血液标本临床检验不合格的原因和对策分析

目的探讨血液标本临床检验不合格原因和相应优化对策。方法对重庆市永州区中医院2012年1～6月收集的4658份血液标本质量行统计学分析。结果本组4658份血液标本中，不合格标本有256份，占5．5％；血液标本不合格常见原因有样本量少（27．7％）、抗凝不全（20．3％）、溶血（12．9％）、凝血（11．3％），还有容器不当（6．6％）、输液同侧采集（6.3％）、送检不及时（6.3％）、受检者准备不足（5．1％）、标签不当（3．1％）、标本污染（0．4％）。标本血液比例不当，凝血酶原时间（PT）、活化部分凝血酶原时间（APTr）测定值显著增加，凝血酶时间（’丌）、纤维蛋白原（Fib）测定值偏低；标本溶血后生化检测指标总胆红素（TBIL）显著降低，间接胆红素（DBIL）、血糖（GLU）测定值偏低，谷草转氨酶（AST）、钾浓度（1（＋）测定值偏高；标本有凝块致血小板（PLT）测定值显著降低，血红蛋白（Hb）、红细胞（RBC）测定值偏低，白细胞（WBC）测定值偏高（P〈0．05）。结论为保证临床检验标本准确性，科室需建立完善质量控制体系，同时提升相关工作人员的责任感、职业道德、专业技能等，最大限度降低样本不合格风险性，提高临床检验准确性。

Analysis of the reasons of unqualified blood specimens in clinical test and the corresponding countermeasures

Objective To observe the reasons of unqualified blood specimens in clinical test and the corresponding optimizing countermeasures. Methods The clinical materials of 4658 blood specimens were reviewed and analyzed from January 2012 to June 2012. Results There were 256 （5.5%） unqualified blood specimens in the 4658 blood specimens. The common reasons of unqualified blood specimens were sample quantity （27.7%）, anticoagulation dys- function （20.3%）, hemolysis （12.9%）, blood coagulation （11：3%）, improper selection of containers （6.6%）, homonymy collection with transfusion （6.3%）, unseasonal submission （6.3%）, inadequate preparation of client （5.1%）, improper of labels （3.1%）, specimen contamination （0.4%）. The measured value of PT and APTT significantly increased, and Tr, Fib significantly reduced in specimens with improper blood ratio. The measured value of TBIL, DBIL and GLU significantly reduced, and ASK, K^＋ significantly increased after hemolysis. The measured value of PLT, Hb and RBC significantly reduced, and WBC significantly increased in specimens with clot （P 〈 0.05）. Conclusion The department needs to build perfect quality control system, and enhance the sense of responsibility, moral level and specialized skill to reducing risk of unqualified blood specimens, and improving accuracy of clinical test.