Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
Am J Surg. 2012 Apr;203(4):423-7. doi: 10.1016/j.amjsurg.2011.10.013. Epub 2012 Feb 25.
Pre- and intraoperative glycemic control has been identified as a putative target to improve outcomes of surgical patients. Glycemic control requires frequent monitoring of blood glucose levels with appropriate adjustments. However, monitoring standards have been called into question, especially in cases in which capillary samples are used. Point-of-care testing (POCT) using capillary samples and glucometers has been noted to give relatively accurate results for critically ill patients. However, the package inserts of most glucometers warn that they should not be used for patients in shock. This has led clinicians to doubt their accuracy in the operating room. The accuracy of capillary samples when tested in patients undergoing surgical procedures has not been proven. This study aims to determine the accuracy of intraoperative blood glucose values using capillary samples relative to arterial samples.
A prospective study was conducted by collecting paired capillary and arterial samples of patients undergoing major operations at a tertiary medical center from August 2009 to May 2011. Subjects were a convenience sample of patients who had arterial lines and needed glucose testing while undergoing the procedure. Precision Xceed Pro (Abbott) handheld glucometers were used to obtain the blood glucose values. Our primary outcome of interest was the degree of correlation between capillary and arterial blood glucose values or the degree to which arterial glucose levels can be predicted by capillary glucose samples. We used linear regression and the Student t tests for statistical analyses.
Seventy-two-paired samples were collected. Of the cases, 54% were major abdominal operations, whereas 24% were vascular operations. The mean values ± standard deviation for glucose levels were 146 ± 35 mg/dL (capillary) and 147 ± 36 mg/dL (arterial). The mean time ± standard deviation between the collection of both samples was 3.5 ± 1.3 minutes. The regression coefficient showed a strong positive correlation of .91 between capillary glucose values and arterial values (P < .001) although correlation was less stringent at the hyperglycemic range of values. The R(2) statistic was 84%. Differences in values between capillary and arterial samples would not have altered the diagnosis of hypo- and hyperglycemia using typical thresholds.
Capillary samples collected intraoperatively are strongly correlated with arterial samples. Glucose monitoring in the operating room can be safely performed by collecting capillary samples for POCT. However, clinicians should still be cautious when interpreting glucose levels that are high, either by repeating the blood glucose test or by having samples sent to the laboratory.
术前和术中血糖控制已被确定为改善手术患者预后的潜在目标。血糖控制需要频繁监测血糖水平，并进行适当调整。然而，监测标准受到质疑，尤其是在使用毛细血管样本的情况下。使用毛细血管样本和血糖仪的即时检验（POCT）已被证明对重症患者的结果相对准确。然而，大多数血糖仪的使用说明警告说，它们不应在休克患者中使用。这导致临床医生对其在手术室中的准确性产生怀疑。在接受手术的患者中，毛细血管样本的准确性尚未得到证实。本研究旨在确定术中毛细血管样本的血糖值与动脉样本相比的准确性。
本前瞻性研究通过收集 2009 年 8 月至 2011 年 5 月在一家三级医疗中心接受大型手术的患者的配对毛细血管和动脉样本进行。研究对象为在手术过程中需要血糖检测且有动脉导管的患者的方便样本。使用 Precision Xceed Pro（雅培）手持血糖仪获得血糖值。我们感兴趣的主要结果是毛细血管和动脉血糖值之间的相关性程度，或者动脉血糖值可以通过毛细血管血糖样本预测的程度。我们使用线性回归和学生 t 检验进行统计分析。
共收集了 72 对样本。其中 54%为大腹部手术，24%为血管手术。血糖水平的平均值±标准差为 146±35mg/dL（毛细血管）和 147±36mg/dL（动脉）。收集两种样本的平均时间±标准差为 3.5±1.3 分钟。回归系数显示毛细血管血糖值与动脉值之间存在很强的正相关关系，相关系数为.91（P<.001），但在高血糖值范围内相关性较弱。R2 统计量为 84%。使用典型阈值，毛细血管样本和动脉样本之间的差值不会改变低血糖和高血糖的诊断。
术中采集的毛细血管样本与动脉样本密切相关。通过采集毛细血管样本进行 POCT，可以安全地在手术室进行血糖监测。然而，当解释高血糖水平时，临床医生仍应谨慎，要么重复血糖测试，要么将样本送到实验室。
