Evren BÜYÜKFIRAT, Ataman GÖNEL, Mahmut Alp KARAHAN, Nuray ALTAY, Kenan EROL, Başak PEHLİVAN, AHMET ATLAS

Yoğun Bakımda Sedasyon Amaçlı Kullanılan İlaçların Biyokimyasal Markerlara Olan İnterferans Etkisinin Deneysel Araştırılması

Amaç: İlaç interferansı nedeniyle laboratuvar testlerinde yanlış sonuçlar alınabilmektedir. Buçalışmanın amacı yoğun bakımda sedasyon amacıyla kullanılan ketamin, tiyopental, propofol,midazolam ve deksmedetomidinin immünassay ve spektrofotometrik yöntemlerle ölçülen rutinbiyokimyasal testler üzerindeki interferans etkilerinin araştırılmasıdır.Yöntem: 180 µL kontrol solüsyonu üzerine 20 µL 5 farklı ilaç solüsyonundan eklenip 5 saniye vor- teksle karıştırıldı. Karışımdan spektrofotometrik ve immünassay metotlarla biyokimyasal testlerölçüldü. Her ölçüm 5 farklı ilaç için ayrı ayrı yapıldı. Kontrol materyaline 20 µL distile su eklenerek3 tekrarlı çalışma gerçekleştirildi. Ortalama değerleri alındı ve ortalama değer hedef değer olarakkabul edilerek % sapma ile sapma miktarları tespit edildi.Bulgular: Tüm ilaçların uygulanmasından sonra, kreatin kinaz MB (CK-MB) testinde %13.51 ile%30.81 arasında negatif interferans, troponin I testinde propofol, tiyopental ve deksmedetomi- dinde %11.67 ile %68.33 arasında pozitif interferans meydana gelmiştir. N-terminal pro BrainNatriuretic Peptid (NT-proBNP) testinde propofol, ketamin, midazolam ve deksmedetomidinde%16.42 ile %37.20 arasında pozitif interferans, tiyopental ile de %85.27 negatif interferans geliş- miştir. Serbest tiroiodotironin (FT3), serbest tiroksin (FT4), tiroid stimülan hormon (TSH) testlerin- de en yüksek interferans tiyopentalde görülürken, en düşük interferans deksmedetomidindesaptandı. C reaktif protein (CRP) testinde en yüksek negatif interferans tiyopentalde (%96.43) endüşük negatif interferans (%10.71) deksmedetomidinde saptandı. Spektrofotometrik testlerde iseinterferans daha az oranda görülürken en sık sodyum ve klor testlerinde saptandı.Sonuç: Sedasyon amacıyla kullanılan ilaçlar analitik fazda immünassay testlerde önemli orandainterferans oluşturmuştur. Spektrofotometrik yöntemin kullanıldığı biyokimyasal markerlardadaha az oranda sapma tespit edilmiştir. Test sonuçlarındaki değişim hastalıkların dışında ilaçkullanımına bağlı hatalı ölçümün neticesi olabilir. Klinisyenler şüpheli test sonuçlarında ilaç kitinteraksiyonuna bağlı hatalı ölçüm ihtimalini değerlendirmelidir.

Experimental Investigation of the Interference Effect of Drugs Used in Intensive Care for Sedation on Biochemical Markers

bjective: Due to drug interference, incorrect results can be obtained in laboratory tests. The aim of this study is to investigate the interference effects of ketamine, thiopental sodium, propofol, midazolam and dexmedetomidine used in intensive care for sedation on routine biochemical tests measured by immunoassay and spectrophotometric methods. Methods: 20 μL from 5 different drug solutions was added to 180 μL control solution and mixed using vortex for 5 seconds. Biochemical tests were measured from the mixture using spectropho- tometric and immunoassay methods. Each measurement was made separately for 5 different drugs and repeated for 3 times, and 20 μL of distilled water was used as the control material, and their average values were obtained. Average value was accepted as the target value, and devia- tion rates were determined with % bias. Results: After application of all drugs, negative interference occurred at a rate of 13.51% to 30.81% in creatine kinase MB (CK-MB) test; positive interference at a rate of 11.67% to 68.33% in troponin I test in propofol, thiopental and dexmedetomidine. In N-terminal pro Brain Natriuretic Peptide (NT-proBNP) test, positive interference developed between 16.42-37.20% in propofol, ketamine, midazolam and dexmedetomidine, and negative interference with thiopental at a rate of 85.27%. The highest interference was observed with thiopental in free thyroiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH) tests, while the lowest interference was found with dexmedetomidine. In C-reactive protein (CRP) test, the highest negative interfer- ence (96.43%) was detected in thiopental, while the lowest negative interference (10.71%) with dexmedetomine. Interference was less common in spectrophotometric tests, while it was most frequently detected in sodium and chlorine tests. Conclusion: In the analytical phase of the drugs used for sedation, a significant interference occurred in immunoassay tests. Less deviation was detected in spectrophotometric method per- formed with biochemical markers. Change in test results may be the result of erroneous measure- ment due to drug use other than diseases. Clinicians should evaluate the possibility of incorrect measurement due to drug-kit interaction in questionable test resuls.

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