摘要目的:通过分析比较生化免疫流水线安装前后，急诊检验样本检测流程及样本周转时间等变化，探讨生化免疫流水线在急诊检验中的应用价值。方法:收集同济大学附属同济医院检验科2017年7至9月及2018年7至9月急诊生化和免疫检测项目的运行数据，开展回顾性研究。（1）比较流水线安装前后，急诊检验样本流转方式及其流程的变化。（2）统计分析流水线安装前后急诊检验的样本检测周转时间变化及分布情况。（3）统计比较安装前后仪器间样本检测量分配情况及故障发生情况。（4）分别对安装前后急诊检验样本检测过程进行生物安全风险评估，分析流水线安装对急诊检验生物安全控制的影响。结果:（1）流水线的应用有效优化控制了样本检测流程，减少了人工参与。（2）安装后各报告的样本检测周转时间较安装前均有大幅度的缩短，急诊的干式生化及心肌酶谱报告的TAT由分别由安装前的39 min及48 min缩短到安装后的34 min及42 min，分别缩短12.82%和12.50%；住院急诊的干式生化及心肌酶谱报告的TAT由分别由安装前的37 min及43 min缩短到安装后的29 min及35 min，分别缩短21.62%和18.60%；分析比较各报告TAT的分布情况，处于0~30 min及31~45 min的报告比例较安装前有明显的提升。急诊和住院急诊的干式生化报告TAT处于0~45 min的比例分别由安装前的72.68%及80.30%提高到安装后的84.70%及86.56%；急诊和住院急诊的心肌酶谱报告TAT处于0~45 min的比例分别由安装前的57.91%及78.28%提高到安装后的74.58%及85.66%。（3）两台VITROS5600样本检测比例分别由安装前的30.29%和69.71%变为安装后的47.63%和52.37%；两台DXI800样本检测比例由安装前的28.77%和71.23%变为安装后的53.49%和46.51%，仪器间样本检测量的平衡趋于合理。各仪器故障发生次数显著减少，两台VITROS5600由安装前的平均每月3.5次/台下降为安装后的平均每月2次/台，两台DXI800由安装前的平均每月2.8次/台下降为安装后的平均每月1.8次/台。（4）流水线的安装降低了急诊检验样本检测过程中发生生物安全事件的风险，其中检测前意外接触样本管气溶胶和检测中生物标本倾翻溢出意外接触两个风险构成均由安装前的高水平降为安装后的低水平。结论:生化免疫流水线的应用改进了急诊检验的流程，提高了检验科室的工作效率，缩短了样本检测的周转时间，降低了生物安全的风险。

abstractsObjective:To explore the application value of biochemical and immunological assembly line in emergency test by comparatively analyzing the changes in sample test process and turnaround time (TAT) in emergency test before and after installation of the assembly line.Methods:A retrospective study was performed with the run data of the emergency biochemical and immunodetection project in Department of Clinical Laboratory in Tongji Hospital Affiliated to Tongji University from July to September in 2017 and from July to September in 2018. (1)The changes in sample circulation mode and test process were compared in emergency test before and after installation of the assembly line.(2)The changes in TAT of sample test and distribution of time interval in emergency laboratory report were statistically analyzed before and after installation.(3)The number of samples tested between instruments and occurrence of instrument failure were statistically compared before and after installation. (4)Biosafety risk assessment was performed on the sample test process before and after installation to analyze the effects of the assembly line installation on biosafety control in emergency test.Results:(1) By applying the assembly line, the sample test process was well controlled and the workload for laboratorians was eased greatly through reduction of manual work.(2) Report TAT was remarkably shortened after installation compared to that before installation; the TAT of dry biochemistry and myocardial zymogram report in emergency test was shorted from 39 min and 48 min to 34 min and 42 min respectively, with a reduction of 12.82% an 12.50% compared to those before installation; the TAT of dry biochemistry and myocardial zymogram report in inpatient emergency was shorted from 37 min and 43 min to 29 min and 35 min respectively, with a reduction of 21.61% an 18.60% compared to those before installation; distribution of report TAT was comparatively analyzed, the percentage of reports in 0-30 min and 31-45 min increased remarkably compared to that before installation, the percentage of TAT of dry biochemistry report falling into 0-45 min increased to 74.58% and 85.66% after installation from 57.91% and 78.28% before installation, respectively in emergency and inpatient emergency. (3)For the model VITROS5600, the percentage of samples tested changed from 30.29% and 69.71% before installation to 47.63% and 52.37% after installation, respectively; for the model DXI800, the percentage of samples tested changed from 28.77% and 71.23% before installation to 53.49% and 46.51% after installation, respectively. After installation, there was a tendency of balance in the number of samples tested between instruments. Instrument failure was significantly reduced: for the model VITROS5600, the frequency of instrument failure decreased from 3.5 times a month/instrument before installation to 2 times a month/instrument after installation on average; for the model DXI800, the frequency of instrument failure decreased from 2.8 times a month/instrument before installation to 1.8 times a month/instrument after installation on average.(4) Installation of the assembly line lowered the risks biosafety events in sample test process in emergency test and the two risks of accidental contact with aerosol in sample tubes before detection and accidental contact with biological specimen due to overturning and spilling during detection were reduced from a high level before installation to a low level after installation.Conclusion:In emergency test, biochemical and immunological assembly line is of certain value in process improvement, reduction of workload for laboratorians, improvement of work efficiency, TAT reduction and optimization, as well as control of biosafety conditions.