推荐回答（1个）
标本溶血，也就是血液标本里面的红细胞发生了破坏，红细胞里面的内容物释放到了外面。在这种情况下，很多检查项目将会受到不同程度的影响，甚至会造成结果的严重不准确。因此，这种时候往往需要重新留取标本。
溶血是临床检验医学血标本中经常出现的一种现象。为了了解溶血对检验结果的干扰和影响,本文就20份非溶血、溶血的生化检验结果进行比较,分析溶血对生化检验结果的影响及其对策。
抽取体检者正常的20份血液标本,其血清无肉眼可见的黄疸、脂浊和溶血。分别置于2支试管中,每支2.5 ml,其中1支室温自然分离,3 min后以1200 r/min离心10 min分离血清,取1 ml血清作为正常血清备用;另1支试管中的标本采用人工方法使其溶血,然后以相同条件离心,分离溶血血清后备用,整个过程在2 h内完成。
结果显示溶血血清ALT、AST、LDH、K、CHO测定结果明显高于正常血清(P小于0.05), ALP的活性随溶血而降低(P小于0.05),溶血对BUN、Cr、TG、GLU、UA测定结果影响较小,正常血清与溶血血清差异无统计学意义(P大于0.05)。
此结果表明,样本溶血几乎影响所有生化检验结果的准确性。所以,无论是临床护士、医生及检验工作者均应给样本溶血问题以足够的重视。本实验结果表明,标本溶血后酶浓度的变化极为显著,酶对标本的要求比其他生化检验项目的要求都要高,因此在日常工作中标本溶血后不适宜再对酶类进行测定。另外血清K受溶血后影响较大,CHO其次,而溶血对蛋白类、Na、Cl-、Ca2、TG、GLU、BUN、Cr、UA等的影响十分有限。
溶血对不同检验项目结果的影响机制不同,主要表现为以下几个方面：细胞内外成分浓度差的干扰,细胞内含量高的血红蛋白、酶类、离子、有机物等,溶血后细胞内的物质顺浓度差溢出,使测得值明显高于非溶血标本;相反,红细胞内浓度极低的物质,如脂蛋白、胆固醇酯、钠等随溶血,细胞内液对血清的稀释作用,使测定结果明显下降;细胞内、外液成分之间反应的干扰;有色物质对吸收光谱的干扰,造成吸光度和散光度产生较大的误差,当被测溶液的颜色与有色物质的颜色接近时发生正干扰,而与有色物质的颜色相差较远时产生负干扰;溶血标本中血红素中的正铁离子,可被试剂中的氧化剂(如亚硝酸钠)氧化成为黄色的高铁血红素,对两点比色法造成干扰;在血清总胆固醇CHODPAP终点法中,Hb高于2 g/L时会引起正干扰;在磷的测定中,溶血标本中红细胞内磷酸酯被水解,使无机磷增加。
预防溶血，则要掌握采集血样本的正确方法。临床采血多选用肘正中静脉或贵要静脉,婴幼儿多选用颈外静脉或股静脉,避免选择过细的静脉,更不要从输液管处抽血。严格按照操作规程办事。妥善保存样本。样本送入检验科后,应放在室温下保存,以防发生溶血。在血样本的运输过程中,防止过度振荡而发生溶血。严把注射器及试管的质量关。严格掌握一次性注射器、一次性试管的进货渠道,杜绝有不合格产品流入市场和医疗单位,保证检验结果的准确性,减少患者不必要的经济负担和痛苦。了解溶血会引起一些生化项目结果假性升高或降低对检验医师减少失误和误差,提高检验结果的准确性,更好地服务于临床有着重要的意义。在工作中一旦发现明显的标本溶血,立即采取相应的措施,如重新采集标本或对溶血程度较轻的标本结果进行校正,尤其是随着全自动生化分析仪的普及使用,检查血清标本外观有否溶血已成为试验过程中质控的重要一环。
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