模拟急诊生化标本不同仪器检测效率比较

doi:10.3969/j.issn.1673-8640.2022.08.013

摘要/Abstract

摘要：

目的比较不同仪器检测模拟急诊生化标本的效率。方法采用A、B、C 3台生化分析仪分别检测单份标本和批量标本（40份）常规化学单一项目、全套项目,记录所需时间。按照不同的项目组合顺序（顺序1、顺序2）检测20份标本,记录所需时间。使用不同的仪器组合（Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ）检测10份标本常规化学与心肌标志物组合项目,分别按照分管和不分管、先测常规化学项目和先测心肌标志物项目进行检测,记录所需时间。分别在开启和关闭血清指数检测功能的状态下采用仪器A、B、C检测40份血清标本（含干扰物质的溶血、黄疸、脂血标本各5份）,比较检测不同状态标本所需时间。随机选取4名检测人员目测判断40份血清标本状态,记录所用时间和结果,计算目测结果的符合率。对3台生化分析仪进行每日维护保养,记录所用时间。结果单份标本在仪器A、B、C上检测葡萄糖项目所需时间分别为6、16、12 min,检测全套常规化学项目所需时间分别为8、18、14 min。批量标本在仪器A、B、C上检测葡萄糖项目所需时间分别为12、19、15 min;检测全套常规化学项目所需时间分别为103、112、72 min。按照不同常规化学项目顺序检测20份标本,仪器A、C用时不变,仪器B顺序2较顺序1用时增加1 min。10份标本常规化学和心肌标志物组合项目检测,组合Ⅰ用时34 min,不分管仪器组合Ⅱ、Ⅲ、Ⅳ、Ⅴ先测常规化学项目用时分别为67、60、92、80 min,先测心肌标志物项目用时分别为69、53、72、71 min;分管检测用时分别为58、48、69、69 min。仪器A、B、C开启和关闭血清指数检测功能检测40份标本全套常规化学项目所需时间相同。4名检测人员目测法判断40份血清标本状态平均用时122 s,对溶血、黄疸、脂血标本判断结果平均符合率分别为100%、48%和76%。A、B、C 3台生化分析仪每日维护保养时间分别为13、21、35 min。结论急诊生化检测标本在不同仪器上的检测效率受标本量、检测流程等因素的影响。血清指数检测能客观反映标本状态,且省时、省力。实验室可通过合理配置仪器、优化检测流程来提高仪器的检测效率,缩短急诊检验实验室内标本周转时间（TAT）。

关键词: 急诊检验, 检测效率, 检测流程, 血清指数, 标本周转时间

Abstract:

Objective To compare the testing efficiency of simulated emergency biochemical samples among different instruments. Methods Single analyte and full-set analytes for single sample and a batch of samples（40 samples） were tested with 3 different instruments（A,B,C）,respectively. The testing times of different instruments were recorded. Totally,20 samples were tested in different sequences（sequence 1 and sequence 2）,and the testing time were recorded. Totally,5 instrument combinations（Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ） were used to test biochemical analytes and cardiac markers for 10 samples. The combinations were determined according to various processes,and the testing times were recorded. Both split sample and unsplit sample were determined on the combinations. The samples were determined in the process of biochemical analytes first or cardiac markers first. A total of 40 samples,containing 5 hemolytic,5 icteric and 5 lipemic samples,were collected,and the 40 samples were also inspected by 4 technicians by visual. The testing time and results were recorded,and the coincidence rates of visual results were calculated. Daily maintenance for the 3 instruments was performed,and the testing time was recorded. Results It took 6,16 and 12 min to test glucose for single sample for instrument A,B and C,respectively,and 8,18 and 14 min to test full-set analytes for the above instruments,respectively. It took 12,19 and 15 min to test glucose for a batch of samples for instrument A,B and C,respectively,and 103,112 and 72 min to test full-set analytes. It took the same time to test the same analytes for 10 samples in different sequences for instrument A and C,while it took 1 more min in sequence 2 than in sequence 1 on instrument B. When 10 samples were tested for biochemical analytes and cardiac markers,it took combination Ⅰ 34 min. It took combination Ⅱ,Ⅲ,Ⅳ and Ⅴ 67,60,92 and 80 min,respectively,when testing biochemical analytes firstly. It took 69,53,72 and 71 min respectively when testing cardiac markers firstly. It took 58,48,69 and 69 min when the samples were split and start testing simultaneously on both instruments. It took the same time for the 3 instruments to test all the biochemical analytes for 40 samples. The average time for visual inspection of 40 serum samples was 122 s. The mean coincidence rates of visual inspection for hemolytic,icteric and lipemic samples were 100%,48% and 76%,respectively. It took 13,21 and 35 min to complete daily maintenance for instrument A,B and C. Conclusions The testing time is influenced by the number of samples,testing process and so on. Serum index testing needs less time and labor than visual inspection. It reflects the status of samples more objectively and helps controlling the error of pre-analysis. Laboratories can improve the testing efficiency of instrument by means of rationally configuring instruments and optimizing testing process,which may help to shorten turn-around time（TAT）.

