二级标准检测系统测定红细胞比积与参考方法检测结果的比较

目的探讨二级标准检测系统测定红细胞比积(Hct)的结果与参考方法测定结果的可比性。方法按照美国临床实验室标准化委员会(NCCLS)EP9-A2文件要求,以二级标准检测系统的检测方法作为被评价方法,依据NCCLS H7-A3文件,以微量比积离心测定法作为参考方法,选用40份健康人的新鲜血样本,同时使用前述的2种方法进行检测,对检测结果进行相关性和偏差评估。结果二级标准检测系统测定结果的偏差为0.45%~1.68%,相关系数为0.998 1。结论二级标准检测系统测定的Hct结果与参考方法测定结果的偏差较小,相关性良好,使用参考方法定值的新鲜血校准二级标准检测系统后,Hct测定结果与参考方法的结果具有良好的可比性。     

红细胞压积参考方法的建立及应用研究

目的建立红细胞压积（PCV）检测参考方法-微量压积法。方法按照NCCLS指南建立PCV检测的微量压积法，同时对该方法的检测性能进行系统评价，并且将SE9500和1800i与其检测结果进行比较。结果微量压积法最佳离心时间为4．5分钟，毛细管间的容积无差异（P〉0．05），PCV读数误差≤0．002，测定PCV高、中、低值标本的批内、批间及总重复性的变异系数（CV）均〈1％。溶血、脂血、黄疸及血小板对PCV检测基本无干扰（P〉0．05）；将血细胞分析仪SE9500、1800i检测结果与其比较发现。其结果间具有良好的相关性（r〉0．975，P〈0．001）。结论微量压积法检测PCV简便、精密度高、结果准确、抗干扰能力强，可用于血细胞分析仪检测Hct的校准。     

微量法红细胞比积测定的实验观察

红细胞比积（Packed－CellVolume简称PCV）测定，国内大多采用温氏法．但由于操作繁杂．且要静脉采血，故婴幼儿难以接受，在贫血筛检中更是无法开展．而微量法测定PCV，国外早有报道；国内也已用于儿童营养状况的调查，但对其方法学评价．报道不多．我们采用国产仪器．进行了微量法PCV测定的实验观察；表明操作简单．结果准确可靠，且只需手指采血，特别适用于婴幼儿的贫血监测．现将实验结果报告如下。1材料和方法1．1材料①BJY－8型红细胞比积检测仪．北京医疗器械研究所、北京安华医疗器械技术开发经理部出品，②毛细玻璃管．长70…     

两种红细胞比积测定方法比较

比较１２０份血样两种方法测定ＨＣＴ的结果，显示GCH测定温氏法高于微量高速离心法，其主要原因是温氏法尚不能完全克服红细胞对血浆的捕获效应；并对两种方法测定ＨＣＴ的重复性进行了比较，结果微量高速离心法优于温氏法，还计算出两种测定方法测定ＨＣＴ的相关系数为1.04．     

三种方法测定红细胞比积之间比较

目的 通过实验来讨论用Wintrobe离心法、血细胞分析仪以及血气分析仪测定红细胞比积（Hct）之间的差异。方法用Wintrobe离心法、血细胞分析仪（Coulter-Hct）以及血气分析仪（NOVA-Hct）测定Hct,统计不同方法测定同一标本的Hct值。结果 三种方法测定结果之间都存在极显著性差异,Wintrobe法与Coulter-Hct结果之差最大为5.2％,最小为0.4％,Wintrobe法与NOVA-Hct结果之差最大为6.9％,最小为1.0％。结论 三种方法各有优点,Wintrobe法实验条件要求相对较低,耗材便宜;血细胞分析仪则自动求得结果并和其他血常规参数一起打印报告,对贫血等疾病诊断颇为便利;而血气分析仪自动测得结果并和其他一些血气分析参数一起打印报告,对缺氧和酸碱失衡的辅助诊断也较为方便。     

