ICU患者双侧双瓶血培养结果分析

目的回顾性分析ICU患者开展双侧双瓶血培养的结果,评价双侧双瓶血培养方法的优缺点。方法分析760例ICU患者双侧双瓶血培养结果的真、假阳性;比较中心静脉导管组导管血、外周血的阳性情况,判断导管相关血流感染(CRBSI)的可能性。结果 760例中真阳性结果 71例(9.34%),污染19例(2.50%),不确定21例(2.76%)。其中,非导管组双侧双瓶血培养真阳性率为14.85%,与以往单瓶血培养报警阳性率9.24%相比,χ2=9.688,P<0.01。非导管组污染菌包括4株阳性杆菌及13株凝固酶阴性葡萄球菌。中心静脉导管组共培养阳性20例,其中外周血和导管血同时阳性的6例和外周血为白色念珠菌的1例提示可能为CRBSI,仅导管血阳性的11例CRBSI情况不确定,可能为导管细菌定植或采集时的污染;其他2例为污染。结论双侧双瓶血培养的开展有利于提高血流感染培养的阳性率,并且有利于鉴别污染和判断CRBSI。     

ELISA法检测试管标本与血辫标本结果分析

ELISA法献血者传染病指标检测阳性的试管标本与血辫标本平行再检十分重要.<血站实验室质量管理规范>13.5条款提出初检阳性标本进一步复检指的是重新留取血辫标本与试管标本进行平行再检[1.2].破损、溶血和细菌污染的试管标本的重新留样取自血辫标本,质控科、临检中心对库存合格血液成分的抽检标本取自血辫标本.     

疑似中心静脉通路装置导管相关血流感染血培养标本采集的最佳证据总结

目的 评价并总结中心静脉通路装置导管相关血流感染血培养标本采集的最佳证据,为规范中心静脉通路装置导管相关血流感染血培养采集工作流程提供指导依据.方法 系统检索Up To Date、BMJ Best Practice、国际指南协作网(guidelines international network,GIN)、苏格兰学院间...     

血培养仪阳性报警时间在血培养检出菌性质鉴别中的应用

目的 探讨血培养仪阳性报警时间(TP)对所检出的凝固酶阴性葡萄球菌(CoNS)性质鉴别中的应用价值.方法 对236例血培养检出CoNS的新生儿血培养标本TP和定量血培养(QBCs)检测结果 进行比较分析,根据QBCs、TP,并结合临床资料,判断CoNS是感染菌或污染菌.结果 TP和QBCs呈显著负相关:TP≤16 h时,QBCs＞100 CFU/mL;TP>20 h时,QBCs＜10 CFU/mL.QBCs检测结果 与患儿临床症状严重程度和抗菌药物治疗的必要性呈明显正相关:QBCs＜10 CFU/mL,即TP≥20 h,预示细菌污染;QBCs＞100 CFU/mL,即TP≤16 h,预示血液中细菌浓度较高,存在血流感染,需积极采取抗菌药物治疗.结论 TP作为判断细菌浓度的指标,也可用于鉴别血培养检出CoNS是否提示血流感染.     

规范化标本采集降低血培养标本污染率分析

血液培养在临床上具有重要指导价值,日益受到临床重视.一方面,血培养可以明确诊断是何种病原菌感染;另一方面,依据血培养结果进行的药敏试验,能够指导临床用药,进而减少抗菌药物的误用和滥用,大大改善患者预后,减少患者医疗费用.但血液培养结果的准确性是发挥其临床指导作用的前提.要获得准确的血液培养结果,首先要确保血培养标本未受到污染[1,2].本文探讨血培养标本采集环节的造成标本污染的相关因素,并提出规范化标本采集措施,报告如下.     

一次性头皮针在动脉血标本采集法中的应用

随着动脉血气分析在临床的广泛应用,护士接触到动脉血采集的机会也相应增加.正确留取标本在保证血气分析结果的可靠性方面起着不可忽视的作用.对于动脉搏动明显的患者,护士经常能快速准确地采集到动脉血,但如果患者的动脉搏动不明显,则经常出现反复穿刺或误采集到静脉血的现象,增加了患者的痛苦,影响了血气分析准确性.我们在实践中使用一次性输液头皮针替换注射器针头,大大提高了动脉血采集的成功率.     