Key words: Emergency test, Testing efficiency, Testing process, Serum index

中图分类号:

R446.1

葛丹红, 方慧玲, 林斐然, 朱宇清. 模拟急诊生化标本不同仪器检测效率比较[J]. 检验医学, 2022, 37(8): 766-771.

Danhong , FANG Huiling, LIN Feiran, ZHU Yuqing. Comparison of testing efficiency of simulated emergency biochemical samples among different instruments GE[J]. Laboratory Medicine, 2022, 37(8): 766-771.

图/表 5

参考文献 10

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标本编号	顺序1	顺序2
1	肝功能	肾功能
2	肾功能	肝功能
3	肝功能、肾功能、心肌酶	全部常规化学项目
4	全部常规化学项目	淀粉酶
5	电解质、钙、葡萄糖	肝功能、肾功能、心肌酶
6	淀粉酶	全部常规化学项目
7	全部常规化学项目	肝功能、肾功能
8	肝功能、肾功能、葡萄糖	电解质、肾功能
9	电解质、肾功能	肝功能、肾功能、葡萄糖
10	肝功能、肾功能	全部常规化学项目
11	肝功能、肾功能	电解质、钙、葡萄糖
12	电解质、肾功能	肝功能
13	肝功能、肾功能、葡萄糖	肝功能、肾功能
14	全部常规化学项目	电解质、肾功能
15	淀粉酶	肝功能、肾功能、葡萄糖
16	肝功能	电解质、钙、葡萄糖
17	肝功能、肾功能、葡萄糖	全部常规化学项目
18	肝功能、电解质、钙	肝功能、肾功能、葡萄糖
19	电解质、钙、葡萄糖	淀粉酶
20	全部常规化学项目	肝功能、电解质、钙

标本编号	顺序1	顺序2
1	肝功能	肾功能
2	肾功能	肝功能
3	肝功能、肾功能、心肌酶	全部常规化学项目
4	全部常规化学项目	淀粉酶
5	电解质、钙、葡萄糖	肝功能、肾功能、心肌酶
6	淀粉酶	全部常规化学项目
7	全部常规化学项目	肝功能、肾功能
8	肝功能、肾功能、葡萄糖	电解质、肾功能
9	电解质、肾功能	肝功能、肾功能、葡萄糖
10	肝功能、肾功能	全部常规化学项目
11	肝功能、肾功能	电解质、钙、葡萄糖
12	电解质、肾功能	肝功能
13	肝功能、肾功能、葡萄糖	肝功能、肾功能
14	全部常规化学项目	电解质、肾功能
15	淀粉酶	肝功能、肾功能、葡萄糖
16	肝功能	电解质、钙、葡萄糖
17	肝功能、肾功能、葡萄糖	全部常规化学项目
18	肝功能、电解质、钙	肝功能、肾功能、葡萄糖
19	电解质、钙、葡萄糖	淀粉酶
20	全部常规化学项目	肝功能、电解质、钙

干扰物质	目测结果				平均符合率/%
干扰物质	甲	乙	丙	丁	平均符合率/%
血红蛋白					100
0.509 g/L	+	+	+	+
1.527 g/L	+	+	+	+
2.545 g/L	+	+	+	+
3.563 g/L	+	+	+	+
4.581 g/L	+	+	+	+
胆红素F					48
32.85 μmol/L	-	-	-	-
98.55 μmol/L	-	+	-	-
164.25 μmol/L	-	+	-	-
229.95 μmol/L	+	+	-	+
295.65 μmol/L	+	+	+	+
乳糜					76
164 FTU	-	+	-	-
492 FTU	-	+	+	-
820 FTU	+	+	+	+
1 148 FTU	+	+	+	+
1 476 FTU	+	+	+	+

干扰物质	目测结果				平均符合率/%
干扰物质	甲	乙	丙	丁	平均符合率/%
血红蛋白					100
0.509 g/L	+	+	+	+
1.527 g/L	+	+	+	+
2.545 g/L	+	+	+	+
3.563 g/L	+	+	+	+
4.581 g/L	+	+	+	+
胆红素F					48
32.85 μmol/L	-	-	-	-
98.55 μmol/L	-	+	-	-
164.25 μmol/L	-	+	-	-
229.95 μmol/L	+	+	-	+
295.65 μmol/L	+	+	+	+
乳糜					76
164 FTU	-	+	-	-
492 FTU	-	+	+	-
820 FTU	+	+	+	+
1 148 FTU	+	+	+	+
1 476 FTU	+	+	+	+

仪器	每日维护保养内容	时间/min
A	加样针维护,清空废物容器,取出过期试剂和空试剂盒,检查和清洁标本架和适配器,清洁信号试剂分配喷嘴,电解质参比液维护,免疫清洗液维护	13
B	空气排空,试剂灌注,孵育池水更换,光度计检查,电解质模块冲洗,探针清洗,管路冲洗,排放废液桶中的废液,清洗废液排出单元	21
C	空气排空,试剂灌注,孵育池水更换,光度计检查,电解质模块冲洗,清洗探针、喷嘴和搅拌棒,排放废液桶中的废液,清洗废液排出单元	35