红细胞比积测定与影响因素

红细胞比积（HCT）是一项传统的临床检验参数。随着血液流变学（血流变）的广泛普及用于临床，为医患所熟悉。HCT测定被赋予了新的临床意义。在血液浓稠性、粘滞性等因素中，HCT有着举足轻重的地位。临床诊断治疗中，产生了着眼改善HCT而治疗高粘滞血症方法，大多数患者在治疗不同阶段取得了预期效果。尤其在预防医学中，HCT也受到研究者重视。本文主要探讨HCT测定中常见的影响因素。     

不同检测系统红细胞压积比测定结果的可比性研究

目的探讨不同检测系统红细胞压积比(hematocrit,Hct)结果的可比性。方法采用质控全血和新鲜抗凝全血同时在3个实验室的7台血液分析仪上检测,统计分析其结果。结果各台仪器检测质控全血结果的变异系数CV<3%,新鲜标本结果各比对仪器间的相关系数均>0.95,可靠性分析信度系数α接近1,其它仪器与ADVIA120比较,除ADVIA60在Hct的医学决定水平X1=14%为4.76%,高于CLIA'88室间质量评价标准规定的允许误差1/2外,其余结果均在可接受范围内。结论7个检测系统的血细胞分析仪测定Hct结果精密度符合临床要求,但个别检测系统临床可接受性能评价存在不可比性。     

不同血细胞计数仪检测红细胞比积的偏差评估

目的 评价不同检测系统红细胞比积(Hct)测定结果的偏差及临床可接受范围.方法 参熙NCCLS EP-9A2文件的标准,每天选取8份标本,分别在CoulterR LH 750 System,Coulter Ac.T 5 diff和Sysmex XT-1800i等三台血细胞计数仪上进行红细胞比积测定,共测定30 d,记录结果.应用SPSS 12.0和Excel 2000软件包对所测结果进行统计分析,计算和评价其系统间的偏差.以Beckman CoulterR LH 750 System为比较检测系统,Coulter Ac.T 5 diff和Sysmex XT-1800i为实验检测系统进行方法学比较,以Hct医学决定水平浓度0.35,0.45,0.50分别代入两方程,计算相对偏差,以美国CLIA'88能力验证计划的分析质量要求所规定的允许误差(T±6%)为标准进行评估.结果 CoulterRLH 750 System与CoulterAc.T 5diff的相关系数r=0.998,回归方程为P=1.008X-0.002 983;coulterRLH 750 System与XT-1800i的相关系数r=0.992,回归方程为Y=0.975X-0.006 817.结论 三种血细胞计数仪检测红细胞比积的偏差在临床可接受范围内(<6%),结果具有可比性.     

不同方法制备的红细胞悬液血比积与容量的探讨

红细胞悬液是临床使用较多的血液成分之一,但目前国内对红细胞悬液仅有质量标准,尚无规范的制备工艺标准,其制备程序各地不一,常导致红细胞悬液的质量差异较大,尤其是血比积和容量,给红细胞悬液质量控制带来一些困难。笔者对本中心不同方法制备的红细胞悬液血比积和容量进行了分析,报告如下。     

二级标准检测系统计数血小板的质量保证与应用

目的 评价二级标准检测系统测定血小板结果的准确性与可比性,以确认新鲜血定值结果的准确和可靠程度.方法 参照美国CLSI文件EP9-A2,将二级标准检测系统与参考方法的血小板计数结果进行比对,评价40份静脉血标本检测结果的相关性和偏倚;将NCCL和日本参考实验室的二级标准检测系统的检测结果进行比对;用二级标准检测系统对36份正常新鲜血标本进行定值,将其作为校准物,用于常规实验室36台血细胞分析仪的校准.结果 二级标准检测系统与参考方法检测结果分布范围分别为(108 ～326)×109/L和(110～327)×109/L,具有良好的相关性,相关系数(r)为0.993,偏倚分布范围为-3.8％～3.4％.2009-2010年NCCL检测质控品的结果分布范围为(185 ～203)×109/L,日本参考实验室检测质控品的结果分布范围为(185～ 198)×109/L,比对数据的CV分别为2.0％～3.0％和2.6％ ～3.4％,比对数据的偏倚分布范围为-1.4％～3.7％;验证结果符合要求的20台血细胞分析仪的偏倚分布范围为-2.6％～2.1％,其余需要校准的16台血细胞分析仪校准前后的偏倚由3.4％ ～ 12.6％降至0％ ～2.8％.结论 参考实验室间的结果比对保证了血小板计数结果的准确性和可比性;二级标准检测系统定值的新鲜血作为校准物用于血细胞分析仪的校准是可行的.     