不同类型标本血电解质及葡萄糖测定结果的比较分析

目的探讨动脉血浆、静脉血浆、动脉血清、静脉血清之间电解质、葡萄糖结果的差异及其原因。方法采集54例患者动静脉抗凝血、动静脉凝集血各1管,分离出相应的血浆和血清,用强生VITROS 5600自动干式生化分析仪对K~+、Na~+、Cl~-、血糖的浓度进行测定,并应用统计学方法对检测结果进行比较分析。结果当标本类型为血清时,动脉血与静脉血之间Na~+、Cl~-、血糖和血清K~+浓度的测定值差异有统计学意义(P0.05);当标本类型为血浆时,动脉血与静脉血之间Na~+、Cl~-、血糖浓度的测定值差异有统计学意义(P0.05),但K~+浓度差异无统计学意义(P0.05)。另外,动脉的血浆和血清之间血糖和血K~+的测定值差异有统计学意义(P0.05),而Na~+、Cl~-测定值的差异无统计学意义(P0.05);同样的,静脉的血浆和血清之间血糖和血K~+的测定值差异有统计学意义(P0.05),而Na~+、Cl~-测定值的差异无统计学意义(P0.05)。结论同一检测系统检测电解质、葡萄糖,动脉血浆、静脉血浆、动脉血清、静脉血清之间测定值存在一定差异,临床上应注意区别对待不同类型标本的测定值,建立、选择合适的参考范围。     

同步采集血生化及血气分析标本的技巧

呼吸、循环功能状态紊乱导致的血电解质紊乱、酸碱平衡失调在危重病、多器官受损患者较为常见，往往需要频繁地同时检测血气分析和血生化。抽取血标本是护士日常工作的基本内容之一，若反复穿刺取动脉血、静脉血，既可增加患者疼痛及穿刺部位血肿、动静脉栓塞形成等不良反应，同时也增加护士的工作量。为了寻找简便、减轻患者痛苦的采血方法，本院采用快速同步采集动静脉血标本的方法，介绍如下。     

一次性头皮针在动脉血标本采集法中的应用

随着动脉血气分析在临床的广泛应用，护士接触到动脉血采集的机会也相应增加。正确留取标本在保证血气分析结果的可靠性方面起着不可忽视的作用。对于动脉搏动明显的患者，护士经常能快速准确地采集到动脉血，但如果患者的动脉搏动不明显，则经常出现反复穿刺或误采集到静脉血的现象。增加了患者的痛苦，影响了血气分析准确性。     

血培养病原菌分布及污染菌判定的实验室检查

目的通过回顾该院的血培养病原菌检出情况以及污染菌的判定分析,了解该院血流感染的主要病原菌构成比,并证实开展双侧双瓶采血检测等实验室检查方法,能有效提高阳性率和血培养污染菌的判定。方法对该院2010年7～12月的1 121份血培养标本进行回顾性分析,了解其病原菌分布,对部分患者开展双侧双瓶采血检测,以血培养中最常见的污染菌凝固酶阴性葡萄球菌(CNS)为例,评价该方法对血培养污染菌判定的价值。结果血培养阳性检出率为10.0%,主要检出菌种为大肠埃希菌,占25.0%,临床分布和时间分布显示为散发,未见院内感染趋势。其中采用双侧双瓶采血检测的血培养标本98例,阳性检出率达22.5%,高于单侧单瓶采血(9.6%),其中检出CNS的比例为22.7%,双瓶48h内同时检出CNS仅为4.5%,而单瓶检出占18.2%,提示临床CNS可能为污染菌,建议结合患者临床资料、状态综合判断,指导用药。结论血培养检出病原菌种类仍以大肠埃希菌为最高,同往年相似。开展采用双侧双瓶采血方法对判定CNS是否为污染菌有一定作用,可提示临床结合患者具体情况综合判断,减少不合理用药。     

Improvement of glucose preservation in blood samples

Preservation of blood glucose is better with added D-mannose than with added sodium fluoride. Nearly complete preservation can be achieved by the use of both D-mannose and sodium fluoride.     

