新鲜抗凝血在血细胞分析仪室间比对中的应用评估

目的使用新鲜抗凝血对不同实验室间的血细胞分析仪进行比对,使检测结果具有可比性。方法以武警广东省总队医院检验科Sysmex XE-2100血细胞分析仪(简称XE-2100)为参照检测系统,广州市干部疗养院检验科Sysmex XT-1800i血细胞分析仪(简称XT-1800i)为比对检测系统,每天从临床标本中选择WBC、RBC、Hb、HCT和PLT的低、中、高值标本各1支,对比两台血细胞分析仪的检测结果,计算相对偏差。结果 WBC中值、Hb高值、HCT中值和高值、PLT中值和高值标本XT-1800i的检测结果低于XE-2100(P<0.05),Hb低值标本XT-1800i的检测结果高于XE-2100(P<0.05),其它标本两台血细胞分析仪的结果基本一致(P>0.05);两个比对系统间五个项目的检测结果偏差符合CLIA’88能力验证分析质量要求,其中RBC、Hb、HCT的相对偏差范围较小,而WBC和PLT的相对偏差范围较大。WBC、RBC、PLT三水平间的相对偏差结果一致(P>0.05),Hb、HCT三水平间的相对偏差结果存在差异(P<0.05)。结论新鲜抗凝血可以用于不同实验室间血细胞分析仪的比对,具有可操作性,且经济方便。     

多台血细胞分析仪检测结果可比性分析

目的运用患者新鲜全血比对试验对本室3台血细胞分析仪间进行可比性探讨分析,以便进一步加强质量控制,保证临床实验报告的准确性。方法每周定期进行1次,选取含高、中、低值患者新鲜全血标本5个,分别在XE-2100(新机)、XE-2100(旧机)和XS-800i3台血细胞分析仪上进行白细胞(WBC)、血小板(PIT)、红细胞(RBC)、血红蛋白(HGB)、红细胞比积(HCT)、血小板(PLT)5个项目的检测,测定的结果以美国临床实验室修正法案(CLIA'88)规定的室间质量评价允许误差的1/2为标准进行比较。结果不同仪器之间相同检测项目结果的相关系数(r)均在0.975～1.000之间,P>0.05,表示有很好的相关性及无明显差异。结论 XE-2100新、旧血细胞分析仪和XS-800i血细胞分析仪检测结果具有可比性,其偏差均在可接受范围内,因此3台仪器在临床应用中可以相互交替使用而不影响结果的一致性。     

医疗机构内不同血细胞分析仪的结果比对与溯源性评价

目的对某医院内不同血细胞分析仪进行结果比对和室内质量控制,探讨结果可比性和溯源性。方法按照美国实验室标准化委员会(NCCLS)EP9-A2文件要求,以多次取得全国质控优秀成绩的XT-2000i血细胞分析仪为参考仪器,XT-1800i血细胞分析仪和MEK-6318K血细胞分析仪为测试仪器,每天随机选取高、中、低值患者标本8例,共分析5 d,来评价白细胞(WBC)、红细胞(RBC)、血小板(PLT)、血红蛋白(HGB)、红细胞比积(HCT)的结果,计算回归方程和相关系数,评估结果之间的可比性。结果3种仪器检测的WBC、RBC、PLT、HGB和HCT检测结果经F检验差异无统计学意义(P>0.05);各参数测定结果之间相关性密切(r≥0.975),一致性良好;偏差在允许范围内。结论实验室使用两个以上检测系统检测同一项目时,应每天进行室内质量控制,定期进行不同检测系统间结果比对和溯源性评估,对结果偏差进行校正,确保结果的准确性。     

不同血液分析仪检测结果比对及临床可接受性评价

目的:探讨不同血液检测系统间同种项目测定结果的可比性。方法:以ABX PENTRA 120血细胞分析仪,原装配套试剂、校准品和质控品组成的检测系统为比较仪器,迈瑞BC-5800为实验仪器,用患者的新鲜抗凝全血分别在两台仪器上对白细胞计数(WBC)、红细胞计数(RBC)、血红蛋白浓度(Hb)、血小板计数(PLT)、红细胞压积(HCT)进行检测,计算相关系数和直线回归方程,对两台仪器之间进行方法学比对和可接受范围评价。结果:WBC、RBC、Hb、PLT、HCT在两台仪器间测定结果无显著性差异,均低于1/3 CLIA'88规定的允许误差范围。结论:方法学比对和可接受范围评价结果表明,两台仪器结果具有可比性。     

两种血细胞分析仪检测结果比较

目的:比较两种血细胞分析仪检测结果。方法:选取医院同实验室型号分别为希森美康xe5000(年使用次数为35 800人次)、迈瑞BC-6800(年使用次数为29 000人次)为研究对象,检测项目包括白细胞(WBC)、红细胞(RBC)、血红蛋白(Hb)、红细胞比容(HCT)、血小板(PLT),比较两台血细胞分析仪检测结果的精准度。结果:经空白样本校准后的两台仪器测定的WBC、RBC、Hb、HCT、PLT值为标准,两台仪器测定结果比较,差异有统计学意义(P<0.05),其中迈瑞BC-6800组检测水平更接近相关指标正常值。两台仪器测定的WBC、RBC、Hb、HCT、PLT值精密度均在仪器规定范围内。结论:迈瑞BC-6800型血细胞分析仪检测精准度优于希森美康xe5000型血细胞分析仪检测精准度。     

