末梢血铅测定的质量管理与评价  

Quality. Management and Assessment of Determination of Distal Blood Lead

作　　者：王艳[1] 宋文琪[1] 罗玲辉[1] 徐樨巍[1] 

机构地区：[1]首都医科大学附属北京儿童医院检验中心,北京100045

出　　处：《现代检验医学杂志》2010年第3期154-156,共3页Journal of Modern Laboratory Medicine

摘　　要：目的建立末稍血铅测定的质量管理和评价方法。方法①通过测定AA7003M型原子吸收光谱仪的检测限、精密度、线性和携带污染率，对该仪器进行性能评估。②对分析前可能带来铅污染的环节进行空白检测。③根据美国CLIA’88能力比对分析质量要求中的TEa（40μg／L）为评价限以及室间质量评价中的不准确度和室内质控的不精密度，采用OPSpecs图设计室内质控方法，计算d值，对血铅测定的质量水平进行评价。结果AA7003M方法检测限为4．8μg／L，方法定量检测限为16μg／L。携带污染率为0．4％。线性相关系数为0．99771，线性范围0～300μg／L。自配0．2ml／dl硝酸、无菌注射用水、75ml／dl酒精、安尔碘、毛细吸管、消毒棉签和纸巾均可基本排除对铅检测结果的影响。末梢血铅测定的σ为3．05，室内质控需采用13s／22s／R4s／41s／10x Westgard多规则，N≥6时，才能达到90％误差检出率，并将假失控率控制在5％以下。结论未梢血铅测定应依据卫生部制定的《血铅临床检验技术规范》严格进行分析前和分析中的质量控制，根据质控性能评价结果，选用合适的室内质控方法，才能保证检测结果的可靠性。Objective To establish quality management and assessment for the determination of distal blood lead. Methods Capability assessment of AA7003M Atomic Absorption Spectrometer was done by detecting the values of detecting limits,precision,linearity and toting contaminative rate. Blank determination for the details which could lead to lead contamination was evaluated. According to the clinical total allowable error of CLIA＇ 88 in USA and inaccuracy in external labora- tory quality assessment and imprecision in internal laboratory quality assessment ,the quality control methods was designed by operational process specifications graph,and the sigma value was calculated. Results The values of method detecting limits,quantitative detecting limits,precision,liner correlative value and toting contaminative rate for AA7003M were 4.8 μg/L, 16 μg/L, 0. 997 71 and 0.4% respectively. The blank determination for disinfectors,capillary tube ,sterile cotton stick and washcloth were all up to par. The sigma value was 3.05 and rules of 13s/22s/R4s/41s/10x with N= 6 were selected in order to achieve analyze quality assurance. Conclusion In order to guarantee reliability of distal blood lead ,laboratories should process quality control according to clinical test criterions for blood lead strictly and select proper Westgard rules.

关 键 词：血铅 石墨炉原子吸收分光光度法 质量控制 

分 类 号：R446.9[医药卫生—诊断学]