分析前因素对血乳酸检测结果的影响

Effect of pre analysis factors on blood lactic acid test results

目的 探究分析前因素对血乳酸检测结果的影响,拟定规范、可行的血乳酸前处理策略,以保障其检验结果的有效性.方法 检测20例氟化钠/草酸钾、肝素抗凝血及其分离血浆于室温、冰浴放置0~8 h期间的乳酸、葡萄糖水平,评估抗凝剂、放置时间、分离血浆和贮存温度对乳酸检测的影响.结果 氟化钠/草酸钾抗凝血室温放置8 h,乳酸结果从（1.43 ± 0.37）mmol/L升高至（1.57 ± 0.38）mmol/L,在1 h后乳酸结果的升高具有统计学差异（P〈0.05）,且超出临床可接受范围（样本比对合格率≤80% ）.肝素抗凝血室温放置1 h,乳酸结果从（1.47 ± 0.32）mmol/L升高至（7.03 ± 1.15）mmol/L,在0.5 h后乳酸结果的升高具有统计学差异（P〈0.05）,且超出临床可接受范围（样本比对合格率≤80% ）.氟化钠/草酸钾抗凝血和肝素抗凝血的分离血浆室温室温放置8 h时的糖酵解率分别为（0.10 ± 1.27）%、（1.04 ± 1.54）%,8 h乳酸检测结果与即刻检测结果之间出现统计学差异（P〈0.05）,但该差异在临床可接受范围（样本比对合格率≥80% ）.氟化钠/草酸钾、肝素抗凝血即刻乳酸检测结果间无统计学差异（t=0.82,P〉0.05）,且均在说明书推荐的生物参考区间内（0.5~2.2 mmol/L）.氟化钠/草酸钾抗凝血冰浴放置2 h时乳酸结果出现有统计学差异的升高（P〉0.05）,但在临床可接受范围（样本比对合格率≥80% ）.结论 氟化钠/草酸钾、肝素抗凝血均可用于检测血乳酸.其中,氟化钠/草酸钾抗凝血须在1h内、肝素抗凝血须即刻检测血乳酸.若不能在规定时间内完成检测,须及时分离血浆标本.分离后的氟化钠/草酸钾、肝素抗凝血浆标本的乳酸结果在室温可稳定8h.在冰浴情况下,氟化钠/草酸钾抗凝血的乳酸结果可稳定2h.

Objective To explore the influence factors of blood lactic acid before analysis of test results,to regulate blood lactic acid and feasible pretreatment strategies,in order to ensure the validity of test results.Methods The levels of lactic acid and glu-cose in 20 cases of sodium fluoride /potassium oxalate,heparin anticoagulant and its separated plasma were measured at room tem-perature and ice bath for 0~8 hours.The effects of anticoagulant,storage time,separation of plasma and storage temperature on the detection of lactic acid were evaluated.Results Fluoride sodium /potassium oxalate anticoagulant placed at room temperature for 8 hours,lactic acid results from 1.43 ± 0.37 mmol/L increased to （1.57 ± 0.38 mmol/L）,in 1 hour after lactic acid results increase with significant difference （P〈0.05）and beyond clinical acceptable range （sample the ratio of qualified rate less than or equal to 80% ）.Heparin anticoagulant placed at room temperature for 1 hour,lactic acid results from 1.47 ± 0.32 mmol/L increased to （7.03 ± 1.15 mmol/L）,0.5 h after lactic acid results increase with significant difference （P〈0.05）in and beyond clinical accepta-ble range （sample the ratio of qualified rate less than or equal to 80% ）.Fluoride sodium /potassium oxalate anticoagulant and hep-arin anticoagulant plasma separation chamber greenhouse temperature placed 8 hours of glycolysis rate respectively （0.10 ± 1.27% ）,（1.04 ± 1.54% ）,8 hours of lactic acid and the detection results of immediate detection results between appeared signifi-cant difference （P〈0.05）,but the difference in clinical can accept range （sample the ratio of qualified rate greater than or equal to 80% ）.There was no significant difference in fluoride sodium /potassium oxalate,heparin anticoagulant immediately detected re-sults of lactic acid （t=0.82,P〉0.05）,and were in the manual recommended biology reference interval （0.5—2.2 mmol/L）.Place the fluoride sodium /potassium oxalate anticoagulant ice bath is 2 hour lactic acid when the result appears to be statistically signifi-cant elevated （P〉0.05）,but in the clinically acceptable range （sample the ratio of qualified rate greater than or equal to 80% ）.Conclusion Fluoride sodium /potassium oxalate,anticoagulant heparin can be used for the detection of blood lactic acid.Among them,fluoride sodium /potassium oxalate anticoagulant should be within 1 hours,blood lactic acid anticoagulant heparin to be test-ed immediately.If you can not complete the inspection within the stipulated time,and shall timely isolated plasma samples.After the separation of the sodium fluoride /potassium oxalate,heparin plasma samples of lactic acid results in room temperature can be sta-ble for 8 hours.In the case of an ice bath,sodium fluoride /potassium oxalate anticoagulant lactic acid results can be stable in 2 hours.