重复离心对监测碳酸锂药物浓度可靠性研究

目的 针对锂(Li+)盐的治疗剂量(0.4～1.5mmol/L)与中毒剂量(1.6mmol/L)十分接近但又难以避免的状况,探讨样本反复离心后Li+浓度监测的可靠性.方法 选择临床服用碳酸锂治疗达稳态的住院患者,采集血清及肝素钠抗凝血标本,采用离子选择电极直接法分别测定Li+、钾(K+)、钠(Na+)、氯(Cl-)离子浓度,比较对照组和研究组的差异.结果 血清重复离心后K+浓度有升高趋势,但差异无统计学意义(P＞0.05),血浆组K+浓度重复离心后显著升高(P＜0.01),同时血清K+浓度显著高于血浆(P＜0.001);重复离心对血清Na+、Cl-浓度无影响(P＞0.05);虽然血浆Na+、Cl-浓度高于血清(P＜ 0.001),并随离心次数增加显著下降(P＜ 0.001),但无临床实用价值.结论 临床上基于某些无法抗拒的原因所导致的反复离心样本对Li+浓度监测无影响,可以认为是安全和有效的,但为了提高对临床的应答速度而使用肝素抗凝血测定Li+、K+、Na+浓度,应建立新的参考范围.

Study on the reliability of monitoring for concentration of lithium carbonate by repeat centrifugation

OBJECTIVE To explore the reliability of monitoring for concentration of lithium carbonate by repeat centrifugation,because the therapeutic dose of Lithium(0.4-1.5mmol/L)is close to its toxic dose(1.6mmol/L).METHODS The concentrations of Li+,K+,Na+ and Cl-in serum samples,collected from taking lithium in treatment of the hospitalized patients,were determined by the use of ion selective electrode.RESULTS There was an increasing trend about the concentration of serum K+,but there was no significant difference(P﹥0.05)between the two groups.Meanwhile,the concentration of K+ in plasma group wAS significantly increased after repeated centrifugation(P﹤0.01),and the concentration of serum K+ was significantly higher than plasma K+(P﹤0.001);There was no effect on the concentration of serum Na+ after repeating centrifugation(P﹥0.05);Although the concentration of plasma Na+,Cl-was significantly higher than that in serum(P﹤0.001),which was decreased significantly after repeat centrifugation(P﹤0.001),but there was no clinical value.CONCLUSION It can be considered safe and effective to detect the concentration of Li+ because of some irresistible reasons caused by repeated centrifugation,however,it should be established a new reference range if using heparin to determine the concentration of Li+,K+,Na+ in order to meet the requirements of clinical.