基于WS/T406标准的血液分析仪比对实验

目的了解4台血液分析仪(LH780、LH750、XN-1000、XS-1000i)检测结果的符合程度。方法在每台仪器的批内精密度和批间精密度均符合要求的基础上,选取20份不同浓度的血常规临床标本,分别在各台仪器上测定。以LH750作为参比仪器,其测定值为标准值,计算另外3台仪器白细胞计数(WBC)、红细胞计数(RBC)、血红蛋白(Hb)、红细胞比容(HCT)、血小板计数(PLT)、红细胞平均体积(MCV)、红细胞平均血红蛋白量(MCH)、红细胞平均血红蛋白浓度(MCHC)等项目测定值与标准值的相对偏差及比对符合率。调查82份低值WBC标本、86份低值PLT标本以及35份有"血小板凝块"报警的标本的WBC和PLT的比对结果。结果 LH780各个项目的比对符合率均达到90%以上。XN-1000和XS-1000i的HCT比对符合率为80%,MCV和MCHC比对符合率低于80%,其余项目比对符合率达85%以上。调整了XN-1000和XS-1000i的HCT校正系数后,2台仪器的HCT、MCV和MCHC符合率达85%以上。WBC<1.0×109/L、PLT<30×109/L的标本WBC和PLT比对符合率在70%以下。有"血小板凝块"报警的标本中,WBC和PLT比对结果也不能达到相对偏差标准。结论应定期对同一实验室中的多台血液分析仪进行比对实验。     

Comparison of wire-guided cricothyrotomy versus standard surgical cricothyrotomy technique

We compared a wire-guided cricothyrotomy technique vs. standard surgical cricothyrotomy in terms of accuracy in placement, complications, performance time, incision length, and user preference. We conducted a randomized, crossover controlled trial in which Emergency Medicine (EM) attendings and residents performed cricothyrotomies by both standard and wire-guided techniques (using a commercially available kit) on human cadavers after a 15-min training session. Procedure time, incision length, and physician preference were recorded. Cadavers were inspected for accuracy of placement and complications. Airway placement was accurate in 13 of 15 cases for the standard technique (86.7%), and 14 of 15 cases for the wire-guided technique (93.3%). When comparing wire-guided vs. standard techniques, there were no differences in complication rates or performance times. The wire-guided technique resulted in a significantly smaller mean incision length than the standard technique (0.53 vs. 2.53 cm, respectively, p < 0.0001). Overall, 14 of 15 physicians stated that they preferred the wire-guided to the standard technique. Our data suggest that this wire-guided cricothyrotomy technique is as accurate and timely to use as the standard technique and is preferred by our physician operators. In addition, the technique results in a smaller incision on human cadaver models.     

Comparison of customized versus standard exercises in rehabilitation of shoulder disorders

OBJECTIVE(S): (1) To compare the effectiveness of customized exercises with that of standard exercises for the treatment of patients with shoulder disorders. (2) To determine whether four weeks or eight weeks would be needed to see improvement in outcome measures. DESIGN: A single-blinded randomized clinical trial. SETTING: An outpatient physical therapy clinic affiliated with an academic institution. SUBJECTS: Thirty patients with shoulder disorders were tested and treated between February 2003 and December 2004. INTERVENTIONS: Patients were randomized to a customized or standard exercise group. Each patient first underwent a standardized physical therapy assessment. Based on the results of the assessment, a classification was determined and a classification-specific exercise programme was instructed to the patients in the customized exercise group. The standard exercise group, regardless of classification, received preselected standard exercises. Both groups were followed for eight weeks. MAIN MEASURES: Shoulder range of motion, strength, pain intensity and function were assessed three times (weeks 0, 4 and 8). RESULTS: There were no significant differences between the customized and standard exercise groups in measures of shoulder range of motion, strength, pain intensity and function after four or eight weeks of exercise. Patients in both groups had significant improvements in shoulder strength, pain intensity and function. Significant improvements occurred at week 8, but not at week 4. CONCLUSION: The customized shoulder exercises did not provide additional benefit to our shoulder patients than the standard exercises.     

