血栓弹力图检测结果的影响因素与 质控实践探讨——基于朔城区人民医院检验科数据的分析

Study on Influencing Factors and Quality Control Practices for Thromboelastography Test Results—An Analysis Based on Data from Department of Clinical Laboratory of Shuocheng District People’s Hospital

摘要: 目的：系统探讨血栓弹力图(TEG)检测结果的影响因素，结合临床实践制定针对性质量控制措施，提升检测准确性，为临床个体化抗血栓治疗提供可靠依据。方法：回顾性分析2024年1月至2025年3月本院210例TEG检测报告，从标本、患者自身、药物、仪器试剂、操作环境五个维度分析各因素对R值、K值、α角、MA值及血小板抑制率的干扰机制，采用多因素Logistic回归识别独立危险因素。结果：不合格标本检出率6.2%，以采血量不准、溶血、送检超时为主；患者年龄、妊娠、血小板功能疾病显著影响基线值；仪器未校准或试剂保存不当可致MA值变异系数 > 10%；操作不规范占误差的15.3%。多因素分析显示，采血量偏差(OR = 9.06)、送检超时(OR = 5.00)、服药信息缺失(OR = 4.00)及新手操作(OR = 3.66)是独立危险因素。实施全流程质控后，复检率从8.5%降至3.2%，临床满意度升至94.5%。结论：TEG-PM检测结果受多重因素显著影响，建立覆盖检测前、中、后的全程质控体系，并强化检验与临床的主动沟通，是保障检测精准性、发挥其临床价值的关键。

Abstract: Objective: To systematically investigate the factors influencing thromboelastography (TEG) test results, and to develop targeted quality control measures based on clinical practice, thereby improving test accuracy and providing a reliable basis for individualized antithrombotic therapy. Methods: A retrospective analysis was conducted on 210 TEG reports from our hospital between January 2024 and March 2025. Interference mechanisms of various factors on R value, K value, α angle, MA value, and platelet inhibition rate were analyzed across five dimensions: specimen characteristics, patient-related factors, medications, instruments and reagents, and operational environment. Multivariate Logistic regression was used to identify independent risk factors. Results: The detection rate of unqualified specimens was 6.2%, primarily due to inaccurate blood collection volume, hemolysis, and delayed submission. Patient age, pregnancy, and platelet function disorders significantly influenced baseline values. Failure to calibrate instruments or improper reagent storage resulted in a coefficient of variation for MA value exceeding 10%. Operator errors accounted for 15.3% of total inaccuracies. Multivariate analysis identified deviations in blood collection volume (OR = 9.06), delayed submission (OR = 5.00), missing medication information (OR = 4.00), and operation by inexperienced staff (OR = 3.66) as independent risk factors. Following implementation of a full-process quality control protocol, the retest rate decreased from 8.5% to 3.2%, and clinical satisfaction increased to 94.5%. Conclusion: TEG-PM test results are significantly influenced by multiple factors. Establishing a comprehensive quality control system covering pre-analytical, analytical, and post-analytical phases, along with strengthened proactive communication between the laboratory and clinical departments, is essential to ensure test accuracy and maximize its clinical value.