科學也可以如此靠近

手術室內血糖儀檢測全麻病人毛細血管和動脈血血糖結果的準確性


2018年3月02日11時 今日科學 麻醉MedicalGroup
麻醉MedicalGroup

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Accuracy of Capillary and Arterial Whole Blood Glucose Measurements Using a Glucose Meter in Patients under General Anesthesia in the Operating Room

背景與目的

本研究將全麻病人手術室內血糖儀測得的毛細血管和動脈血血糖值與實驗室內血氣分析儀測得的動脈血血糖值比較,從而評估手術室內血糖儀監測血糖值的準確性。

方 法

本研究共納入196名全麻手術患者,其中368份成對毛細血管和動脈血血液樣品用Nova statstrip

血糖儀監測,而另外368份成對血液樣品由血氣分析儀所檢測。主要結果為:使用實驗室血氣分析儀的動脈血血糖值作為參考,分別計算血糖儀測得毛細血管和動脈血血糖濃度值與參考值之間的差值中位數。其次,觀察並分析測量時間、術中體位、糖尿病類型等因素是否會影響血糖儀測量值的準確性。

結 果

毛細血管血糖濃度測量值及動脈血血糖濃度測量值與參考血糖濃度值之間的偏差分別為:−4mg/dl(−9~0mg/dl)、−5mg/dl(−9~-1mg/dl),兩者之間沒有顯著差異。對於皮下注射胰島素的患者而言,血糖儀測量的所有血糖值都在可接受範圍內。而對於通過靜脈注射胰島素的患者,毛細血管採血血糖儀檢測值僅有89%(327∕368)的結果符合結果準確性,且這個比例在在動脈血血糖儀測量值中為93%(344∕368)。另外,測量時間、病人體位、糖尿病的類型與測量結果發生偏差無明確相關性。

結 論

皮下注射胰島素的患者術中使用血糖儀檢測毛細血管血糖值及動脈血血糖值的結果是可靠的。而對於緊急醫療環境中實施強化血糖控制方案(靜脈注射胰島素)的病人來說,術中血糖儀檢測的血糖值不能達到指南的要求。

原始文獻摘要

Karon B S, Donato L J, Larsen C M, et al. Accuracy of Capillary and Arterial Whole Blood Glucose Measurements Using a Glucose Meter in Patients under General Anesthesia in the Operating

Room. Anesthesiology, 2017.

Background: The aim of this study was to evaluate the use of a glucose meter with surgical patients under general anesthesia in the operating room.

Methods: Glucose measurements were performed intraoperatively on 368 paired capillary and arterial whole blood samples using a Nova StatStrip (Nova Biomedical, USA) glucose

meter and compared with 368 reference arterial whole blood glucose measurements by blood gas analyzer in 196 patients. Primary outcomes were median bias (meter minus reference), percentage of glucose

meter samples meeting accuracy criteria for subcutaneous insulin dosing as defined by Parkes error grid analysis for type 1 diabetes mellitus, and accuracy criteria for intravenous insulin infusion

as defined by Clinical and Laboratory Standards Institute guidelines. Time under anesthesia, patient position, diabetes status, and other variables were studied to determine whether any affected

glucose meter bias.

Results: Median bias (interquartile range) was −4 mg/dl (−9 to 0 mg/dl), which did not differ from median arterial meter bias of −5 mg/dl (−9 to −1 mg/dl; P =

0.32). All of the capillary and arterial glucose meter values met acceptability criteria for subcutaneous insulin dosing, whereas only 89% (327 of 368) of capillary and 93% (344 of 368) arterial

glucose meter values met accuracy criteria for intravenous insulin infusion. Time, patient position, and diabetes status were not associated with meter bias.

Conclusions: Capillary and arterial blood glucose measured using the glucose meter are acceptable for intraoperative subcutaneous insulin dosing. Whole blood glucose on the

meter did not meet accuracy guidelines established specifically for more intensive (e.g., intravenous insulin) glycemic control in the acute care environment.

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