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静脉血常规与末梢血常规采集的区别\n\n如此看来，你是否直观地认为静脉血常规比末梢血常规更准确，可以替代末梢小弟弟了？\n[img:9269920958921572864]\n解误一：与其纠结静脉血常规还是末梢血常规准确，不如正确地选择使用。\n\n虽然日常医生开具静脉血常规还是末梢血常规有病情等的评判，但一定要敲敲黑板的是，他们各自也有独立于世的“生存法则”。\n\n各领风骚，各显其能。需要注意的是，这对兄弟还是“偏科选手”，血常规的部分项目交出的答卷大不相同。楚河汉界，亲兄弟也要明划分，让我来把他们分麾竖旗（图2）。\n\n图2 静脉血常规与末梢血常规结果数值区别\n\n哥哥静脉血常规数值高的有：淋巴细胞百分比、淋巴细胞绝对值、嗜碱性粒细胞绝对值、嗜碱性粒细胞百分比、平均红细胞体积和血小板计数。\n\n[img:9269920958977147392]弟弟末梢血常规数值高的有：中性粒细胞百分比、中性粒细胞绝对值、红细胞计数、血红蛋白、红细胞比容、平均红细胞血红蛋白含量、平均红细胞血红蛋白浓度、网织红细胞百分比、网织红细胞绝对值、高荧光强度网织红细胞百分比和网织红细胞血红蛋白含量。\n\n究其原因，主要是末梢采血时皮肤挤压、局部血液浓缩、血小板活化聚集及血浆外渗有关。因此，本着充分发挥各自专长且就低不就高的原则，窥探一下医生选择开单的“葵花宝典”：第一式为长期监测单一指标，仅选用其中一种血常规检测，尤其是血液肿瘤患者。第二式为贫血疾病诊疗，优选静脉血常规并同时检测网织红细胞。第三式为血小板数量、形态问题，优选末梢血并同时增加手工计数血小板（图3）。\n\n图3 选择静脉血常规与末梢血常规检测的原则\n\n什么？儿童也采静脉血常规，成人也能采末梢血常规？你搞错了吧？少安毋躁，因为你又走入另一个认知误区。\n[img:9269920959001264640]\n解误二：不是只有儿童可以采末梢血，末梢血和静脉血只是采集方式不同，没有年龄限制。\n\n小弟末梢血常规，量小速度快，多是家长眼中“小可爱”；加之儿童的血管相对较细，静脉采血有一定挑战，因此在儿科普遍使用。但，查询“家产”后发现，现行儿童血常规分析标准，是有静脉血与末梢血常规两版参考区间的。而成人末梢组织紧凑，挤压过程中血浆外渗更多干扰结果，因此成人多首选哥哥静脉血常规。\n\n那什么是干扰因素，又有哪些需要留心？干扰因素就是影响检测结果至关重要的环节。首先，饮食不会影响结果，不用刻意饿肚子。其次，所有人为影响结果的因素都应该避免。为保证兄弟俩状态良好，建议在静止或平缓运动、情绪平静5分钟后再采血，若激烈运动后或情绪过激，至少平静30分钟后再采血。\n[img:9269920959024857600]\n对了，弟弟末梢血常规还有点“小脾气”。采血前，若非指尖过脏、抓食后，不要洗手降温增加出血困难；不要揉搓指尖，增加血浆外渗机会。洗手后，需要完全拭干，非揉搓恢复手温10分钟后再采血。\n\n兄长静脉血常规就没有脾气，从哪里采血都可以。怎么可能？\n\n解误三：手上有输液留置针或手臂埋输液港，是不能从中直接抽取静脉血的。\n\n输液留置针或输液港常有输注药物残留或注入液体封闭管路，这些物质会严重影响血常规检测结果，一般不建议被使用采血。紧急情况采用时，需要弃去2倍的采血量血液后才可采集，确保检测准确。\n\n好吧，都有性格，那就一直使用右侧采血总没错了。轻轻安慰你一下，也不是哟。\n\n[img:9269920959080956416]解误四：采血方向虽没有严格规定，但首选右侧是临床医护日常实践出的经验。\n\n大哥静脉血常规首选右侧手臂采集，完全是方便右力手操作的护士采集，也利于辅助者按扶。而小弟末梢血常规首选无名指，主要是他“懒”。主动使用率低，误触伤口概率小。因此，末梢采血通常优选无名指，次选中指。当然，右手也比左手好握，好操作。\n\n另外两点绝对细听：同一天再次取血时，不论末梢还是静脉，一般会换另一侧，防止上次取血后伤口渗血或血肿。一般采血后，按压3～5分钟即可止血，若10分钟后血液仍奔涌而出，绝不能放任自流，要立即寻求医生、护士处理。\n\n既然这对兄弟都是“讲究人”，那送检也不能马虎，医生我可是一路晃着就怕凝。停，快停，防止血液凝固可不是这么“玩”的。\n\n[img:9269920959139676672]解误五：静脉血采集后要一直晃动才能防止血液凝固，这是不对的。\n\n静脉血采集后，护士会将其颠倒混匀5～8次，送检时则不需再晃，否则会人为影响结果。而导致取血凝固其实是采血“战线超长”，血液还没来得及与抗凝剂结合就“堵在路上”了。也有少数原因是个体差异，对常规抗凝剂不敏感，此时摒弃紫帽乙二胺四乙酸（EDTA）抗凝剂采血管或末梢取血管，改用蓝帽枸橼酸钠抗凝剂的采血管采血即可（图4）。\n\n图4 两种不同抗凝剂的静脉采血管\n\n带队到此，我们也算走出了“迷雾森林”。如何去看待这对兄弟，还望各位小主眼明心亮。\n\n文、图 | 王蜀平、马丽娟、池杨\n\n来源 | 医学参考报\n\n编辑 | 宣传中心 刘赫晨\n\n来源：北京号\n\n作者: 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