Performance evaluation of leukocyte differential on the hematology analyzer Celltac G compared with two hematology analyzers,reference flow cytometry method,and two manual methods

BackgroundThe automated hematology analyzer Celltac G (Nihon Kohden) was designed to improve leukocyte differential performance. Comparison with analyzers using different leukocyte detection principles and differential leukocyte count on wedge film (Wedge‐Diff) shows its clinical utility, and comparison with immunophenotypic leukocyte differential reference method (FCM‐Ref) shows its accuracy performance.MethodsFor method comparison, 598 clinical samples and 46 healthy volunteer samples were selected. The two comparative hematology analyzers (CAAs) used were XN‐9000 (Sysmex) and CELL‐DYN Sapphire (Abbott). The FCM‐Ref provided by the Japanese Society for Laboratory Hematology was selected, and a flow cytometer Navios (Beckman‐Coulter) was used. In manual differential, two kinds of automated slide makers were used: SP‐10 (Sysmex) for wedge technique and SPINNER‐2000 (Lion‐Power) for spinner technique. The spinner technique avoids the issue of Wedge‐Diff smudge cells by removing the risk of breaking cells and non‐uniformity of blood cell distribution on films (Spinner‐Diff).ResultsThe Celltac G showed sufficient comparability (r = 0.67–1.00) with the CAAs for each leukocyte differential counting value at 0.00–40.87(10⁹/L), and sufficient comparability (r = 0.73–0.97) with FCM‐Ref for each leukocyte differential percentage at 0.4–78.5. The identification ratio of the FCM‐Ref in CD45‐positive cells was 99.7% (99.4% to 99.8%). Differences were found between FCM‐Ref/Celltac G/XN‐9000/Spinner‐Diff and Wedge‐Diff for monocytes and neutrophils. The appearance ratio of smudge cells on wedge and spinner film was 12.5% and 0.5%.ConclusionThe Celltac G hematology analyzer''s leukocyte differential showed adequate accuracy compared with the CAAs, FCM‐Ref, and two manual methods and was considered suitable for clinical use.     

二级标准血液分析仪的质量控制与应用

目的 保证血细胞计数测定结果的溯源性和准确性。方法 参照国际血液学标准化委员会（ICSH）的有关标准，使用二级标准血液分析仪，制定一系列的质量控制程序和措施并予以实施。结果 保证了该标准仪器测定结果的精密度和准确性，为全国血液室间质评的定值提供标准，在仪器校准及试剂检定方面均发挥了作用。结论 全面的质量控制措施是标准血液分析仪正常发挥作用的关键。     

Comparison of standard versus pharmacokinetically adjusted amikacin dosing in granulocytopenic cancer patients

The capabilities of two pharmacokinetic amikacin dosing methods were evaluated and compared with the standard amikacin dosage recommended by the manufacturer. Study patients participated in two consecutive prospective randomized double-blind trials of empiric antibiotic therapy for febrile episodes during granulocytopenia. Patients in study 1 received amikacin at a dosage of 15 mg/kg per day in four divided doses in combination with either ticarcillin or piperacillin. Patients in study 2 received either ticarcillin or moxalactam in combination with amikacin. Amikacin dosages in study 2 were adjusted to achieve a 1-h-postinfusion concentration of approximately 25 micrograms/ml and a trough concentration of approximately 8 micrograms/ml. Initial amikacin dosage requirements were established based on the lean body weight and estimated renal function of the patient. If amikacin serum concentrations were not within acceptable ranges, further dosage adjustments were made by using patient-specific pharmacokinetic parameters. The median 1-h-postinfusion concentration of amikacin in study 1 was 13.0 micrograms/ml, with a median trough concentration of 6.1 micrograms/ml. In study 2 the median 1-h-postinfusion concentration was 20.8 micrograms/ml, with a median trough of 6.4 micrograms/ml. Patients in study 2 required a mean dosage of 29.4 mg/kg per day. The incidence of amikacin-induced nephrotoxicity was not increased despite the substantial increase in dosage. Ototoxicity was not evaluated in study 1, but the incidence of ototoxicity in study 2 (17%) exceeded the incidence observed in a previous amikacin-plus-ticarcillin trial in which patients received 15 mg of amikacin per kg per day.     

