静脉采血时握拳时间过长导致假性高钾血症2例及文献复习  

Two Cases of Pseudohyperkalemia Caused by Prolonged Fist ClenchingDuring Venous Blood Collection and Related Literature Review

作　　者：贾秋桦 侯立安[1] 程倩[1] 张颖[1] 刘荔[1] 苏玉君[1] 刘欣[1] 梁小悦 李洪雷[1] 夏良裕[1] JIA Qiuhua;HOU Li’an;CHENG Qian;ZHANG Ying;LIU Li;SU Yujun;LIU Xin;LIANG Xiaoyue;LI Honglei;XIA Liangyu(Department of Clinical Laboratory,Peking Union Medical College Hospital,Peking Union Medical College&Chinese Academy of Medical Science,Beijing 100730,China;Department of Clinical Laboratory,Linyi Maternal and Child Health Hospital,Linyi 276000,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院检验科,北京100730 [2]临沂市妇幼保健院检验科,山东临沂276000

出　　处：《标记免疫分析与临床》2023年第10期1663-1666,共4页Labeled Immunoassays and Clinical Medicine

基　　金：中央高水平医院临床科研专项(编号:2022-PUMCH-B-073)。

摘　　要：目的 通过分析两例血钾增高患者的临床表现和实验室结果特点,为识别采血过程中握拳导致的假性高钾血症及促进规范采血过程提供依据。方法 查阅患者病历并与患者、采血护士、医生进行沟通确认高钾与临床表现的符合性及采血过程中的影响因素;进行握拳试验、检测同时采集的多个样本分析血钾的连续变化特点;查阅文献并结合前述结果进行综合分析。结果 1例为糖尿病患者,肾功正常。在采血过程中全程紧握拳头。行握拳试验结果为:不握拳采样血钾为4.5mmol/L,握拳1min立即采样血钾为5.1mmol/L。另一患者因身材矮小就诊,无高钾血症相关病因及临床表现。该患者同一时间采集的6个血清管样本血钾结果由5.4mmol/L升高到6.2mmol/L。2例患者均排除样本溶血、输液、容器错误、高白细胞、高血小板、样本保存与处理不当等导致血钾增高的因素。结论 采血时握拳时间过长可导致假性高钾血症,在临床工作应注意鉴别,并通过规范采血过程避免此类问题。Objective To provide evidences for identifying pseudohyperkalemia caused by fist clenching during blood collection and promoting standardized blood collection procedures by analyzing the clinical manifestations and laboratory results of two patients with elevated blood potassium.Methods We consulted patients’medical record and communicated with the selected patients,nurse,and physician to confirm the consistency between high potassium and clinical manifestations,as well as the influencing factors during the blood collection process.We then conducted a fist-clench test and detected multiple samples collected simultaneously to analyze the continuous changes in blood potassium.We also conducted a comprehensive analysis based on literature review and the aforementioned results.Results Case 1 was a diabetic patient with normal renal function.He had been clenching his fist tightly throughout the blood collection process.The results of the fist-clenching test were as following:the blood potassium was 4.5 mmol/L before clenching the fist and 5.1 mmol/L when clenched for 1 minute.Another patient was diagnosed with short stature and had no cause or clinical manifestation of hyperkalemia.The blood potassium results of the six serum tube samples collected from the patient at the same time showed an increasing trend,from 5.4mmol/L to 6.2mmol/L.Both patients were excluded from factors that could lead to elevated blood potassium,such as sample hemolysis,infusion,container error,high white blood cell count,high platelet count,and improper sample storage and handling.Conclusion Clenching fist for too long during blood collection can lead to pseudohyperkalemia,which should be identified in clinical practice and avoided by standardizing the blood collection process.

关 键 词：假性高钾血症 握拳 静脉采血 

分 类 号：R446.11[医药卫生—诊断学]