Lima-Oliveira Gabriel, Guidi Gian Cesare, Salvagno Gian Luca, Brocco Giorgio, Danese Elisa, Lippi Giuseppe
Laboratory of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Laboratory of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Clin Biochem. 2016 Dec;49(18):1364-1367. doi: 10.1016/j.clinbiochem.2016.07.007. Epub 2016 Jul 19.
An experimental study was planned to assess the influence on routine clinical chemistry parameters of fist making prior to, and maintenance during, venipuncture.
Blood was collected from 16 healthy volunteers with two separate sequential procedures, entailing standard venipuncture with hand opened throughout blood collection, or clenching the fist 6 times before venipuncture and maintaining the fist until completion of blood collection. After separation of lithium-heparin plasma at vacuum tubes with gel separator, 28 routine clinical chemistry parameters and serum indices were measured on Roche Cobas 6000 〈c501〉 module.
Fist clenching and maintaining were associated with significant variations of 8/26 (31%) analytes tested. Specifically, aspartate aminotransferase (+2.3%), calcium (+2.2%), chloride (+1.0%), creatine kinase (+2.0%), magnesium (+2.3%), potassium (+13.4%), and sodium (+0.7%) increased, whereas phosphate (-5.0%) decreased. All variations except aspartate aminotransferase and creatine kinase exceeded the quality specifications for desirable imprecision. A remarkable increase of free hemoglobin in plasma (i.e., +28.2%) was also observed. The ratio of plasma potassium was significantly associated with that of plasma CK (r=0.55; p=0.029), but not with variations of other analytes. No significant correlation was observed between the ratio of free hemoglobin and those of other analytes.
The results of our investigation demonstrate that repeated clenching and maintenance of fist during venipuncture may trigger acute variations of several routine clinical chemistry parameters, which may be attributable to muscle contraction, hemolysis or both. Accordingly, venipuncture should be performed avoiding fist clenching and maintenance.
计划进行一项实验研究，以评估静脉穿刺前握拳及穿刺过程中持续握拳对常规临床化学参数的影响。
采用两种不同的连续程序从16名健康志愿者身上采集血液，一种是在整个采血过程中手保持张开状态进行标准静脉穿刺，另一种是在静脉穿刺前握拳6次并在采血完成前一直保持握拳状态。在使用带有凝胶分离器的真空管分离锂肝素血浆后，在罗氏Cobas 6000〈c501〉模块上测量28项常规临床化学参数和血清指标。
握拳及持续握拳与所检测的26项分析物中的8项（31%）显著变化相关。具体而言，天冬氨酸转氨酶（+2.3%）、钙（+2.2%）、氯（+1.0%）、肌酸激酶（+2.0%）、镁（+2.3%）、钾（+13.4%）和钠（+0.7%）升高，而磷酸盐（-5.0%）降低。除天冬氨酸转氨酶和肌酸激酶外，所有变化均超出了理想不精密度的质量规范。还观察到血浆中游离血红蛋白显著增加（即+28.2%）。血浆钾的比率与血浆肌酸激酶的比率显著相关（r=0.55；p=0.029），但与其他分析物的变化无关。游离血红蛋白的比率与其他分析物的比率之间未观察到显著相关性。
我们的研究结果表明，静脉穿刺过程中反复握拳及持续握拳可能引发多项常规临床化学参数的急性变化，这可能归因于肌肉收缩、溶血或两者兼有。因此，静脉穿刺应避免握拳及持续握拳。
