摘要
目的使用Excel电子表格中IF函数编辑公式,根据动脉血气分析结果自动判断酸碱平衡紊乱类型.方法通过建立酸碱平衡紊乱分析流程,采用四步分析法进行程序化分析:①根据pH值判定酸、碱,结合动脉血二氧化碳分压(PaCO2)、HCO3-及其变化率,确定原发或主要酸碱失衡类型;②根据原发或主要酸碱失衡类型选取预计代偿公式,确定有无混合型酸碱失衡;③当阴离子隙(AG)增高型代谢性酸中毒(代酸)时,对前两步判断原发或主要酸碱失衡为呼吸性酸中毒(呼酸)或呼吸性碱中毒(呼碱)时,计算潜在HCO3-,用潜在HCO3-替代实际HCO3^-与呼酸或呼碱预计代偿公式计算的代偿区间进行比较,进而判断有无三重酸碱失衡(TABD);④当AG增高型代酸时,对前两步判断原发或主要酸碱失衡为代酸时,计算ΔAG↑/ΔHCO3^-↓比值,进一步判断是否合并代谢性碱中毒(代碱)或正常AG代酸.使用Excel 2003电子表格中IF函数编辑公式对动脉血气分析结果进行判断.选择徐州市中心医院重症监护病房(ICU)收治的96例患者,根据动脉血气分析结果,分别使用人工判断(人工组)和血气分析自动判断Excel电子表格(Excel电子表格组)判定患者的酸碱失衡类型.人工组由2名新生儿重症监护病房(NICU)副主任医师及1名呼吸科主治医师完成,如结果不一致则讨论后决定判断结果.Excel电子表格组由1名NICU主治医师输入数据,另一人核对.比较两组在酸碱失衡类型判断结果和时间上的差异.结果采用四步分析法,在血气分析自动判断Excel电子表格中输入pH、PaCO2、实际HCO3^-、Na^+、Cl^-和代偿时限等相关参数,即可给出42种酸碱失衡类型.对96例患者的数据分析显示,使用Excel电子表格自动判断酸碱失衡类型的准确率高于人工判断,但差异无统计学意义〔正常及单纯型酸碱失衡:100%(26/26)比100%(26/26),混合型酸碱失衡:100%(51/51)比96.08%(49/51),TABD:100%(19/19)比89.4
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:①the 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(PaCO2),HCO3^- and their change rate;②the expected compensation formula was selected to determine whether there was mixed acid-base imbalance,according to the primary or main acid-base imbalance type;③the potential HCO3-should be calculated to replace the measured HCO3-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);④while the following two parts were judged:metabolic acidosis accompanied with AG increased-metabolic acidosis according to the prior two steps,ΔAG↑/ΔHCO3^-↓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
作者
翟敬芳
吴子健
吴杰斌
周彬
Zhai Jingfang;Wu Zijian;Wu Jiebin;Zhou Bin(Xuzhou Clinical School of Xuzhou Medical University,Prenatal Diagnosis Center of Xuzhou Center Hospital,Xuzhou 221009,Jiangsu,China;Computer Science and Technology,Xuhai College of China University of Mining,Xuzhou 221008,Jiangsu,China;Department of Neonatology,Xuzhou Clinical School of Xuzhou Medical University,Xuzhou Center Hospital,Xuzhou 221009,Jiangsu,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2020年第8期976-981,共6页
Chinese Critical Care Medicine
基金
江苏省徐州市科学技术局重点研发计划(社会发展)课题 (KC18185)。