溯源性比对在血球分析仪间的实际应用

目的 为更好地提高血液分析仪的检测质量,确保检测结果的准确性和可靠性,应用新鲜全血样本对我科的二台血细胞分析仪进行比对分析,使二台血细胞分析仪检测参数之间具有可比性与溯源性.方法 参考NCCLS标准文件EP9- A2“批准指南-第二版”,以WBC、RBC、Hb、HCT、PLT等作为比对的主要项目;先对参比分析仪LH750(Beckman- Coulter公司)进行校准,并以此仪作为基准仪器,与待评仪器SYSMEX XS - 800i NO:1173进行比对分析.结果 LH750与XS - 800i NO:1173间的WBC、RBC、Hb4HCT、PLT五项指标的相关系数r＞0.975,系统误差(Bc)均小于规定的允许总误差(Ea)范围.按1/2美国CLIA88比对标准,比对前的WBC、RBC、Hb、PLT的40个出对偏倚值中,有29个值(29/40,占72.5％)在控;比对后,WBC、RBC、Hb、PLT的40个比对偏倚值中,有39个值(39/40,占97.5％)在控,检测结果的一致性得到了保证.结论 该方法能方便、经济地对不同厂家、不同型号的血液分析仪进行有效的质量控制,且具有可比性与溯源性.     

不同型号全自动血细胞分析仪检测结果的比对分析

目的对三种不同型号全自动血细胞分析仪手动与自动模式的结果进行比对,分析结果之间的偏差及相关性,提高血液标本检测的准确性。方法随机选取高、中、低值标本共40例分别在Sysmex XE-5000,Sysmex XN-2000及迈瑞BC-6800全自动血细胞分析仪进行检测,同一仪器手动与自动模式共60例新鲜全血标本进行比对,对各仪器及仪器不同模式的白细胞(WBC)、红细胞(RBC)、血红蛋白(HB)、红细胞压积(HCT)及血细胞板(PLT)结果进行相关性分析。结果检测结果均在可允许误差范围内,相关系数0.98,P0.05,Sysmex XE-5000,Sysmex XN-2000及迈瑞BC-6800检测结果无显著性差异。结论 3台不同型号血细胞分析仪检测血常规结果之间存在可比性,可交替用于检验工作。     

SYSMEX XT-2000i全血细胞分析仪的使用评价

目的对校准后的SYSMEXXT-2D00i全血细胞分析仪进行主要性能评价。方法对SYSMEXXT-2000i分别进行精密度,携带污染率．总重复性和白细胞分类重复性,线性范围（稀释效应）、仪器与人工白细胞分类此较,并与SYSMEXXE-2100全血细胞分析仪作可比性测定。结果精密度高：WBC、RBC、HGB、HCT、PLT检测的CV％均〈2％;携带污染率低：WBC、RBC、HGB、HCT、PLT的交叉污染率均〈1％;总重复性好：除PLT为2．67％外,WBC。RBC．HGB,HCT检测的CV％均（2％;线性范围好：WBC,RBC,HGB,HCT、PLT检测的相关系数接近1．0。SYSMEXXT-2000i与SYSMEXXE-2100全血细胞分析仪有很好的可比性。结论该仪器检测结果准确、可靠,主要性能指标符合实验要求。SYSMEXXT-2000i是一种较理想的全血细胞分析仪。     

同型血细胞分析仪检测结果可比性分析

目的探讨我科两台同型血细胞分析仪检测结果之间的可比性。方法重复性试验用同一标本分别在两台仪器连续检测10次,算得CV值。比对试验以检验医学中心使用的血细胞计数仪为比对试验,门诊使用的计数仪为试验仪器,每天使用6个患者的新鲜标本,先后在两台仪器进行检测(WBC、RBC、HB、HCT、PLT)5个项目,算出其相关系数及回归方程,根据美国临床实验室改进修正法案(CLIA’88)标准进行判断。结果试验仪器重复性试验除PLT外均不符合要求;比对试验除PLT不接受外,其余检测项目结果可以接受。结论如果存在同一科室同时使用两台或两台以上同型号血细胞分析仪的时候,除了应使用统一的试剂、定标及质控值外。仪器定标、校准及保养应同时进行,并且应定期进行仪器比对试验,以达到检测结果的一致性。     

采用新鲜全血比对控制ADVIA2120五分类血液分析仪质量的方法探讨

目的探讨在没有质控品的情况下用新鲜全血对ADVIA2120血液分析仪进行室内质量控制的效果。方法每天用新鲜全血标本,在经溯源至参考方法的配套校准物校准的迈瑞BC-3000 Plus三分群血液分析仪及经其定值的新鲜血校准的ADVIA2120五分类血液分析仪上测定,比对两台仪器所测主要参数白细胞(WBC)、红细胞(RBC)、血红蛋白(HGB)、血小板(PLT)、红细胞比容(HCT)、平均红细胞体积(MCV),以此作为ADVIA2120五分类血液分析仪的室内质量控制。结果两台仪器PLT平均偏差均小于10%,其他参数平均偏差小于5%。均未超过美国CLIA′88能力比对检验的分析质量要求推荐的允许误差范围,但RBC及PLT有几次超出允许误差范围,按失控处理。结论同一个实验室内不同血液分析仪用新鲜血每日比对是控制质量的可行方法。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.