2007至2010年检验不合格标本分析

Analysis of rejected specimens in the department of clinical laboratory medicine from 2007 to 2010

目的分析如何控制和降低不合格标本量，以确保分析前质量。方法回顾性分析2007至2010年复旦大学附属中山医院检验科收到的住院患者血液不合格标本40035份及2010年收到的住院患者体液不合格标本，包括尿液不合格标本162份及粪便不合格标本167份。以不合格率描述不合格标本情况，采用Pearson，检验比较不同种类的抗凝管发生标本凝块的风险。结果注射器-玻璃管／硅化塑料管加自配抗凝剂采集标本的不合格率远高于真空采血系统（不合格率分别为11．58％和1．33％）；2007至2010年真空采血系统采集标本的不合格率分别为13．29％0、1．49％。、0．76％0及0．52％0，呈逐年下降趋势；不合格的3大主要原因为标本凝块、标本量少及标本类型错误，其中标本凝块又以柠檬酸钠抗凝管最常见（，=202．3，P=0．000）；体液不合格标本以粪便标本无标本为主，通过改用透明容器后不合格率由原先的2．0％o以上下降至1．5％0以下。结论检验科应建立控制标本不合格率的制度，并通过不断分析及与临床医护人员的沟通交流，有效降低标本不合格率，确保分析前质量。

Objective To investigate how to control and decrease the number of rejected specimens in order to improve pre-analytical quality. Methods The 40 035 rejected blood specimens from 2007 to 2010 and the rejected body fluid specimens including 162 urine specimens and 167 feces specimens in 2010 in the Department of Clinical Laboratory Medicine, Zbongshan Hospital, Fudan University were analyzed retrospectively. Results were shown by the percentage of rejected specimens in which Pearsonx2 test was used to assess the percentage of clotted specimens with different anticoagulant tubes. Results The percentage of rejected specimens collected by syringes with glass tubes or plastic tubes with anticoagulant artificially was 11.58%, which was higher than that of rejected specimens collected by vacuum blood collection system （ 1.33% ）. The percentage of rejected specimens from 2007 to 2010 collected by vacuum blood collection system was 13.29%0, 1.49%0, 0. 76%0 and 0. 52%0, respectively, which was decreased year by year. The three main reasons of rejected specimens were specimen clotted, insufficient specimen quantity and improper specimen type, respectively. Specimen clotted was more frequently in sodium citrate anticoagulant tube samples than others （X2 = 202. 3, P = 0. 000）. The rejected specimens of body fluid specimens were mainly feces specimens without samples. The number of rejected feces specimens was significantly decreased from 2%0 above to 1.5%o below with the implementations of transparent sample containers. Conclusion Appropriate improvement measures of rejected specimens with clinical communication should be taken by the clinical laboratory to reduce the number of rejected specimens and improve pre-analytieal quality.