Ma Chunyuan, Liu Xiangying, Ling Kai
Department of Nephrology, Suzhou Ninth People's Hospital, Suzhou 215200, Jiangsu, China. Corresponding author: Ling Kai, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Feb;33(2):216-222. doi: 10.3760/cma.j.cn121430-20201012-00667.
To develop a diagnostic analysis software for determining the type of acid-base balance disorder.
Mathematical models were built based on Henderson-Hasselbalch equations and compensation formulas, to determine the important parameters of acid-base balance disorder, and to develope acid-base balance disorder analysis process. The software was compiled using the Visual Basic.NET programming language, and the installation package was generated after debugging. Acid-base balance disorder cases were searched by PubMed, Wanfang and CNKI databases from 1980 to 2015, and the blood gas parameters [pH, arterial partial pressure of carbon dioxide (PaCO), HCO and anion gap (AG)] and the types of acid-base imbalance (literature results) were recorded. All cases were reanalyzed by software and the type of acid-base balance disorder was determined (software diagnostic type). Kappa-test and McNemar-test were performed for the two diagnostic results.
The "four parameters-four steps" analysis method was used as the analysis process to judge the types of acid-base balance disorder. "Four parameters" included pH, PaCO, HCO and AG. "Four steps" were outlined by following aspects: (1) according to the pH, combined with PaCO and HCO, the primary types of acid-base balance disorder was determined; (2) according to the compensation situation, double mixed acid-base balance disorder (DABD) was determined; (3) according to AG value, three mixed acid-base disorders (TABD) were determined; (4) the ratio of ΔAG ↑ /ΔHCO ↓ was also calculated to determine whether there was normal AG metabolic acidosis or metabolic alkalosis. The software had the characteristics of simple interface, convenient operation, rapid judgment, and comprehensive analysis. It could judge all acid-base balance disorder types excepted "AG normal metabolic acidosis combined metabolic alkalosis". The software was used to reanalyze 112 cases of acid-base balance disorder reported in the literature, with a consistent rate of 87.50% and better consistency of the diagnostic results (Kappa test: κ = 0.84, P < 0.01; McNemar test: χ = 0.87, P = 0.65).
The software can be used as an important tool to judge the type of acid-base balance disorder, and provide clinicians with diagnostic reference, which have practical value and application prospect.
开发一款用于确定酸碱平衡紊乱类型的诊断分析软件。
基于亨德森 - 哈塞尔巴尔赫方程和代偿公式建立数学模型，以确定酸碱平衡紊乱的重要参数，并制定酸碱平衡紊乱分析流程。使用Visual Basic.NET编程语言编写软件，调试后生成安装包。通过PubMed、万方和知网数据库检索1980年至2015年的酸碱平衡紊乱病例，记录血气参数[pH、动脉血二氧化碳分压（PaCO）、HCO和阴离子间隙（AG）]以及酸碱失衡类型（文献结果）。所有病例均通过软件重新分析并确定酸碱平衡紊乱类型（软件诊断类型）。对两种诊断结果进行Kappa检验和McNemar检验。
采用“四参数 - 四步骤”分析方法作为判断酸碱平衡紊乱类型的分析流程。“四参数”包括pH、PaCO、HCO和AG。“四步骤”包括以下方面：（1）根据pH，结合PaCO和HCO，确定酸碱平衡紊乱的原发性类型；（2）根据代偿情况，确定双重混合性酸碱平衡紊乱（DABD）；（3）根据AG值，确定三重混合性酸碱紊乱（TABD）；（4）计算ΔAG↑/ΔHCO↓的比值，以确定是否存在正常AG代谢性酸中毒或代谢性碱中毒。该软件具有界面简单、操作方便、判断迅速、分析全面的特点。除“AG正常代谢性酸中毒合并代谢性碱中毒”外，它能判断所有酸碱平衡紊乱类型。该软件用于重新分析文献报道的112例酸碱平衡紊乱病例，符合率为87.50%，诊断结果一致性较好（Kappa检验：κ = 0.84，P < 0.01；McNemar检验：χ = 0.87，P = 0.65）。
该软件可作为判断酸碱平衡紊乱类型的重要工具，为临床医生提供诊断参考，具有实际应用价值和应用前景。
