Ray J G, Hamielec C, Mastracci T
Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Crit Care Med. 2001 Nov;29(11):2205-7. doi: 10.1097/00003246-200111000-00025.
To evaluate the accuracy of bedside glucometry among critically ill patients.
Prospective audit, with sequential specimen collection.
Thirty-two-bed cardiovascular, neurosurgical, and medical-surgical intensive care unit in a single Canadian center.
Ten critically ill adults, who were sequentially followed during their intensive care unit stay. Eight had diabetes mellitus, and three were in shock.
Repeat arterial blood samples were obtained by the attending nurse, who withdrew a portion of the sample and performed reflectance glucometry at the bedside. The remainder was immediately sent in a vacuum-sealed plasma separation tube to the hospital laboratory, and analyzed using a conventional plasma glucose analyzer by a laboratory technologist. Sequential samples were taken at intervals of at least 12 hrs of one other. A total of 105 arterial glucose pairs were obtained. There was a significant correlation between the laboratory and glucometry determined glucose concentrations (intraclass correlation coefficient = 0.86, p <.0001). The overall average laboratory-glucometry glucose difference was -0.04 mmol/L (95% confidence interval [CI] -2.3-2.2 mmol/L). Five out of 105 values (4.8%) lay beyond these confidence bounds. The square of the Pearson correlation coefficient (r(2)) between the mean glucose level and the laboratory-glucometry glucose difference was not significant (0.01, 95% CI 0.005-0.04; p =.22), suggesting the absence of any trend between rising glucose concentration and the laboratory-glucometry difference.
Bedside glucose testing of arterial whole blood samples may be an accurate alternative to laboratory plasma glucose measurement among critically ill adults, within approximately 2.3 mmol/L of certainty. Because previous studies have suggested that this bedside technique may be prone to a moderate degree of error among patients in shock as well as those with an abnormal blood pH or hematocrit, larger studies are needed to confirm our findings.
评估危重症患者床旁血糖仪检测的准确性。
前瞻性审计，采用序贯样本采集。
加拿大一个中心的拥有32张床位的心血管、神经外科及内科-外科重症监护病房。
10名危重症成年患者，在其重症监护病房住院期间进行序贯跟踪。其中8例患有糖尿病，3例处于休克状态。
主治护士采集重复动脉血样本，抽取部分样本并在床旁进行反射式血糖仪检测。其余样本立即用真空密封血浆分离管送至医院实验室，由实验室技术人员使用传统血浆葡萄糖分析仪进行分析。序贯样本每隔至少12小时采集一次。共获得105对动脉血糖值。实验室检测与血糖仪检测的葡萄糖浓度之间存在显著相关性（组内相关系数 = 0.86，p <.0001）。实验室检测与血糖仪检测的葡萄糖总体平均差值为 -0.04 mmol/L（95%置信区间[CI] -2.3 - 2.2 mmol/L）。105个值中有5个（4.8%）超出了这些置信区间。平均葡萄糖水平与实验室检测 - 血糖仪检测葡萄糖差值之间的Pearson相关系数平方（r(2)）不显著（0.01，95% CI 0.005 - 0.04；p =.22），表明葡萄糖浓度升高与实验室检测 - 血糖仪检测差值之间不存在任何趋势。
对于危重症成年患者，在约2.3 mmol/L的确定性范围内，床旁检测动脉全血样本的血糖可能是实验室检测血浆葡萄糖的准确替代方法。由于先前的研究表明，这种床旁技术在休克患者以及血液pH值或血细胞比容异常的患者中可能存在中等程度的误差，因此需要更大规模的研究来证实我们的发现。
