儿科重症监护中即时检测凝血酶原时间：两种设备易用性的观察性研究。

Point-of-care prothrombin time testing in paediatric intensive care: an observational study of the ease of use of two devices.

机构信息

Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.

出版信息

Eur J Anaesthesiol. 2012 Feb;29(2):75-81. doi: 10.1097/EJA.0b013e32834b7d65.

DOI:10.1097/EJA.0b013e32834b7d65

PMID:22012176

Abstract

BACKGROUND

Two major difficulties arise when taking blood samples in children: the challenge of venous access and the comparatively large amount of blood required.

OBJECTIVE

To assess the value of point-of-care prothrombin time testing in paediatric intensive care patients. We evaluated two point-of-care devices, CoaguChek XS Plus and CoaLine, assessing ease of use in clinical practice and correlation with the standard prothrombin time measurement of the haematology laboratory.

DESIGN

Single-centre observational study.

SETTING

Between October 2007 and March 2008, patients in an interdisciplinary paediatric ICU of a tertiary centre were analysed.

PATIENTS OR OTHER PARTICIPANTS

Thirty-eight patients, 22 female and 16 male (58 and 42%), aged between 0 and 13 years, participated in the study. The intention was to evaluate the ease of use of the devices in daily clinical practice, and no exclusion criteria were applied.

MAIN OUTCOME MEASURES

The usefulness of the two point-of-care devices in the paediatric setting was evaluated. Measurements of point-of-care and standard laboratory prothrombin time were compared in terms of agreement and correlation.

RESULTS

CoaguChek XS Plus had a failure rate of 2%, CoaLine 17% and the laboratory standard 4%. CoaguChek XS Plus received a better ease of use rating than CoaLine by the study personnel. Compared with the laboratory standard, there was considerable variability of the observed measurements with both devices. The measurements of CoaguChek XS Plus and the standard had a correlation coefficient r of being 0.79. CoaLine and the standard had a correlation coefficient r value of 0.72.

CONCLUSION

CoaguChek XS Plus showed 'good' agreement, whereas CoaLine showed 'moderate' agreement compared with prothrombin time values using the standard method. The fast availability of results and the reduction of the required blood volume are advantages of point-of-care tests in the paediatric setting.

摘要

背景

在儿童中采集血样存在两个主要困难：静脉通路的挑战和所需的相对大量血液。

目的

评估即时凝血酶原时间检测在儿科重症监护患者中的价值。我们评估了两种即时检测设备，CoaguChek XS Plus 和 CoaLine，评估了其在临床实践中的易用性，并与血液学实验室的标准凝血酶原时间测量进行了相关性评估。

设计

单中心观察性研究。

地点

2007 年 10 月至 2008 年 3 月，在一家三级中心的跨学科儿科重症监护病房对患者进行了分析。

患者或其他参与者

38 名患者，22 名女性和 16 名男性（58%和 42%），年龄 0 至 13 岁，参与了这项研究。目的是评估设备在日常临床实践中的易用性，没有应用排除标准。

主要观察指标

评估两种即时检测设备在儿科环境中的有效性。比较即时检测和标准实验室凝血酶原时间的测量值，评估一致性和相关性。

结果

CoaguChek XS Plus 的失败率为 2%，CoaLine 为 17%，实验室标准为 4%。研究人员认为 CoaguChek XS Plus 的易用性评分优于 CoaLine。与实验室标准相比，两种设备的测量值都有很大的变异性。CoaguChek XS Plus 与实验室标准的测量值之间的相关系数 r 为 0.79。CoaLine 与实验室标准的相关系数 r 值为 0.72。