[Clinical application of Excel spreadsheet with blood gas analysis in automatic judging the type of acid-base balance disorder].

OBJECTIVE

To judge the type of acid-base balance disorder automatically according to the results of arterial blood gas analysis by using the IF function editing formula in an Excel spreadsheet.

METHODS

The four-step analysis was used to carry out programmatically through establishing acid-base balance disorder analysis process: (1) the acid and base types were determined according to pH value and the primary or main type of acid-base balance disorder was determined according to the pH value combined with blood carbon dioxide pressure (PaCO), HCO and their change rate; (2) the expected compensation formula was selected to determine whether there was mixed acid-base imbalance, according to the primary or main acid-base imbalance type; (3) the potential HCO should be calculated to replace the measured HCO when the primary acid-base imbalance was divided into two parts according to the prior two steps: respiratory acidosis or respiratory alkalosis accompanied with anion gap (AG) increased-metabolic acidosis and compared with the compensatory interval calculated by the predicted compensatory formula for acid or alkali to determine whether there were triple acid-base imbalance (TABD); (4) while the following two parts were judged: metabolic acidosis accompanied with AG increased-metabolic acidosis according to the prior two steps, ΔAG↑/ΔHCO↓ should be calculated to determine whether there was metabolic alkalosis or metabolic acidosis with normal AG. The results of arterial blood gas analysis were judged by using the editing formula of IF function in Excel 2003 spreadsheet. A total of 96 patients admitted to the department of intensive care unit (ICU) of Xuzhou Central Hospital were enrolled. According to the results of arterial blood gas analysis, the type of acid-base imbalance of patients was judged by both artificial judgment (artificial group) and Excel spreadsheet automatic judgment (Excel spreadsheet group). The artificial group was composed by 2 associate chief physicians from neonatal intensive care unit (NICU) and 1 attending respiratory physician. If the results were inconsistent, the decision should be made after discussion. In the Excel spreadsheet group, data were input by one NICU attending physician and checked by another. The differences in the results and the time spent in judging the type of acid-base imbalance between the two groups were compared.

RESULTS

Forty-two types of acid-base imbalance were obtained by using the four-step analysis method and inputting relevant parameters such as pH, PaCO, actual HCO, Na, Cl and compensation time limited into the Excel spreadsheet for blood gas analysis. Data analyses of 96 patients showed that the accuracy of using Excel spreadsheets to automatically determine the type of acid-base imbalance was higher than artificial group, but there was no statistically significant difference between the two groups [normal and simple acid-base imbalance: 100% (26/26) vs. 100% (26/26), mixed acid-base imbalance: 100% (51/51) vs. 96.08% (49/51), TABD: 100% (19/19) vs. 89.47% (17/19), all P > 0.05], and it took less time to judge the results of blood gas analysis by the Excel spreadsheet group compared with the artificial group (s: normal and simple acid-base imbalance: 31.13±4.70 vs. 74.20±16.53, mixed acid-base imbalance: 31.59±5.49 vs. 138.10±22.26, TABD: 30.98±5.40 vs. 308.40±78.12, all P < 0.01).

CONCLUSIONS

The automatic judging Excel spreadsheet with blood gas analysis can quickly and accurately determine the type of acid-base imbalance in arterial blood gas analysis.