凝血检验的影响因素观察

邱菊　许风波

[摘要] 目的 探讨凝血检验的相关影响因素。方法 2013年1月～2015年2月随机选取200份血液样本进行凝血检验，对比分析不同放置时间、离心时间、溶血状态下的凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原等四项检验结果的差异性。对200例患者样本进行复查，统计凝血检验正确率、失误率，观察上述指标与检验失误之间的关系。结果 样本放置2、4h的凝血活酶时间、凝血酶时间和纤维蛋白原存在统计学差异（P<0.05）；离心5min的凝血酶原时间、凝血活酶时间明显低于离心10min的结果，差异有统计学意义（P<0.05）；溶血前后的四项指标均存在统计学差异（P<0.05）；凝血检验的正确率为90.0%，失误原因包括仪器因素、样品处理情况、内源性因素及其他。结论 凝血检验指标的质量控制需缩短标本的放置时间，严格控制离心时间，防止发生溶血，以免造成假性检验结论误导医师作出错误判断。

[关键词] 凝血检验；凝血酶原时间；凝血活酶时间；凝血酶时间；纤维蛋白原；影响因素

[中图分类号] R446.1 [文献标识码] B [文章编号] 2095-0616（2016）09-137-04

[Abstract] Objective To explore and discuss the related influence factors of coagulation test. Methods 200 blood samples from January 2013 to February 2015 were randomly selected for coagulation tests. The four test results difference of different storage time， centrifugation time， prothrombin time of hemolytic state， activated partial thromboplastin time， thrombin time and fibrinogen etc were compared and analyzed. 200 patients samples were reviewed to obtain the statistics of coagulation tests accuracy rate and error rate and to observe the relationship between these indicators and inspection mistakes. Results The thromboplastin time of samples placed 2 h and 4 h， thrombin time and fibrinogen had statistical differences（P<0.05）. The prothrombin time and thromboplastin time of centrifugation 5min were dramatically lower than those of centrifugation 10min， which had statistical significance between the differences（P<0.05）. There had statistical differences between the four indicators of the before and after hemolysis（P<0.05）. The accuracy rate of coagulation tests was 90.0%， while the error causes included instrument， sample processing， endogenous factors and others. Conclusion The quality control of coagulation tests index had to shorten specimen placement time， strictly control centrifugal time， and prevent the hemolysis occurrence， in case to avoid false test results to mislead the false judgments made by doctors.

[Key words] Coagulation test； Prothrombin time； Thromboplastin time； Thrombin time； Fibrinogen； Influence factor

凝血检验属于检验科常规检测项目之一，旨在检验血脂性疾病，患者在进行手术前，医生会要求患者进行凝血四项检查，目的在于了解患者有无止血功能缺陷，从而及时做好抢救准备工作，因此，凝血检验对于了解患者的凝血机制及指导临床治疗具有重要意义[1]。随着生物学技术研究的不断深入，凝血四项检查已经形成了一套系统而规范的流程，包括标准试剂、质控品和报告形式，进一步推动实验室检查工作不断向标准化和流程化的方向发展[2-3]。高精度凝血分析仪的使用极大地提高了凝血检验效率，但检验结果也容易受到各种因素的影响。为探讨凝血检验的相关影响因素，我院于2013年1月～2015年2月随机选取200份血液样本进行凝血检验，分析不同影响因素下的检验结果，现将结果报道如下。

1 资料与……