,P值 =0 .0 0 0 )及碱剩余 (t值 =-3.4 0 8,P值 =0 .0 0 3)方面差异有非常显著性 ,同时在二氧化碳分压 (t值 =- 2 .5 84 ,P值 =0 .0 17)方面差异亦有显著性。结论　气管切开后 ,气管切开罩能有效改善肺的通气功能 ,提高氧含量 ,维持机体酸碱平衡 ,预防和治疗呼吸性碱中毒和呼碱代酸中毒 ,减少电解质紊乱的发生。