CAJ | 학술논문

目的：对住院患者血标本进行分析前全程监控和定期分析，探讨不合格标本发生原因，为制定改进措施提供依据，以提高分析前检验质量。方法采用调查性研究设计。以血标本唯一性条形码建立全程监控标本流程的信息系统，比较分析2012年1至6月与实施全程监控的2013年同期浙江大学医学院附属第二医院检验科收集的本院住院患者血标本的丢失率、标本超时送检率、标本不合格率，并对科室分布情况及其原因进行分析与评价。结果2013年1至6月共收到501135份住院患者血标本，标本丢失0.006‰（3/501135份），标本超时送检率1.64%（8195/501135份），标本不合格率为3.676‰（1842/501135份）；而未采取监控措施的2012年同期共收集血标本为450463份，标本丢失率为0.053‰（24/450463份），标本超时送检率为6.50%（29280/450463份），标本不合格率为7.830‰（3527/450463份），两年同期数据比较，差异均有统计学意义（χ2值分别为18.7、14839.9、729.7；P均＜0.01）。标本凝块[28.3%（521/1842份）]、标本溶血[27.6%（508/1842份）]及标本量少[24.8%（456/1842份）]是标本不合格的三大主要原因。不合格标本主要分布在中心ICU1、2病区，外科ICU、脑科ICU、急诊ICU和心内科ICU 6个监护病房。2013年1至6月，6个科室不合格标本数占全院不合格标本总数的比例分别为32.6%（118/362份）、39.3%（87/221份）、35.0%（112/320份）、32.7%（113/354份）、32.2%（98/306份）和22.5%（63/279份）。结论专职部门运用信息系统对标本分析前阶段全程监控，及时追踪可有效提高标本送检及时率、减少标本丢失率；对不合格标本发生原因及分布科室进行分析，可与临床进行有效沟通，有助于提高分析前血标本检验质量。
목적：대주원환자혈표본진행분석전전정감공화정기분석，탐토불합격표본발생원인，위제정개진조시제공의거，이제고분석전검험질량。방법채용조사성연구설계。이혈표본유일성조형마건립전정감공표본류정적신식계통，비교분석2012년1지6월여실시전정감공적2013년동기절강대학의학원부속제이의원검험과수집적본원주원환자혈표본적주실솔、표본초시송검솔、표본불합격솔，병대과실분포정황급기원인진행분석여평개。결과2013년1지6월공수도501135빈주원환자혈표본，표본주실0.006‰（3/501135빈），표본초시송검솔1.64%（8195/501135빈），표본불합격솔위3.676‰（1842/501135빈）；이미채취감공조시적2012년동기공수집혈표본위450463빈，표본주실솔위0.053‰（24/450463빈），표본초시송검솔위6.50%（29280/450463빈），표본불합격솔위7.830‰（3527/450463빈），량년동기수거비교，차이균유통계학의의（χ2치분별위18.7、14839.9、729.7；P균＜0.01）。표본응괴[28.3%（521/1842빈）]、표본용혈[27.6%（508/1842빈）]급표본량소[24.8%（456/1842빈）]시표본불합격적삼대주요원인。불합격표본주요분포재중심ICU1、2병구，외과ICU、뇌과ICU、급진ICU화심내과ICU 6개감호병방。2013년1지6월，6개과실불합격표본수점전원불합격표본총수적비례분별위32.6%（118/362빈）、39.3%（87/221빈）、35.0%（112/320빈）、32.7%（113/354빈）、32.2%（98/306빈）화22.5%（63/279빈）。결론전직부문운용신식계통대표본분석전계단전정감공，급시추종가유효제고표본송검급시솔、감소표본주실솔；대불합격표본발생원인급분포과실진행분석，가여림상진행유효구통，유조우제고분석전혈표본검험질량。
ObjectiveTo unveil the causes of unqualiifed specimens and provide basis for improvement so as to make progress in the pre-testing quality by overall tracing of inpatients’ blood specimens and periodical analysis.MethodsThe entire process monitoring information system based on blood sample barocode was adopted to compare the rate of specimen loss overdue transportation and rejection between January to June 2012 and January to June 2013 in the Second Afifliated Hospital, Zhejiang University School of Medicine. The distribution of unqualiifed specimen and causes were futher analyzed.ResultsTotally 501 135 in patients blood samples were received with 0.006‰ (3/501 135 specimens) sample loss rate, 1.64% (8195/501 135 specimens) specimen transportation overtime rate, 3.676‰ (1842/501 135 specimens) specimen unqualified rate from January to June 2013; otherwise, 450 463 specimens with 0.053‰ (24/450 4630 specimens) loss rate, 6.50% (29 280 / 450 463 specimens) transportation overtime rate, 7.830‰ (3527/450 463 specimens) unqualiifed rate without control measures during the first half year of 2012 were received, differences were statistically significant (χ2=18.7, 14839.9, 729.7, P<0.01) between those two periods; the clotted, haemolysed and insufifcient volume were the three main rejection reasons which accounts for 28.3% (521/1842 specimens), 27.6% (508/1842 specimens) and 24.8% (456/1842specimens) respectively. Unqualiifed specimens are mainly distributed in six intensive care units (center ICU1/2, surgical ICU, neurology ICU, emergency ICU and heart ICU) ,which accounts for 32.6% (118/362 specimens), 39.3% (87/221 specimens), 35.0% (112/320 specimens), 32.7% (113/354 specimens), 32.2% (98/306 specimens) and 22.5% (63/27 specimens) of total reject ratio from January to June 2013.ConclusionsFull monitoring of specimens in the pre-analysis by Laboratory Information Systems can improve the timely rate of specimens transportation and reduce the rate of the lost and unqualified specimens. Analysis of the occurrence rate of unqualiifed specimens and effectively negotiating with relevant departments can make great progress in pre-analytical quality control of blood specimens.