血液标本采集及送检对生化检验结果的影响分析

The study on the influence of blood specimen collection to the hospital inspection results

目的：探讨血液标本采集部位、送检时间及溶血等因素对生化检验结果的影响。方法对接受静脉采血进行血常规和凝血四项检查2586份标本进行调查和分析，对溶血标本与合格标本的生化检验结果进行比较。结果2586份标本中发现不合格血检样本18份，发生率为0．70％（18／2586），对不同科室来源的样本的不合格情况进行对比发现不同科室之间血检样本的不合格发生率差异无统计学意义（F ＝0．36， P ＞0．05）。在18份不合格血检样本中因技术问题而发生不合格的样本所占比例最高，达88．89％（16／18）；经统计学分析发现技术因素所导致的不合格样本明显多于仪器因素或固定因素，且差异有统计学意义（χ2＝152．63、98．52，均 P ＜0．05）。另外，在技术因素中因溶血导致的不合格样本最多。对选择在输液的同侧部位或异侧部位采集的血液标本进行钾、钠、氯、肌酐、尿酸、葡萄糖检测发现，在输液同侧抽血对上述生化检验结果均有不同程度的影响。其中钾、氯、肌酐明显下降，而钠、尿酸、葡萄糖等指标则明显上升（t ＝4．51、4.98、5.50、3．25、10．18、15．25，均 P ＜0．05）。溶血样本的γ-转肽酶、磷酸肌酸激酶、钠及尿酸等指标明显低于正常样本，而丙氨酸氨基转移酶、直接胆红素、钾、磷、肌酐、肌酸激酶等指标则明显高于合格样本（t ＝14.85、21.21、7．15、4．86、10．33、4．02、3．11、8．20、7．54、5．11，均 P ＜0．05）。从采集血液后到送至检验室的时间对生化检验结果有着明显的影响，其中丙氨酸氨基转移酶、天冬氨酸氨基转移酶、葡萄糖、肌酸激酶及α-羟丁酸等项目的1 h 后送检均值明显低于规范送检均值，而1 h 后送检的乳酸脱氢酶、肌酸激酶同工酶等指标则明显高于规范送检均值（t ＝2．95、4．82、2．88、5．44、4．05、3．98、4．89，均 P ＜0．05）。结论标本采集的部位、标本溶血以及送检时间对血液标本生化检验均有影响，所以对于血液标本采集必须严格按照要求进行操作。

Objective To investigate the blood specimen collection site,inspection time and hemolysis influ-ence on biochemical test results.Methods The specimens of 2586 cases outpatients and hospitalized patients in our hospital who accepted blood routine and blood coagulation four check were analyzed.The hemolysis and qualified specimens of biochemical test results were compared.Results 2 586 specimens found unqualified blood samples in 18 cases,and the incidence rate was 0.70% （18 /2 586）.Samples of different section and source were compared and found there were no significant difference （F =0.36,P 〉0.05）.In 18 cases of unqualified blood samples due to technical problems and unqualified sample accounted for 88.89% （16 /18）.The technical factors that lead to unqualified samples was significantly higher than that of the instrument factor or fixed factors,and the difference was statistically significant（χ2 =152.63,98.52,all P〈0.05）.In addition,hemolysis caused the most of the unqualified samples for the technical factors.To choose potassium infusion on the side ipsilateral to the site or from the opposite side of the site collected blood samples.Sodium,chlorine,creatinine,uric acid,glucose detection found in effect of blood on the same side of the infusion of the biochemical test results in varying degrees.Potassium,chlorine,sodium, creatinine decreased significantly,and uric acid,glucose and other indicators were significantly increased （t =4.51, 4.98,5.50,3.25,10.18,15.25,all P〈0.05）.Gamma transpeptidase,creatine kinase,sodium and uric acid and other index of hemolytic samples were significantly lower than those of normal samples,and alanine aminotransferase （ALT）,direct bilirubin,potassium,phosphorus,serum creatinine and creatine kinase were significantly higher than those of the normal samples （t =14.85,21.21,7.15,4.86,10.33,4.02,3.11,8.20,7.54,5.11,all P〈0.05）.This may cause the depth in erythrocytes and some related substances.The time of collecting blood to sent to the room had obvious influence on the biochemical test results,alanine aminotransferase,aspartate amino transferase,glucose, creatine kinase and hydroxybutyrate and project them 1 h after submission were significantly lower than those of the standard inspection,and 1 hour after the submission of lactate dehydrogenase and creatine kinase isoenzyme index were significantly higher than those of the standardize inspection means （t =2.95,4.82,2.88,5.44,4.05,3.98, 4.89,all P〈0.05）.Conclusion Sampling sites,hemolysis and inspection time had effect on blood specimen,so for the collection of blood samples must be strictly in accordance with the requirements of the operation.