心肺复苏期间通过血液颜色和血气鉴别动脉穿刺与静脉穿刺的可靠性。

Reliability of blood color and blood gases in discriminating arterial from venous puncture during cardiopulmonary resuscitation.

作者信息

Park Je Sung, Lee Byung Kook, Jeung Kyung Woon, Choi Sung Soo, Park Sang Wook, Song Kyung Hwan, Lee Sung Min, Heo Tag, Min Yong Il

机构信息

Department of Emergency Medicine, Chonnam National University Hospital, 42, Jebong-ro, Donggu, Gwangju, Republic of Korea.

出版信息

Am J Emerg Med. 2015 Apr;33(4):553-8. doi: 10.1016/j.ajem.2015.01.014. Epub 2015 Jan 22.

DOI:10.1016/j.ajem.2015.01.014

PMID:25656331

Abstract

PURPOSE

We investigated the use of blood color brightness and blood gas variables for discriminating arterial from venous puncture during cardiopulmonary resuscitation (CPR). The study's aims were to determine if discrimination using Po2 is superior to using blood color brightness, and if blood color brightness, Po2, and acid-base variables derived from blood gas analysis accurately discriminate arterial from venous blood during CPR.

METHODS

Fifteen pigs underwent ventricular fibrillation followed by CPR. During CPR, paired femoral arterial and venous blood samples were obtained, and 2 blinded observers were asked to identify the blood's origin. Blood color brightness was measured using a blood brightness scale (BBS). The discriminatory performances of the BBS and blood gas variables were evaluated by calculating the area under receiver operating characteristic curves (AUC).

RESULTS

The observers accurately discriminated arterial from venous blood with a sensitivity of 97.0% (84.7%-99.5%) and specificity of 84.9% (69.1%-93.4%). The BBS (AUC = 0.983) and Po2 (AUC = 0.981) methods both showed comparable and excellent discriminatory performances. pH, Pco2, and HCO3(-) all discriminated arterial from venous blood (AUC = 0.831, 0.971, and 0.652, respectively). The AUC for Pco2 was comparable to that for Po2 but significantly larger than that for pH (P = .002) or HCO3(-) (P < .001).

CONCLUSION

The BBS and Po2 methods showed comparable and excellent discrimination performances. Using pH, Pco2, and HCO3(-) levels also discriminated arterial from venous blood during CPR with statistical significance.

摘要

目的

我们研究了在心肺复苏（CPR）期间，利用血液颜色亮度和血气变量来区分动脉穿刺血和静脉穿刺血。本研究的目的是确定使用氧分压（Po2）进行区分是否优于使用血液颜色亮度，以及血液颜色亮度、Po2和来自血气分析的酸碱变量在CPR期间能否准确区分动脉血和静脉血。

方法

15头猪经历室颤后进行心肺复苏。在心肺复苏期间，采集配对的股动脉血和静脉血样本，让2名不知情的观察者识别血液来源。使用血液亮度量表（BBS）测量血液颜色亮度。通过计算受试者工作特征曲线（AUC）下的面积来评估BBS和血气变量的鉴别性能。

结果

观察者准确区分动脉血和静脉血，灵敏度为97.0%（84.7%-99.5%），特异性为84.9%（69.1%-93.4%）。BBS（AUC = 0.983）和Po2（AUC = 0.981）方法均显示出相当且出色的鉴别性能。pH值、二氧化碳分压（Pco2）和碳酸氢根离子（HCO3(-)）均能区分动脉血和静脉血（AUC分别为0.831、0.971和0.652）。Pco2的AUC与Po2相当，但显著大于pH值（P = 0.002）或HCO3(-)（P < 0.001）的AUC。