动静脉血部分生化指标比较

目的探讨动、静脉血样钾（K^＋）、钠（Na^＋）、离子钙（ica^2＋）、碳酸氢根（HCO3^-）、葡萄糖（GLU）、乳酸（LAC）测定结果的差异。方法对同一受检者同时采动脉血和静脉血分别测定上述指标。结果动、静脉血样本K^＋、iCa^2＋、HCO3^-、GLU均值差异有统计学意义，而Na^＋、LAC差异无统计学意义。结论需要建立动脉血K^＋、iCa^2＋、HCO3^-、GLU参考值范围。     

Stability of YKL-40 concentration in blood samples

The stability of YKL-40, a mammalian member of the family of 18 glycosyl-hydrolases, in blood samples handled under different temperatures and different time intervals before centrifugation was studied in paired serum and plasma samples from 25 healthy premenopausal Danish women. Significant elevations of YKL-40 were found in 8 paired serum samples left on the clot for more than 3 h at room temperature compared to paired serum samples left on the clot for 3 h or less. Significant elevations of YKL-40 were found in 8 paired plasma (EDTA) samples left on the blood cells for more than 8 h at room temperature compared to paired plasma (EDTA) samples left on the blood cells for 8 h or less. No elevations were found in YKL-40 levels in serum samples left on the clot at 4°C for 24 h or in plasma (EDTA) samples left on the blood cells for 72 h before centrifugation. Significantly lower concentrations of YKL-40 were measured in plasma (EDTA) compared with paired serum samples with a serum/plasma ratio of 1.4 in samples left on the clot or on blood cells at 4°C for up to 24 h. Repetitive freezing and thawing had no significant effect on the measured YKL-40 concentrations. In conclusion, we have shown that YKL-40 is very dependent on the handling procedures. All the blood samples must be processed into plasma (EDTA) within 8 h at room temperature or into serum in less than 3 h at room temperature. If this is not possible, the blood samples must be stored at 4°C until processed.     

Stability of YKL-40 concentration in blood samples

The stability of YKL-40, a mammalian member of the family of 18 glycosylhydrolases, in blood samples handled under different temperatures and different time intervals before centrifugation was studied in paired serum and plasma samples from 25 healthy premenopausal Danish women. Significant elevations of YKL-40 were found in 8 paired serum samples left on the clot for more than 3 h at room temperature compared to paired serum samples left on the clot for 3 h or less. Significant elevations of YKL-40 were found in 8 paired plasma (EDTA) samples left on the blood cells for more than 8 h at room temperature compared to paired plasma (EDTA) samples left on the blood cells for 8 h or less. No elevations were found in YKL-40 levels in serum samples left on the clot at 4 degrees C for 24 h or in plasma (EDTA) samples left on the blood cells for 72 h before centrifugation. Significantly lower concentrations of YKL-40 were measured in plasma (EDTA) compared with paired serum samples with a serum/plasma ratio of 1.4 in samples left on the clot or on blood cells at 4 degrees C for up to 24 h. Repetitive freezing and thawing had no significant effect on the measured YKL-40 concentrations. In conclusion, we have shown that YKL-40 is very dependent on the handling procedures. All the blood samples must be processed into plasma (EDTA) within 8 h at room temperature or into serum in less than 3 h at room temperature. If this is not possible, the blood samples must be stored at 4 degrees C until processed.     

Various applications of direct PCR using blood samples

Samples of blood or other animal fluids contain a variety of substances that inhibit the polymerase chain reaction (PCR), meaning that isolation of DNA, involving multiple labor-intensive steps, is generally necessary prior to PCR. We have developed a novel reagent cocktail that effectively suppresses these inhibitory substances. Using this reagent cocktail, DNA from various targets can be efficiently amplified directly from various forms of blood samples without DNA isolation. 1. DNA sequences within the beta-globin gene could be amplified directly from human blood samples treated with various anticoagulants. Either fresh blood or blood samples stored frozen for up to 4 years could be used for PCR. 2. DNA sequences of up to 2056 bp within the beta-globin gene could be amplified directly from human blood samples. 3. Human chromosomal and mitochondrial DNA from different individuals could be amplified directly from blood samples. 4. Low titers of hepatitis B virus could be amplified directly from human blood samples. 5. DNA could be amplified directly from various target sequences using dried blood in a PCR tube or on a filter paper. 6. Transgenes could be detected directly in blood samples from transgenic mice.     

Electronic nose analysis of urine samples containing blood

In this paper the possible application of an electronic nose to the analysis of urine is presented. In contrast with the conventional applications of sensors and biosensors operating in liquid, the approach discussed here makes use of gas sensors performing an analysis of the headspace. The application deals with urine samples from patients affected by kidney diseases; some of the samples contained traces of blood. Results show the possibility of distinguishing the samples containing blood from the others, and a linear correlation between the first three principal components and the blood content was found. Furthermore, the electronic nose matched with a suitable neural network showed good performance in measuring the pH and the specific weight of the samples.