血气酸碱失衡分析软件的开发与应用评价  

Development and practice evaluation of blood acid-base imbalance analysis software

作　　者：陈波[1] 黄海樱[1] 周强[1] 彭珊[2] 嘉红云[1] 冀天星[1] 

机构地区：[1]广州医科大学附属第二医院检验科,广东510260 [2]广州医科大学金域检验学院,广东510182

出　　处：《中华危重病急救医学》2014年第11期832-835,共4页Chinese Critical Care Medicine

基　　金：中华医学会医学教育分会、中国高等教育学会医学教育专业委员会医学教育研究立项课题（2010-14-15）

摘　　要：目的：通过开发血气酸碱失衡分析软件计算机辅助诊断系统，快速准确地自动判断患者酸碱失衡类型，并进行临床应用评价。方法用VBA语言编写程序，开发一种判断血气酸碱平衡的计算机辅助诊断软件。回顾性分析广州医科大学附属第二医院收治的220例患者的临床资料，收集患者的动脉血气数据〔pH值、碳酸氢根（HCO3-）、动脉血二氧化碳分压（PaCO2）〕和电解质数据（Na＋、Cl-），将数据录入计算机软件自动进行酸碱失衡判断；同时用手工法将数据代入改良H-H代偿公式，通过计算结果判断酸碱失衡类型。用Kappa检验评价计算机软件判断结果和手工法判断结果的一致性，并对其判断所需时间进行比较。结果临床诊断220例患者的酸碱失衡类型为：正常65例，单纯型90例，混合型41例，三重型24例。计算机软件判断和手工法判断正常及三重型的准确率均为100%，判断单纯型的准确率为98.9%，判断混合型的准确率为78.0%，总准确率为95.5%。计算机软件判断结果和手工法判断结果的Kappa值为0.935，P＝0.000，说明一致性非常好。计算机软件判断酸碱失衡所需时间明显短于手工法判断（s：18.14±3.80比43.79±23.86，t＝7.466，P＝0.000），说明计算机软件判断所需时间远远快于手工法。结论开发的血气酸碱失衡分析软件判断结果可以代替手工法判断，具有快速、准确和方便等特点，能提高临床医生的工作效率和质量，具有较大的临床应用推广价值。Objective To develop a blood gas,acid-base imbalance analysis computer software to diagnose systematically,rapidly,accurately and automatically determine acid-base imbalance type,and evaluate the clinical application. Methods Using VBA programming language,a computer aided diagnostic software for the judgment of acid-base balance was developed. The clinical data of 220 patients admitted to the Second Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. The arterial blood gas〔pH value,HCO3-,arterial partial pressure of carbon dioxide（PaCO2）〕and electrolytes included data（Na＋and Cl-）were collected. Data were entered into the software for acid-base imbalances judgment. At the same time the data generation was calculated manually by H-H compensation formula for determining the type of acid-base imbalance. The consistency of judgment results from software and manual calculation was evaluated,and the judgment time of two methods was compared. Results The clinical diagnosis of the types of acid-base imbalance for the 220 patients：65 cases were normal,90 cases with simple type,mixed type in 41 cases,and triplex type in 24 cases. The accuracy of the judgment results of the normal and triplex types from computer software compared with which were calculated manually was 100%,the accuracy of the simple type judgment was 98.9% and 78.0% for the mixed type,and the total accuracy was 95.5%. The Kappa value of judgment result from software and manual judgment was 0.935,P=0.000. It was demonstrated that the consistency was very good. The time for software to determine acid-base imbalances was significantly shorter than the manual judgment（seconds：18.14±3.80 vs. 43.79±23.86,t=7.466,P=0.000）,so the method of software was much faster than the manual method. Conclusion Software judgment can replace manual judgment with the characteristics of rapid,accurate and convenient,can improve work efficiency and quality of clinical doctors and has great clinical application promotion value.

关 键 词：血气分析 酸碱失衡 计算机软件 应用评价 

分 类 号：R319[医药卫生—基础医学]