Bartkus E A, Daya M, Hedges J R, Jui J
Department of Emergency Medicine, Oregon Health Sciences University, Portland 97201.
Prehosp Disaster Med. 1993 Jul-Sep;8(3):217-27. doi: 10.1017/s1049023x00040395.
Current prehospital protocols for the management of patients with altered mental status include the empiric administration of hypertonic glucose, naloxone, and thiamine. The injudicious use of 50% dextrose (D50W) may result in hyperosmolarity, a worsening of hypokalemia, and unwarranted additional health-care costs for the patient. The administration of D50W also may worsen the neurological outcome of patients with local or generalized ischemia.
To evaluate the ExacTech blood glucose meter's ability to estimate blood glucose levels accurately and rapidly.
Emergency medical technicians (EMTs) from selected advanced life support (ALS) units in the Portland, Ore., metropolitan area participated in a prospective clinical trial of the ExacTech blood glucose meter. A convenience sample was drawn from emergency medical services (EMS) patients with suspected diabetic emergencies, altered mental status, and other neurological deficits. Venous blood samples were drawn from these populations at the same time as the ExacTech readings were obtained. The venous blood was submitted to the receiving hospitals for laboratory analysis of blood glucose levels, and a comparison was made between the results of the two methods.
A total of 80 matched sets of data were obtained from 1 April 1990 through 6 May 1991. The hospital blood glucose values ranged from 8 to 1233 mg/dl. Sixteen (20%) of the patients were hypoglycemic (&.lt.60 mg/dl) and 23 (28.8%) were hyperglycemic ( greater than 180 mg/dl). The ExacTech device sensitivity and specificity for hypoglycemia using venous samples were 94.6% and 89.2%, respectively. For hyperglycemia, these same parameters were 87.5% and 97.1%. Pearson's r over the range of the instrument (40-450 mg/dl) was 0.8656 (p less than .001). If the prehospital "definition" of hypoglycemia (for threshold-to-treat) is raised to 65 mg/dl, the device has 100% sensitivity in the sample population.
The device functioned accurately and consistently in the prehospital environment over a wide range of temperatures, and in the hands of many different individuals.
目前针对意识状态改变患者的院前处理方案包括经验性给予高渗葡萄糖、纳洛酮和硫胺素。不当使用50%葡萄糖（D50W）可能导致高渗状态、低钾血症恶化，并给患者带来不必要的额外医疗费用。给予D50W还可能使局部或全身性缺血患者的神经学预后恶化。
评估ExacTech血糖仪准确、快速估算血糖水平的能力。
来自俄勒冈州波特兰市大都市区选定的高级生命支持（ALS）单位的急救医疗技术员（EMT）参与了ExacTech血糖仪的前瞻性临床试验。从疑似糖尿病急症、意识状态改变及其他神经功能缺损的急救医疗服务（EMS）患者中抽取便利样本。在获取ExacTech读数的同时，从这些人群中采集静脉血样。将静脉血送交接收医院进行血糖水平的实验室分析，并对两种方法的结果进行比较。
从1990年4月1日至1991年5月6日共获得80组匹配数据。医院测得的血糖值范围为8至1233mg/dl。16名（20%）患者低血糖（<60mg/dl），23名（28.8%）患者高血糖（>180mg/dl）。使用静脉样本时，ExacTech设备对低血糖的敏感性和特异性分别为94.6%和89.2%。对于高血糖，这些参数分别为87.5%和97.1%。在仪器测量范围（40 - 450mg/dl）内，皮尔逊相关系数r为0.8656（p<0.001）。如果将院前低血糖“治疗阈值”定义提高到65mg/dl，该设备在样本人群中的敏感性为100%。
该设备在院前环境中，在广泛的温度范围内，以及在许多不同人员手中，都能准确、稳定地发挥功能。
