Frankel H L, Rozycki G S, Ochsner M G, McCabe J E, Harviel J D, Jeng J C, Champion H R
Department of Surgery, Washington Hospital Center, Washington, DC.
J Trauma. 1994 Nov;37(5):728-36. doi: 10.1097/00005373-199411000-00006.
Routine admission laboratory test protocols in injured patients are costly and involve excessive phlebotomy and turnaround time. The purpose of this prospective study was to evaluate the utility of (1) a microanalyzer, NOVA-SP5 (which provides rapid results on minimal blood volume), and (2) each component of our standard laboratory test battery.
Laboratory test results for 200 consecutive injured patients admitted to a level I trauma center were evaluated by paired sample analysis. Our standard battery [60 mL: ($348): type and screen, complete blood count, PT/PTT, electrolytes, BUN, creatinine, glucose, calcium, amylase, ethanol level, and arterial blood gas] run "stat" in the central laboratory was compared to the microanalyzer profile [< 1 mL: ($182): hemoglobin, hematocrit, electrolytes, glucose, Ca2+, and arterial blood gas] run by the trauma team in the resuscitation area. Patient data and laboratory turnaround time (from time of admission to time results obtained) were recorded. Data were analyzed by linear regression.
Components of the paired samples correlated well (r2 0.78 to 0.99). Turnaround times were 64 (+/- 3) and 6 (+/- 1) minutes for standard analysis and microanalysis, respectively. Only two of the 26 patients requiring emergent surgical procedures had standard results available preoperatively. These patients had twice as many laboratory abnormalities as the remainder. Minimal diagnosis or intervention resulted from those values exclusive to standard analysis (white blood count, amylase, ethanol level, BUN, creatinine, platelet count, PT, and PTT). Six of ten abnormal BUN or creatinine results normalized, including two values in patients who received contrast for portable intravenous pyelography, and in all patients without a history of hypertension or diabetes. Platelet count and PT/PTT were normal in 85% of non-head-injured patients, compared with 58% of those with GCS score < or = 8.
Microanalysis is accurate, expedient, conserves blood, and is sufficient for evaluation of most trauma patients. Those with hypertension, diabetes, or severe head trauma may require additional testing. Routine use of this technique could reduce cost substantially ($16,000/100 patients). The role of microanalysis in follow-up laboratory evaluation of injured patients remains to be elucidated.
受伤患者的常规入院实验室检查方案成本高昂，涉及过多的静脉穿刺和周转时间。这项前瞻性研究的目的是评估（1）一种微量分析仪NOVA-SP5（能以最少血量快速得出结果）以及（2）我们标准实验室检查项目中各组成部分的实用性。
通过配对样本分析对连续收治到一级创伤中心的200例受伤患者的实验室检查结果进行评估。将中心实验室常规进行的标准检查项目[60毫升：（348美元）：血型筛查、全血细胞计数、PT/PTT、电解质、尿素氮、肌酐、葡萄糖、钙、淀粉酶、乙醇水平和动脉血气分析]与创伤团队在复苏区进行的微量分析仪检查项目[<1毫升：（182美元）：血红蛋白、血细胞比容、电解质、葡萄糖、Ca2+和动脉血气分析]进行比较，并记录患者数据和实验室周转时间（从入院到获得结果的时间），通过线性回归分析数据。
配对样本的各组成部分相关性良好（r2为0.78至0.99）。标准分析和微量分析的周转时间分别为64（±3）分钟和6（±1）分钟。26例需要紧急手术的患者中，只有2例术前获得了标准检查结果，这些患者的实验室异常情况是其余患者的两倍。标准分析特有的项目（白细胞计数、淀粉酶、乙醇水平、尿素氮、肌酐、血小板计数、PT和PTT）对诊断或干预的作用极小。10例异常尿素氮或肌酐结果中有6例恢复正常，包括2例接受便携式静脉肾盂造影造影剂的患者，以及所有无高血压或糖尿病病史的患者。85%的非颅脑损伤患者血小板计数和PT/PTT正常，而格拉斯哥昏迷评分≤8分的患者这一比例为58%。
微量分析准确、便捷、节省血液，足以评估大多数创伤患者。患有高血压、糖尿病或严重颅脑损伤的患者可能需要额外检查。常规使用该技术可大幅降低成本（每100例患者节省16,000美元）。微量分析在受伤患者后续实验室评估中的作用仍有待阐明。