5种浓度水平冰冻混合人血清ALT、AST二级标准品的研制

目的：研制5个浓度水平冰冻混合人血清丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）二级标准品,为常规检测ALT、AST提供稳定性和互通性良好的准确度验证材料和校准品。 方法：收集无脂血、溶血的含ALT和AST 的5个浓度水平的混合人血清,滤菌后分装于冻存管中,（-70±2） ℃保存。采用单因素方差分析检验该标准品的均匀性,并观察其在15~25 ℃（室温）、2~8 ℃和-70 ℃的稳定性。4家实验室采用国际临床化学联合会（IFCC）推荐的含和不含磷酸吡哆醛（PLP）参考方法对标准物质定值,并评定不确定度。观察血清物质在7种进口配套检测系统的互通性,并用直线回归分析进行评价。 结果：血清物质均匀性良好（P＞0.05）,稳定性在15~25 ℃和2~8 ℃时能满足使用要求,-70 ℃保存至少稳定1年。4家实验室对该标准品的定值结果具有一致性,总体不确定度较小。血清物质的互通性良好,仅浓度4和5在含PLP的方法间互通性稍差。 结论：研制的5水平冰冻混合人血清均匀性、稳定性、互通性良好,定值准确,可用作ALT、AST的二级标准品。     

不同血细胞分析仪检测结果的比对研究

目的探讨不同血细胞分析仪检测结果的可接受性,为临床提供准确、可比的血细胞检验结果。方法参考NCCLS(美国临床实验室标准化委员会)颁布的EP9-A2文件,在5台血细胞分析仪(Sysmex XE-2100、Beckman-Coulter ACT5.diff、2台Sysmex K-4500和Coulter ACT.diff2)均处于正常状态下,双份检测新鲜抗凝全血,获取白细胞计数(WBC)、红细胞计数(RBC)、血红蛋白浓度(Hb)、血细胞比容(Hct)和血小板计数(PLT)检测数据,与参加卫生部室间质评并可溯源的血细胞分析仪(Sysmex XE-2100)比较,建立回归方程,以医学决定水平或参考值作为自变量(X)计算偏倚,以1/2CLIA′88允许误差为标准判断偏倚是否可接受。结果在WBC的医学决定水平为3.0×109/L及11.0×109/L时,其偏倚均小于或等于1/2CLIA′88允许误差范围(7.5%);在RBC参考区间下限4.0×1012/L及上限5.5×1012/L处,其偏倚均小于或等于1/2CLIA′88允许范围(3.0%);在Hb的医学决定水平为45g/L及230g/L处,除Coulter ACT.diff2分析仪(偏倚为3.7%)外,其他仪器的偏倚均小于或等于1/2CLIA′88允许范围(3.5%);在Hct参考区间下限0.40处,只有K4500-1分析仪可比(偏倚为2.80%,小于或等于1/2CLIA′88标准3.0%),在Hct参考区间上限0.50处,5台仪器Hct结果均不可比;在PLT的医学决定水平为100×109/L及600×109/L时,其偏倚均小于或等于1/2CLIA′88允许范围(12.5%)。结论 相同实验室使用不同血细胞分析仪检测血液样本时,应定期执行比对试验,以便为临床疾病的诊疗提供准确、可比的血细胞检验数据。