新生儿电解质紊乱——哪种钠才是正确答案？
Electrolytes in sick neonates - which sodium is the right answer?
机构信息
Clinical Biochemistry Unit, Canterbury Health Laboratories, Cnr Hagley Ave and Tuam Street, PO Box 151, Christchurch 8011, New Zealand.
出版信息
Arch Dis Child Fetal Neonatal Ed. 2013 Jan;98(1):F74-6. doi: 10.1136/archdischild-2011-300929. Epub 2012 Jan 3.
INTRODUCTION
Hypoproteinaemia leads to spuriously high-sodium values when measured by indirect ion-selective electrodes (ISE) as used in main laboratory analysers compared with direct ISE employed in point-of-care analysers (POCT). The authors, therefore, investigated the occurrence of hypoalbuminaemia and its effect on measured sodium from POCT and the main laboratory analyser of neonatal intensive-care samples.
METHOD
Sodium, in paired retrospective samples, measured by the main laboratory and neonatal unit blood-gas (POCT) analysers were compared.
RESULTS
Hypoalbuminaemia (<30 g/l) was present in 1400/2420 paired results. Sodium was higher when measured by laboratory analyser, the difference increased with decreasing albumin; sodium (laboratory - POCT)=7.6 (±1.1)-0.22 (±0.04)×albumin. A difference >3 mmol/l was present in 31% and consequently underestimated (9.4%) hyponatraemia and overestimated (3.8%) hypernatraemia.
CONCLUSION
Hypoalbuminaemia is common in sick neonates and monitoring electrolytes using POCT and laboratory analysers frequently yield significantly different results with consequent misclassification. In these patients, measurement of electrolytes by direct ISE (blood-gas analyser) may be more accurate.
简介
与床边即时检验（POCT）分析仪中使用的直接离子选择性电极（ISE）相比，间接 ISE 用于主要实验室分析仪测量时会导致蛋白低下的血钠值假性升高。因此，作者研究了低蛋白血症的发生及其对新生儿重症监护样本中 POCT 和主要实验室分析仪测量的钠的影响。
方法
比较了主要实验室和新生儿血气（POCT）分析仪测量的配对回顾性样本中的钠。
结果
1400/2420 对配对结果中存在低蛋白血症（<30 g/l）。当通过实验室分析仪测量时，钠值更高，差异随着白蛋白的降低而增加；钠（实验室-POCT）=7.6（±1.1）-0.22（±0.04）×白蛋白。31%的患者差值>3mmol/L，因此低估（9.4%）低钠血症和高估（3.8%）高钠血症。
结论
在患病的新生儿中，低蛋白血症很常见，使用 POCT 和实验室分析仪监测电解质常常会产生显著不同的结果，从而导致错误分类。在这些患者中，直接 ISE（血气分析仪）测量电解质可能更准确。
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