The internal management of critical value

doi:10.3877/cma.j.issn.2095-5820.2018.01.012

Abstract

Abstract:

The reporting of clinical values are directly related to the life safety of patients, involving in laboratory, information department and clinician. Selecting the items of clinical values and alert limits of the test results, establishing the critical value reporting system and modifying the laboratory information system is the key to accurate reports and medical security.

Key words: Critical value, Quality of care, Laboratory information management

Hangqi Liu, Mei Jia. The internal management of critical value[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2018, 06(01): 47-51.

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项目	危急低值	危急高值	依据
pH	≥7.55	≤7.20	1.美国病理家学会对623家医疗机构的统计结果
?	?	?	2. 《临床实验诊断学---实验结果的应用和评估》
?	?	?	3.经临床广泛评定并认可
血钾(K)	≥6.0 mmol/L	≤2.8 mmol/L	1.美国病理家学会对623家医疗机构的统计结果 2. 《临床实验诊断学---实验结果的应用和评估》等参考文献 3.征求临床心内科、呼吸内科医生意见；经临床广泛评定并认可
血钙(Ca)	≥3.4 mmol/L	≤1.5mmol/L儿科除外
血钠(Na)	≥160 mmol/L	≤120 mmol/L
空腹血糖(Glu)	≥ 25 mmol/L	≤2.5 mmol/L新生儿<2.2 mmol/L
总胆红素(婴儿)	≥342 μmol/L	—
国际标准化比值(INR)	≥4	—	根据国际权威的抗栓治疗指南ACCP8：INR>4以上出血风险增加，可能导致患者死亡
活化部分凝血活酶时间(APTT)	≥150 s	—	临床实验室所确建立APTT和肝素浓度的关系为，治疗计量的肝素浓度在0.4-0.6 U/ml，对应0.6 U/ml肝素的APTT浓度是150 s，这是药物剂量的上限，过量肝素导致APTT延长出血
纤维蛋白原(FIB)	—	≤0.8 g/L	1. 《血栓与止血学》第三版，纤维蛋白原低于1 g/L出血风险增加，但是征求临床科室意见后，将标准定在0.8 g/L 2.经临床广泛评定并认可
血红蛋白(HGB)	成人≥200 g/L	成人≤50 g/L	参照第六版人卫版内科学成人贫血标准
血小板(PLT)	≥1000X10⁹/L	≤20X10⁹/L	参照第六版人卫版内科学：血小板<2万自发出血，血小板>100万，血栓风险。医保输血小板标准2万，产科学：5万血小板保证分娩
白细胞(WBC)	≥30X10⁹/L	≤2.0X10⁹/L	1.血液科主任建议，患者WBC低于2千患者感染风险很大。大于3万应考虑类白血病反应和白血病 2.经临床广泛评定并认 3.由于血液科患者及治疗的特殊性，其血常规危急值不上报
血液、心包液、脑脊液涂片镜检	见到细菌或真菌	—	1.参考《医学实验室质量和能力认可准则ISO1518(临床微生物检验领域的应用说明)》 2.经临床广泛评定并认可
血液、心包液、脑脊液细菌或真菌培养	阳性	—	1.参考《医学实验室质量和能力认可准则ISO1518(临床微生物检验领域的应用说明)》 2.经临床广泛评定并认可

项目	危急低值	危急高值	依据
pH	≥7.55	≤7.20	1.美国病理家学会对623家医疗机构的统计结果
?	?	?	2. 《临床实验诊断学---实验结果的应用和评估》
?	?	?	3.经临床广泛评定并认可
血钾(K)	≥6.0 mmol/L	≤2.8 mmol/L	1.美国病理家学会对623家医疗机构的统计结果 2. 《临床实验诊断学---实验结果的应用和评估》等参考文献 3.征求临床心内科、呼吸内科医生意见；经临床广泛评定并认可
血钙(Ca)	≥3.4 mmol/L	≤1.5mmol/L儿科除外
血钠(Na)	≥160 mmol/L	≤120 mmol/L
空腹血糖(Glu)	≥ 25 mmol/L	≤2.5 mmol/L新生儿<2.2 mmol/L
总胆红素(婴儿)	≥342 μmol/L	—
国际标准化比值(INR)	≥4	—	根据国际权威的抗栓治疗指南ACCP8：INR>4以上出血风险增加，可能导致患者死亡
活化部分凝血活酶时间(APTT)	≥150 s	—	临床实验室所确建立APTT和肝素浓度的关系为，治疗计量的肝素浓度在0.4-0.6 U/ml，对应0.6 U/ml肝素的APTT浓度是150 s，这是药物剂量的上限，过量肝素导致APTT延长出血
纤维蛋白原(FIB)	—	≤0.8 g/L	1. 《血栓与止血学》第三版，纤维蛋白原低于1 g/L出血风险增加，但是征求临床科室意见后，将标准定在0.8 g/L 2.经临床广泛评定并认可
血红蛋白(HGB)	成人≥200 g/L	成人≤50 g/L	参照第六版人卫版内科学成人贫血标准
血小板(PLT)	≥1000X10⁹/L	≤20X10⁹/L	参照第六版人卫版内科学：血小板<2万自发出血，血小板>100万，血栓风险。医保输血小板标准2万，产科学：5万血小板保证分娩
白细胞(WBC)	≥30X10⁹/L	≤2.0X10⁹/L	1.血液科主任建议，患者WBC低于2千患者感染风险很大。大于3万应考虑类白血病反应和白血病 2.经临床广泛评定并认 3.由于血液科患者及治疗的特殊性，其血常规危急值不上报
血液、心包液、脑脊液涂片镜检	见到细菌或真菌	—	1.参考《医学实验室质量和能力认可准则ISO1518(临床微生物检验领域的应用说明)》 2.经临床广泛评定并认可
血液、心包液、脑脊液细菌或真菌培养	阳性	—	1.参考《医学实验室质量和能力认可准则ISO1518(临床微生物检验领域的应用说明)》 2.经临床广泛评定并认可

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